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Background: Gastric carcinoma is a major cause of cancer-related morbidity and mortality worldwide. Gastric neoplasms arise from genetic and epigenetic changes in various genes. Present study evaluates the immunoexpression of PTEN, HER2/neu, and Ki-67 in endoscopic gastric carcinoma biopsies and correlates the expression of these proteins with clinicopathological features. Material and Methods: Adequate endoscopic biopsies of 27 cases of gastric carcinoma were evaluated for World Health Organization (WHO) and Lauren's classification subtypes along with HER2/neu, PTEN, and Ki-67 immunoexpression. HER2/neu immunostaining was scored as proposed in the Trastuzumab for gastric cancer (ToGA) trial while PTEN staining and downregulation were assessed using an immunoreactive score. The cut-off for Ki-67 expression was taken as 90th percentile of the values in adjacent non-neoplastic tissue. All statistical analysis was done at 5% level of significance with SPSS v22 statistical software. Results: Tubular adenocarcinoma was the commonest WHO histological subtype and 56% of cases were of intestinal type as per Lauren's classification. 55.6% of cases showed a complete loss of PTEN expression in neoplastic tissue. 17 of the 19 cases with adjacent non-neoplastic tissue showed PTEN downregulation in neoplastic tissue. 81.5% of cases had a high Ki-67 index and HER2/neu overexpression was noted in 36% of cases. All the four cases who died had high Ki-67 proliferation indices; 3 patients had loss of PTEN expression and HER2/neu overexpression. Conclusion: We conclude that these immunomarkers can play important role in the behavior of gastric carcinomas and can be targeted for new therapies.
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Myofibroma is a rare benign mesenchymal tumor of uncertain histogenesis. A six-year-old boy presented with a unilateral lower eyelid mass of six weeks' duration. MRI revealed a circumscribed mass in the inferolateral orbit with bony erosion. A systemic examination was unremarkable. Excision with histopathology revealed a partially infiltrative spindle cell tumor with bland nuclear morphology expressing smooth muscle actin and muscle-specific actin, compatible with myofibroma. Solitary myofibroma is a rare childhood orbital tumor and may clinico-radiologically closely mimic a malignancy. Histopathology and immunohistochemistry can help reach a definitive diagnosis. Systemic evaluation and close follow up are crucial in such cases.
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Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.
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Background: Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances. Stress level in all aspects of life is growing at an exponential rate but stress level in students, especially MBBS students is alarming. Objective: To find out the level of stress and relieving methods used by medical students before examination. Material and Methods: Observational, Cross sectional study was conducted on 600 medical students using questionnaire. Responses of the students were recorded on Likert’s scale just after the examination. Data was tabulated and analyzed statistically. Results: The mean age of 600 medical students were 20.1±0.9. 143(23.8%) students always felt stressed, 161(26.8%) often, 211(35.2%) sometimes, 37(6.2%) rarely and 48(8%) never felt stressed before examination. 252(42%) reported that this level of stress did not affect their performance in examination while decrease in performance was reported by 198(33%). 150(25%) said that their performance was improved during examination due to stress. 145(24.2%) felt no anxiety during examination, 432(72%) felt healthy anxiety and 23(3.8%) felt unhealthy anxiety level. Conclusion: Majority of the medical students experiences some level of anxiety during exams and used various coping mechanisms to deal with stress. Although some degree of stress is accepted as a normal part of medical training and can be a motivator for some individuals, not all students find the stress manageable.
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Background: Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances. Stress level in all aspects of life is growing at an exponential rate but stress level in students, especially MBBS students is alarming. Objective: To find out the level of stress and relieving methods used by medical students before examination. Material and Methods: Observational, Cross sectional study was conducted on 600 medical students using questionnaire. Responses of the students were recorded on Likert’s scale just after the examination. Data was tabulated and analyzed statistically. Results: The mean age of 600 medical students were 20.1±0.9. 143(23.8%) students always felt stressed, 161(26.8%) often, 211(35.2%) sometimes, 37(6.2%) rarely and 48(8%) never felt stressed before examination. 252(42%) reported that this level of stress did not affect their performance in examination while decrease in performance was reported by 198(33%). 150(25%) said that their performance was improved during examination due to stress. 145(24.2%) felt no anxiety during examination, 432(72%) felt healthy anxiety and 23(3.8%) felt unhealthy anxiety level. Conclusion: Majority of the medical students experiences some level of anxiety during exams and used various coping mechanisms to deal with stress. Although some degree of stress is accepted as a normal part of medical training and can be a motivator for some individuals, not all students find the stress manageable.
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Survivin, a member of the inhibitor of apoptosis (IAP) protein family that inhibits caspases and blocks cell death, is highly expressed in most cancers and is associated with a poor clinical outcome. Survivin has consistently been identified by molecular profiling analysis to be associated with high tumour grade cancers, different disease survival and recurrence. Polymorphisms in the survivin gene are emerging as powerful tools to study the biology of the disease and have the potential to be used in disease prognosis and diagnosis. The survivin gene polymorphisms have also been reported to influence tumour aggressiveness as well as survival of cancer patients. The differential expression of survivin in cancer cells compared to normal tissues and its role as a nodal protein in a number of cellular pathways make it a high target for different therapeutics. This review discusses the complex circuitry of survivin in human cancers and gene variants of survivin, and highlights novel therapy that targets this important protein.
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Objective: This cross-sectional study was design to investigate prevalence and risk factors of generalized anxiety disorder in traumatic brain injury (TBI). Materials and Methods: The Group studied consists of 204 patients of mild and moderate TBI between 14- days to one-year post injury. Demographic characteristics of the participants were assessed on a self-designed semi structured performa. Interviews focused on assessment of severity of TBI, generalized anxiety disorder (GAD) and quality of life (Qol) using GCS, GAD-7 and WHOBREF-QOL respectively. Results: Total 204 patients were included. 11.76% participants were found to have generalized anxiety disorder. None of the demographic variables were associated with GAD except injury severity. Mild TBI patient (75.00%) had higher occurrence of GAD than the moderate cases (25.00%). GAD patients also had poor Qol than those without GAD in all domains except physical and social health domain. Neuroanatomical localization was also correlated with GAD. Left frontal contusions were the most common (37.50 %) lesions associated with GAD. Conclusion: GAD is commonly associated, yet under diagnosed clinical entities in head injury and have tremendous impact in overall outcome measures. Every patient of head injury warrants psychiatric evaluation and concomitant treatment if required to ensure the attainment of not only neuroanatomical intact but overall productive and qualitative life vindicating the holistic and multidisciplinary treatment approach.
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Background & objectives: The characteristics of prostate specific antigen (PSA) for trans-rectal ultrasonography guided prostate biopsy in men with lower urinary tract symptoms (LUTS) are not well defined. This study was carried out to analyse the threshold of PSA for biopsy in symptomatic men in India. Methods: From January 2000 to June 2011, consecutive patients who had digital rectal examination (DRE) and PSA testing done for LUTS were included in this study. PSA was done with ELISA technique. Patients with acute or chronic prostatitis, prostatic abscess, history of surgery on prostate within the previous three months and patients on 5α-reductase inhibitors or on urethral catheter were excluded. Results: Of the 4702 patients evaluated, 70.9 per cent had PSA of less than 4 ng/ml and 29.1 per cent had PSA of more than 4 ng/ml. Of these, 875 men with a mean age of 65.72±7.4 (range 50-75 yr) had trans rectal ultrasonography (TRUS) guided biopsy. Twenty five men had biopsy at PSA level of <4 ng/ml due to positive DRE, 263 at 4.1-10ng/ml, 156 at 10.1-20 ng/ml and 431 at >20 ng/ml. Positive predictive value of PSA in ranges of 4.1-10, 10.1-20, >20 ng/ml was 15.2, 24 and 62.6 per cent, respectively with negative DRE. PSA cut-off to do biopsy was derived by ROC curve as 5.82 ng/ml for all the men. When the subjects were further stratified on the basis of DRE findings, a cut-off of 5.4 ng/ml was derived in men with normal DRE. Interpretation & conclusions: A cut-off for biopsy in symptomatic men with negative DRE could safely be raised to 5.4 ng/ml, which could avoid subjecting 10 per cent of men to undergo unnecessary biopsy.
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Objectives: This study was conducted to know the status of thyroid disorder in people of far western region of Nepal. Methods: A total of 808 cases, out of which 133 male and 675 female were included and study was carried out using data retrieved from the register maintained in the Department of Biochemistry of the Nepalgunj Teaching Hospital, Kohalpur, Banke, Nepal, between 1st January, 2011 and 28th February, 2012. The variables collected were age, sex, and thyroid function profile including free T3, free T4 and TSH. The data was analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: The percentage of thyroid disorders was 33.66% in people of far western region of Nepal. The people were highly affected by overt hyperthyroidism (14.9%) followed by subclinical hyperthyroidism (9.9%). The subclinical hypothyroidism was 7.9% while 1% overt hypothyroidism only. Serum fT3, fT4 and TSH level were significantly different in male and females. Similarly, fT3, fT4 and TSH levels show statistically significant differences in different thyroid disorders. The fT3 and fT4 level in overt hyperthyroidism and subclinical hypothyroidism showed statistically significant differences when compared with euthyroidism group. Likewise, TSH level also shows statistically significant in all the thyroid disorders when compared with euthyroidism group. The fT3 and fT4 levels were statistically insignificant in all the age groups whereas TSH level showed statistically significant different in all the age groups. The fT3 and fT4 level in 21-40 years showed statistically significant when compared with serum level of fT3 and fT4 of 0-20 years. Similarly, serum level of TSH in 21-40 and 41-60 years also showed statistically significant when compared with serum level of TSH of 0-20 years. Conclusion: The people residing in far western region have risk for thyroid disorders. They were suffering with thyroid disorder, especially overt hyperthyroidism (14.9%) and subclinical hyperthyroidism (9.9%). Further studies are required to characterize the reasons for this high prevalence of overt hyperthyroidism and subclinical hyperthyroidism.
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Background & objectives: It is mandatory for all new drugs to be tested for their potential genotoxicity in addition to general toxicity testing. Some old drugs have not been tested adequately for their genotoxic effects as these were in use before the regulations were enforced. The present study therefore aims to explore the genotoxic potential of some commonly used opioids like codeine, dextromethorphan and dextropropoxyphene in swiss albino mice. Methods: Therapeutic equivalent doses of codeine, dextromethorphan and dextropropoxyphene were given orally. Single dose for acute study and multiple doses (repeated every 24 h for 7 times) in additional groups of mice (n=5 in each) for subacute study. Cyclophosphamide served as positive control while normal saline as negative control. About 0.5 ml of blood was collected by retroorbital sinus for comet assay and later the mice were sacrifi ced to aspirate the femoral bone marrow for micronucleus test. Percentage of micronucleated polychromatic erythrocytes (MnPCE) and comet tail length were calculated in micronucleus assay and comet assay respectively, which served as markers of genotoxicity. Results: Signifi cant Signififi (P<0.001) increase in comet tail length and % MnPCE was observed in both acute and subacute studies of cyclophosphamide group, whereas codeine, dextromethorphan and dextropropoxyphene treated groups did not show any signifi cant changes. Interpretation & conclusion: The results indicated that codeine, dextromethorphan and dextropropoxyphene were devoid of genotoxicity in mice.
Subject(s)
Analgesics, Opioid/pharmacology , Animals , Antitussive Agents/pharmacology , Comet Assay , Cyclophosphamide/pharmacology , DNA/drug effects , DNA Damage , Dextromethorphan/pharmacology , Dextropropoxyphene/pharmacology , Erythrocytes/cytology , Female , Mice , Micronucleus Tests , Mutagens/pharmacology , PregnancyABSTRACT
Emergency Medicine (EM) is a new discipline for India. As Medical Council of India (MCI) makes progress in recognizing the need to develop EM residency training programs in India it is important that there exist an established training model for future faculty, residents and medical students. This INDO-US white paper makes a serious attempt to recognize the opportunities and challenges in developing academic emergency medicine in India. The contents of this white paper address the overall scenario and are not targeted towards a person, physician, body, hospital or any other associated entity. This paper emphasizes the importance of MCI recognized training in Emergency Medicine for physicians in India.
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Curriculum/standards , Education, Medical, Graduate , Emergency Medical Services/organization & administration , Emergency Medicine/education , Humans , India , Students, MedicalABSTRACT
Correlation coefficient analysis conducted on 22 triticale x bread wheat derivatives along with six checks to select true- breeding derivative(s) for future hybridization programme with tolerance to drought and cold stress conditions as well as better quality traits revealed significant correlation of grain yield with spikelets per spike, biological yield, harvest index, leaf area index. Interestingly, the grain yield and drought susceptibility index showed no association. However, with cold tolerance it showed significant positive correlation indicating the desirability of certain plant traits under cold stress. The grain yield exhibited no association with quality traits which might assist in the predictability of high yielding varieties with high protein, total sugars, reducing sugars and non-reducing sugars. Path coefficient analysis revealed that biological yield had the highest positive direct effect on grain yield followed by harvest index, specific leaf weight, stomatal number, 1000 grain weight, stomatal size, spikelets per spike and days to heading. Therefore, indirect selection for these plant traits in order should be exercised in selecting drought tolerant genotypes. Two genotypes (RL-124-2P2 and RL 111P2) were found to be drought and cold tolerant with high grain yield, spikes per plant, spikelets per spike and leaf area index.
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Adaptation, Biological , Bread , Carbohydrate Metabolism , Cold Temperature , Disasters , Genotype , Plant Leaves/anatomy & histology , Plant Stomata/anatomy & histology , Triticum/anatomy & histologyABSTRACT
The aim of the present study was to evaluate the effectiveness of Dental Health Education programs among school children of different socioeconomic groups. The investigators made a visit to three different schools and studied 500 children. A ten items, open-ended, self-administered questionnaire was pretested on the primary and higher primary school children before and after an educational intervention. A second visit was made to one of the schools 1 year later and the same questionnaire was re-administered to those subjects who had participated in the original study. Results showed that although educational intervention was successful in improving the Dental health awareness of most children, the socioeconomic background is an important determinant for the same. Also, single-lecture technique seems to be inadequate in improving the knowledge of children in the long term.
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Twenty six hexaploid triticale (X Triticosecale Wittmack) X bread wheat (Triticum aestivum L. em Thell) derivatives, along with 2 bread wheat and 2 triticale checks, were grown in normal and P-stress environments. Spikes/plant and grain yield/plant, followed by peduncle length, Were the most sensitive to phosphorus deficiency, which also caused a delay in heading and maturity. The heritability and genetic advance for grain yield/plant were high in the stress environment, reflecting the effectiveness of direct selection. The 1000-grain weight, grains/spike and plant height were the important traits for phenotypic selections in both the environments.
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Bread , Edible Grain/genetics , Genetic Variation , Phosphorus/metabolism , SoilABSTRACT
BACKGROUND: Glutathione-S-transferases (GSTs) are active in the detoxification of wide variety of endogenous or exogenous carcinogens. The genetic polymorphisms of GSTM1 and GSTT1 genes have been studied earlier to evaluate the relative risk of various cancers. AIM, SETTING AND DESIGN: In the present study, we examined the association of the GSTM1 and GSTT1 gene polymorphisms with sporadic prostate cancer patients in north Indian population. MATERIAL AND METHODS: This case control study was undertaken over a period of 24 months and included 103 prostate cancer patients and 117 controls; both patients and controls originated from northern part of India. The GSTT1 and GSTM1 genotypes were identified by multiplex PCR in peripheral blood DNA samples. STATISTICAL ANALYSIS: Difference in genotype prevalence and association between case and control group were assessed by the Chi square and Fisher Exact tests. RESULTS: Frequencies of null genotypes in GSTT1 and GSTM1, was 11% (13/117) and 30% (35/117) respectively in control individuals. The frequencies of GSTT1 and GSTM1 null genotypes in prostate cancer patients were 34% (35/103) and 53% (55/103) respectively. CONCLUSION: Our study demonstrates that the null genotypes of GSTT1 and GSTM1 are substantially at higher risk for prostate carcinoma as compared to the normal healthy controls. The GSTT1 and GSTM1 null genotypes did not show significant association with tobacco usage in prostate cancer patients. However, the null genotypes were significantly stratified in 50-60 year-old patients when incidence of prostate cancer is high.