Downregulation of apolipoprotein A-IV in plasma & impaired reverse cholesterol transport in individuals with recent acts of deliberate self-harm

Background & objectives: The major limiting factor in the prevention of suicide is the limited knowledge on molecular insights in individuals at risk. Identification of peripheral protein markers which can classify individuals at high-risk of suicide might aid in early diagnosis and effective medical intervention. The aim of the present study was, therefore, to analyze the differential regulation of plasma proteins in individuals with deliberate self-harm compared to controls. Methods: Using two-dimensional gel electrophoresis coupled with matrix-assisted laser desorption-ionization mass spectrometry, differentially expressed plasma proteins were identified in study participants with deliberate self-harm compared to age- and gender-matched controls. The finding was validated using mass spectrometry-based isotope-labelled relative quantification and Western blot analysis in a new set of individuals with deliberate self-harm and controls. Results: The plasma proteomic analysis showed that apolipoprotein A-IV (Apo A-IV ) was downregulated by 2.63-fold (confidence interval: 1.52-4.54) in individuals with deliberate self-harm (n=10) compared to matched controls, which was consistent in mass spectrometry-based relative quantification and Western blot analysis performed in an independent set of individuals with deliberate self-harm (n=18). In addition, plasma levels of total cholesterol, esterified cholesterol and high-density lipoprotein (HDL) were observed to be significantly lower individuals with deliberate self-harm compared to controls. Interpretation & conclusions: Apo A-IV, which plays a crucial role in the esterification of free cholesterol, was found to be downregulated with concomitantly decreased levels of HDL, esterified cholesterol and total cholesterol in individuals with deliberate self-harm compared to matched controls. The present findings might provide a link between the differential regulation of plasma proteins and the previously reported results on altered cholesterol levels in individuals with deliberate self-harm.

Clinical aspects and outcome of patients with swine flu among survivors and non-survivors

Background: Swine flu is an infective disease caused by any one of the several types of Influenza viruses. The world saw its first pandemic of swine flu this century in the year 2009 when the WHO raised a world-wide pandemic alert to level 6 on June 11, 2009. In India, first few cases (index cases) of swine flu were reported from Pune, Maharashtra. The most recent outbreak of this dreaded infection was reported during late winter of 2015.Methods: The present study was retrospective study. In order to collect the data, we reviewed medical charts of patients who were hospitalized in our hospital during the study period. Diagnosis of swine flu was confirmed after sending the blood-samples to Government approved laboratories in Pune and Mumbai. Real time, Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) method was employed for serological diagnosis. Forty-five confirmed cases of swine flu were included in this retrospective study. The primary objective of this study was to highlight the differences in the clinical profile as well as outcome between the patients who survived the attack of swine flu and those who did not.Results: Forty-five of these patients tested positive for H1N1 amounting to a positivity rate of 52.94%. Cough (93.3%) was the most common symptom followed by fever (88.8%) and breathlessness (82.2%). Patients who did not survive were more likely to have associated co-morbid conditions like Hypertension, Diabetes, cardio-vascular disease, pre-existing lung disease and pregnancy though this was not statistically significant ( p=0.189). Acute Respiratory Distress Syndrome (ARDS), Multi-Organ Dysfunction (MOD) and secondary bacterial infections were among the most common conditions that lead to death.Conclusions: Early detection of swine flu through meticulous screening in the community with a high index of suspicion followed by prompt and adequate treatment can go a long way in preventing another pandemic. Creating awareness among the lay people about personal as well as public hygiene is also vital to prevent the spread of this viral illness.

Axillary Lymph Node Metastasis from Thyroid Malignancy: Unusual Presentation with Ominous Implications.

Lymph node metastases to cervical group of nodes occur frequently in well-differentiated thyroid carcinoma. Metastasis to axillary lymph nodes however, is exceptional, leading to diagnostic and management dilemma. While presenting a case of thyroid malignancy with axillary lymph node metastasis, the literature is reviewed for similar cases to analyze their clinico-pathological features, investigations, management and outcome. Fifteen cases have been reported so far. Majority of these patients were female (male: female ratio 6:9) and their mean age was 54.5 years. Axillary lymph node metastases occurred concurrently or as recurrent disease after initial treatment of primary disease in about equal number of these patients. The predominant histological type was papillary carcinoma and 83.3% of these were poorly differentiated. Visceral metastases to lungs and bones were often seen. Despite treating these patients with thyroidectomy, lymph node clearance and adjuvant therapy, 40% of them died; some within one year and among the 60% who were alive, 30% still had active disease. Conclusion: Axillary lymph node metastasis from thyroid cancer, even though rare should be considered in the differential diagnosis in patients presenting with axillary mass and thyroid malignancy. Based on the limited number of cases reported in the literature it appears that it is generally a manifestation of the aggressive nature of this tumor with overall poor outcome.

Splenic flexure volvulus presenting with gangrene

Volvulus of the splenic flexure is very rare cause of colonic obstruction constituting 2% of cases of colonic segmental volvulus. Primary splenic flexure volvulus [SFV] is due to congenital absence or laxity of the phrenocolic, gastro colic, and splenocolic ligaments while secondary volvulus is due to other causes including some prior surgery releasing these ligaments. A preoperative diagnosis can be established based on the characteristic radiological findings on plain x-ray abdomen and CT scan. We present a case of SFV in a young man who presented with acute abdominal pain, and distension, and illustrate the usefulness of CT scan, and plain x-ray of the abdomen in making a preoperative diagnosis. Laparotomy revealed a gangrenous SFV, which was resected and primary anastomosis was carried out. Literature is reviewed with regards to predisposing factors, presentation, investigation, and management among the more than 32 cases reported so far

Papillary carcinoma of the thyroid presenting primarily as cervical lymphadenopathy: an approach to management

Papillary carcinoma of thyroid usually presents as a palpable thyroid mass. This could be associated with pain, hoarseness, stridor or dysphagia. Rarely, it presents solely as cervical lympadenopthy in the presence of an otherwise grossly normal thyroid gland. This could pose management problems. We report here a middle-aged lady who presented with cervical lymphadenopathy which on fine needle aspiration cytology was confirmed as metastatic papillary thyroid carcinoma. The thyroid gland was, however, normal on clinical examination and radiological investigations. Neck exploration confirmed a grossly normal thyroid gland; however, the cervical lymph node was found to invade the internal jugular vein. She underwent a total thyroidectomy and unilateral functional block dissection with resection of the involved segment of the internal jugular vein. Histopathology confirmed metastasis in the lymph node and a 2mm sized microcarcinoma in the resected thyroid gland. A radioactive iodine scan in the postoperative period revealed no other metastasis. The patient was prescribed lifelong thyroxine. She is on regular follow-up and 4 years following surgery continues to do well

Isolated agenesis of the gallbladder

We report a rare case of agenesis of the gallbladder, which was misdiagnosed as cholecystitis. This is the first reported case from the Middle East. Despite advances in biliary imaging, the diagnosis is usually made at surgery. Like most patients, our patient became asymptomatic after the surgery. Extensive dissection to exclude the presence of gallbladder in an ectopic site is discouraged