Correlation of fasting blood, salivary glucose and malondialdehyde in subjects with & without type 2 diabetes

Oxidative stress is identified as the common pathogenic factor that leads to insulin resistance in diabetics. Malondialdehyde is a product of lipid peroxidation. Aim: The aim of this study was to determine the variation in the Salivary malondialdehyde (MDA) among subjects with and without T2DM in comparison to the fasting blood and Salivary glucose. Methods: This study involved 29 healthy participants as Controls (group I) and 29 participants with Type 2 Diabetes Mellitus as Cases (group II). Salivary Glucose was analysed by glucose oxidase end-point assay. Thiobarbituric acid (TBA) assay method was considered for estimation of MDA in fasting saliva. Data was Statistically analysed using SPSS20. Parametric test was performed to analyse the data. Results: The correlation calculated between FBG with FSG level was found to be highly significant. A positive correlation between MDA levels with FBG was found. The relationship between FBG and FSG (r = 0.7815, p < 0.05), FBG and MDA (r =0.3678, p < 0.05) and FSG and MDA (r = 0.2869, p < 0.05) were found to be positively significant. Conclusion: Saliva as a unique body fluid can serve as a medium for biochemical analysis only in standard settings and with multiple measures to be used as a diagnostic tool in par with the gold standard serum. Salivary MDA levels can be considered as one of the oxidative stress markers in Type 2 Diabetic condition

Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India

Background: Measles continues to be a major cause of childhood morbidity and mortality in India. Measles is considered one of the leading vaccine-preventable causes of child mortality worldwide. Major reasons for low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization. Materials and Methods: A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under-five children of Asudgaon village. All under-five children residing in every 5th household of the village were included(n = 445). After obtaining consent from the mother, data was collected from her using a pre-designed and pre-tested questionnaire. The data was entered and analyzed in SPSS 23. Results: There was a total of 100 children eligible for the study. Overall, 41% of children were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized. The most reasons for partial or non-immunization for measles were inadequate knowledge about immunization (19%), unawareness of days of vaccination(n = 14%), the child being ill at the time of vaccination, husband or mother-in-law against vaccination, fear of effects, and others. The Chi-square test indicates a significant association between mothers’ education and measles vaccination. Conclusion: Immunization status needs to be improved through education, increasing awareness, and counseling of parents regarding immunization and associated misconceptions as observed in the study.

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms

Objective@#A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized. @*Methods@#Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence. @*Results@#A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence. @*Conclusions@#The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.

Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms

Objective@#A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized. @*Methods@#Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence. @*Results@#A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence. @*Conclusions@#The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.

WT1 in astrocytomas: Comprehensive evaluation of immunohistochemical expression and its potential utility in different histological grades

BACKGROUND: Wilms' tumor 1 (WT1) mutation has recently been detected in gliomas. Growing data indicate that WT1 mutation plays a causal role in gliomagenesis and is overexpressed in most glioblastomas. An emerging immunotherapy targeting WT1 has shown to be effective in resistant glioblastomas in clinical trials. WT1 expression and its potential utility in various grades of astrocytomas is still unclear and needs further elucidation. The evaluation of WT1 can be done by molecular or immunohistochemical methods. As immunohistochemistry is easier with wider routine use, immunoexpression of this biomarker was studied. AIM: The aim of this study was to characterize WT1 immunoexpression across different histological grades of astrocytomas to routinely aid in diagnosis and reproducibility and to assess the association between WT1 and immunomarker isocitrate dehydrogenase (IDH1). MATERIAL AND METHODS: This was an observational prospective study on 79 cases of astrocytomas. RESULTS: Seventy-nine astrocytomas including 11 recurrent tumors were assessed for WT1 by immunohistochemistry. WT1 expression was detected in all astrocytomas (100%). The control group of reactive gliosis was negative. WT1 score correlated with histological tumor grades (P < 0.001) with higher score in higher grade. It was also observed that different tumor grades depicted two distinct expression patterns. WT1 score and pattern were valuable in differentiating high- and low-grade astrocytomas. CONCLUSION: This study supports the oncogenic role of WT1 in astrocytomas. WT1 was found to be valuable in distinguishing different grades of astrocytomas. WT1 can aid in differentiating neoplastic process from reactive gliosis, particularly in recurrent tumors. Higher expression in glioblastomas supports its immunotherapy potential.

A Study of Reasons for Nonimmunization among Children attending the Services of a Rural Hospital in Raigad District, Maharashtra.

Introduction: Immunization is a cost-effective public health intervention to decrease childhood morbidity and mortality. According to the 3rd National Family Health Survey (NFHS-3), 43.5% children aged 12 to 23 months were fully vaccinated. The 3rd District Level Household & Facility Survey (DLHS-3) showed 69% full-immunization coverage in Maharashtra with major regional variations. Rural Hospital, Panvel (Raigad), is in a peri-urban area providing health services to a mix of urban, rural, and migrant population. The study was conducted in this hospital with the aim to understand why people seeking health services for secondary prevention refrain from complying with routine immunization services. Objectives: To assess the reasons for partial and nonimmunization of the children and the knowledge regarding routine immunization. Materials and methods: All children who completed 1 year but below 5 years of age, attending the Rural Hospital, Panvel, during a period of 1 month from October 16 to November 15, 2014, were screened and those who were not fully immunized for the age were included in the study. Sociodemographic background, immunization status, reasons for partial and nonimmunization, and knowledge about routine immunization data were collected by personal interview using a prestructured, pretested questionnaire after obtaining informed consent. Results: Out of 303 children, 57 (18.8%) were found to be either partially immunized (47; 15.5%) or nonimmunized (10; 3.3%). The lack of knowledge (36%), lack of priority for immunization (33%), and poor communication by the health worker (21%) were the major reasons. 42% of the mothers were aware about the severity of the vaccine preventable diseases. However, 80% did not have the correct knowledge regarding the immunization schedule. Conclusion: The opportunities to vaccinate are still being missed and consolidated efforts to improve the active involvement of mother in the immunization activity are required.

Frequency of Gc-globin promoter 158 [C>T] XmnI polymorphism in patients with homozygous/compound heterozygous beta thalassaemia

BACKGROUND: Response to hydroxyurea therapy in homozygous or compound heterozygous beta thalassaemia [BT] has been reported as more favourable in the presence of XmnI polymorphism. The prevalence of XmnI polymorphism may vary with BT phenotypes and genotypes, and differs geographically in distribution. Prevalence of XmnI polymorphism is not known in northern Pakistan. Objective: To determine the frequency of Gc-globin promoter 158 [C>T] XmnI polymorphism [XmnI polymorphism] in patients with homozygous or compound heterozygous beta thalassaemia. MATERIALS: Polymerase chain reaction [PCR] for common beta thalassaemia mutations and Gc-globin promoter 158 [C>T] XmnI polymorphism was performed on 107 blood samples of transfusion dependent beta thalassaemia [BT] patients in Pakistan. One hundred samples of unrelated BT traits and 94 samples of healthy subjects as controls were also analysed for BT mutations and XmnI polymorphism. Results: Out of 301 DNA samples, XmnI polymorphism was detected in 71[24%]; in normal controls, XmnI polymorphism was detected in 34/94 [36%] subjects; while in homozygous/compound heterozygous BT, it was detected in 14/107[13%] patients [Fisher's exact test, p =. 0002]. In heterozygous BT group, XmnI polymorphism was detected in 23/100 subjects [Fisher's exact test, p =. 03 with normal controls, and p =. 049 with homozygous/compound heterozygous BT]. The most common BT genotype was Frame Shift [Fr] 8–9/Fr 8–9, and none of the patients with this genotype had XmnI polymorphism. The second most common genotype was IVSI-5/IVSI-5; 4/26 [15%]. Cases with this genotype had XmnI polymorphism. Conclusion: XmnI polymorphism in homozygous/compound heterozygous BT group is 13%. The most common genotype associated with XmnI polymorphism was IVSI-5/IVSI-5

Real time polymerase chain reaction in diagnosis of chronic myeloid leukemia

To compare the sensitivity and specificity of Real Time Polymerase Chain Reaction [RT-PCR] with conventional cytogenetics in diagnosis of chronic myeloid leukemia. A cross-sectional, analytical study. The Armed Forces Institute of Pathology [AFIP], Rawalpindi, from December 2010 to January 2012. A total number of 40 patients were studied, in which all were diagnosed as CML on peripheral blood and bone marrow aspiration. The subjects were tested for the presence of Philadelphia [Ph] chromosome by cytogenetics and BCR-ABL fusion gene by RT-PCR. 2-3 ml of venous blood was collected, half in sodium heparin [anti-coagulant] for cytogenetics and half in EDTA for PCR. For cytogenetics, cells were cultured for 72 hours in RPMI 1640 medium and examined by arresting in metaphase using Colchicine to identify Philadelphia chromosome. For PCR, RNA extraction was done by Tri Reagent LS [MRC, USA] and cDNA was synthesized using reverse transcriptase and gene specific primer. RT- PCR was done on ABI-7500. The positive samples were identified when fluorescence exceeded threshold limit. Results of cytogenetics and RT PCR were compared. Out of the 40 patients, PCR showed 37 [92.5%] were positive and 3 [7.5%] were negative for BCR-ABL fusion gene, whereas in cytogenetics 28 [70%] were positive for Ph chromosome and 12 [30%] were negative for Ph chromosome. Sensitivity and specificity of cytogenetics was 75.6% and 100% respectively. Real time PCR as compared to cytogenetics is less tedious, gives quick results, does not require multiple sampling due to culture failure and can be done on peripheral blood

Spectrum of Histopathological Findings in Liver Biopsy.

The significance of abnormal liver function tests in the absence of diagnostic serology is unclear. The aim of this prospective study is to report liver biopsy findings in a large group of patients with unexplained abnormal liver biochemistry and correlate them with the clinical features to assess the severity of these diseases. Percutaneous liver biopsy is a relatively safe and accurate method of diagnosing liver disease and should be considered in such cases. A total of 65 liver biopsies were studied, of which, 26.15% (n=17) hepatic tumors, 23.08% (n=15) cirrhosis, 20.00% (n=13) fatty liver and 06.15% (n=4) viral hepatitis were seen. Further, 01.54% case (n=1) each of alcoholic hepatitis, benign recurrent intrahepatic cholestasis, extrahepatic biliary atresia, granulomatous hepatitis, neonatal hepatitis, Niemann-Pick disease and secondary biliary cirrhosis were also observed. Liver biopsy was non specific in 9.23% (n=6) and inadequate in 4.62% (n=3) cases .The role of histopathological examination of liver biopsy is highlighted in this paper.

Amaranthus roxburghianus root extract in combination with piperine as a potential treatment of ulcerative colitis in mice / 中西医结合学报

<p><b>OBJECTIVE</b>The present work was undertaken to determine the effects of Amaranthus roxburghianus Nevski. (Amaranthaceae) root alone and in combination with piperine in treating ulcerative colitis (UC) in mice.</p><p><b>METHODS</b>Swiss albino mice were divided into seven groups (n = 6). Standard group received prednisolone (5 mg/kg, intraperitoneally). Treatment groups received hydroalcoholic extract of roots of A. roxburghianus (50 and 100 mg/kg, per oral) and a combination of hydroalcoholic extract of roots of A. roxburghianus (50 and 100 mg/kg, per oral) and piperine (5 mg/kg, per oral). Ulcer index, colitis severity, myeloperoxidase (MPO), malondialdehyde and glutathione were estimated from blood and tissue. Column chromatography of the extract was done and purified fractions were analyzed by gas chromatography-mass spectroscopy (GC-MS).</p><p><b>RESULTS</b>Treatment with the combination of hydroalcoholic extract of A. roxburghianus and piperine showed minimal ulceration, hemorrhage, necrosis and leucocyte infiltration by histopathological observation. Acetic acid increased MPO levels in blood and colon tissue to 355 U/mL and 385 U/mg, respectively. The combination of hydroalcoholic extract of A. roxburghianus (100 mg/kg) and piperine (5 mg/kg) significantly decreased MPO in blood and tissue to 182 U/mL and 193 U/mg, respectively (P < 0.05). Similarly, this combination significantly reduced malondialdehyde levels and increased glutathione levels in blood and tissue. Various phytoconstituents were detected by GC-MS.</p><p><b>CONCLUSION</b>The combination of hydroalcoholic extract of A. roxburghianus and piperine is effective in the treatment of UC and the effects are comparable with the standard drug prednisolone. 4H-pyran-4-one, 2,3-dihydro-3,5-dihydroxy-6-methyl, eugenol and benzene, and 1-(1,5-dimethyl-4-hexenyl)-4-methyl are reported having analgesic, anti-inflammatory, and antioxidant properties; they may play a role in the biological activity of A. roxburghianus root.</p>

Primary cutaneous amyloidosis: A clinico-pathological study with emphasis on polarized microscopy.

Background: Primary localized cutaneous amyloidosis (PCA) is a relatively rare condition characterized by amyloid deposition in dermis without systemic involvement. Although, histopathological examination of the lesion reveals amorphous eosinophilic deposits in papillary dermis examination of congo red stained slides under polarized light will give definitive diagnosis Aims: To study the clinicopathological features of cutaneous amyloidosis emphasizing the utility of polarized light in diagnosis. Materials and Methods : A clinicopathological study of primary cutaneous amyloidosis over a period of 8 years was undertaken. All the cases, clinically diagnosed and histopathologically proven as cutaneous amyloidosis were stained with congo red and studied under polarized light. Results and Conclusions: Of the 45 cases of clinically suspected amyloidosis, 32 cases were proven histopathologically as primary cutaneous amyloidosis and confirmed by congo red stain under polarized light which showed apple green birefringence. Among the two types of PCA, lichen amyloidosis was the most common variant accounting to 65.63% with pure cases of macular amyloidosis accounting for only 15.63%. Biphasic amyloidosis was seen in 18.75%. Knee was the commonest site of involvement with pruritis being the most common symptom. Histopathologically, the most common findings were hyperkeratosis, irregular acanthosis and expansion of dermal papillae by amyloid deposits showing apple green birefringence under polarized microscope with congo red staining. Although, H and E stain gives a clue for the diagnosis of amyloid nevertheless congo red staining under polarized light forms a very sensitive and definitive method for confirmation.

Erythematous nodules of the hand: A rare site of metastatic breast carcinoma.

Acral cutaneous metastasis is a rare phenomenon. A 38-year-old woman presented with painful lesions in the left hand since 1 month. On examination, multiple painful, erythematous, lobulated plaques and nodules were present over the palmar aspect of the finger tips and thenar eminence. Biopsy of the nodule revealed lobules of small pleomorphic epithelial cells arranged in singles, small nests, cords and small abortive luminal pattern in an abundant mucoid matrix, suggestive of metastatic mucinous carcinoma. Past history revealed that the patient had undergone bilateral mastectomy for carcinoma breast. Diagnosis of cutaneous metastases is based on clinical history and histopathological examination. Identification of the primary tumor is very important for prompt treatment and prognosis. The rarity of pure acral cutaneous metastasis and its possible pathogenetic mechanisms are discussed.

A Comparative Study of Magnesium Sulphate Versus Phenytoin Sodium in Prophylaxis & Control of Eclamptic Seizures.

To evaluate the efficacy of Magnesium sulphate and Phenytoin sodium regime in the prevention & control of eclamptic fits. This retrospective study was conducted for one year. 197 eclamptic cases were reported of which 147 cases were managed with magnesium sulphate and 47 were managed with Phenytoin sodium regime.There were 197 cases of eclampsia among 12,170 deliveries, incidence being 1.61%. In magnesium sulphate regime, seizures were controlled within 4hrs of therapy in 97.94% patients while it was 80.86% in Phenytoin sodium group. Recurrent convulsions with Magnesium sulphate (4.76%) were less as compared to phenytoin sodium(34.04%)p<0.01. 91.8% of patients in Magnesium sulphate regained their consciousness within 12 hrs of therapy while it was only 70-72% in Phenytoin sodium regime p<0.01.It is therefore inferred that Magnesium Sulphate therapy has proved superior to Phenytoin sodium regime because of minimal CNS depressant action, minimal fits recurrence and better level of consciousness.All the above factors collectively help in reducing maternal mortality and morbidity &improving foetal salvage.

Subcutaneous Panniculitic-Like T-Cell Lymphoma: A red alert! The role of a vigilant histopathologist.

Subcutaneous panniculitic-like T-cell lymphoma constitutes a distinctive clinicopathologic entity derived from cytotoxic T lymphocytes. A 25-year-old female presented with fever and skin lesions over the upper limb, lower limb and trunk since 2 years. On examination, there were multiple subcutaneous, tender, erythematous, poorly circumscribed indurated plaques and nodules on the upper limbs and lower limbs. Histopathological examination revealed subcutaneous fat displaying a predominantly lobular infiltration of atypical lymphoid cells. Characteristically, there was rimming of individual fat cells by the surrounding neoplastic lymphocytes. Immunohistochemical evaluation of the neoplastic lymphocytes showed CD3 and CD5 immunoreactivity and CD30 and CD20 negativity. A diagnosis of subcutaneous panniculitic T-cell lymphoma was made. SPTCL is a rare cytotoxic lymphoma that can be misdiagnosed as benign panniculitis due to similarities in clinical and histological features between the two entities and thus cause a diagnostic hindrance.

Cystic Echinococcosis of the Pelvic Bone with Recurrences: A Case Report

Hydatid cysts commonly affect the liver and the lung. However, they rarely involve bones with vertebral column. We hereby report a case of a female patient with cystic echinococcosis of the hip bone and ilium. She presented with a long history of frequent recurrences highlighting the dismal prognosis at this rare site. Resection of the hydatid cyst from the sacroiliac region was done with allograft and autograft (rib graft) with lumbosacroiliac fixation. Follow-up of the patient at 6 months showed no detectable abnormality on radiology and the patient was doing well.