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Background & objectives: Oral squamous cell carcinoma (OSCC) is widely prevalent in the Indian subcontinent mainly due to habit-associated aetiologies. Immune regulation and angiogenesis are the part of tumourigenesis that play a crucial role in metastasis and survival. However, the concurrent expression of vascular endothelial growth factor (VEGF) and CD3 (immune regulator receptor on T-lymphocyte) in the same OSCC tissue samples has not been reported in the Indian population. The present study evaluated the expression of CD3+ T-cells and VEGF in OSCC tissue samples and studied the clinicopathological correlation and survival analysis in an Indian population. Methods: This was a retrospective study conducted on 30 formalin-fixed and paraffin embedded sections which were histologically diagnosed as OSCC cases comprising of 15 metastatic OSCC and 15 non- metastatic OSCC with available clinical data and survival status. Results: Reduced expression of CD3+ T-cells and increased VEGF expression were observed in metastatic OSCC samples. The correlation of expression of CD3+ T-cells and VEGF with clinicopathological parameters showed a significant association between these markers with age, nodal status, site of the lesion and survival. Interpretation & conclusions: Reduced expression of CD3+ T-cells in OSCC was found to be associated with a significantly poor survival. VEGF was found to be over expressed in metastatic OSCC as compared to that in non-metastatic OSCC. The study findings suggest that the evaluation of CD3 and VEGF in incisional OSCC biopsies can be considered for predicting the survival outcome and metastasis
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Objective To analyze the expression of muscle scinderin(SCIN)in primary hepatocellular carci-noma(HCC)with portal vein tumor thrombus (PVTT)and its clinical significance.Methods 46 primary HCC patients with PVTT were selected.All patients'carcinoma adjacent tissues,HCC tissues,PVTT tissues were collected. SCIN expression in three kinds of surgical specimen was detected by immunohistochemical staining,the results were compared.All patients were followed up for three years,the recurrence rate within half a year and 3 -year mortality were compared.Results The positive expression rates of SCIN in carcinoma adjacent tissues,HCC tissues and PVTT tissues were 69.57%,45.65%,23.91%,which showed a decreasing trend.The relapsed within six months and 3 -year mortality rate of the SCIN -negative patients were 85.71%,95.24%,which were significantly higher than those of the SCIN -positive patients.The SCIN expression level was closely related to tumor size,with or without coating and alpha -fetoprotein level,the differences were statistically significant (χ2 =0.000,0.007,0.035,all P <0.05). Conclusion The SCIN expression level in primary HCC patients with PVTT is low,and it can be used as a prognos-tic indicator for primary HCC patients with PVTT.
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Objective: To assess the sensitivity, specificity, and predictive value of EEG as a diagnostic and prognostic tool in the febrile seizures. Method: This study was conducted on 50 consecutive children with febrile seizures attending the pediatric OPD of a tertiary care hospital. The children were prospectively identified and EEG was carried out on two occasions. First EEG was done within one week of febrile seizure episode and second EEG was done after 03 months of first EEG. EEG records were obtained with the standard international protocols for duration of 35 minutes which included 25 minutes of sleep record in all the children. Photic stimulation, hyperventilation and sleep deprivation were used as activation procedures. Descriptive analysis of EEG tracings was done in terms of background activity and presence of abnormal waveforms. Result: Paroxysmal EEG abnormalities were present in 54% of children. Most common epileptiform discharges were of generalized epileptic discharge followed by focal polyspikes. Sleep deprivation was the most effective activation procedure in evaluating febrile seizure with abnormal epileptiform discharge patterns. Validity measures of EEG in febrile seizure were found to have 90% sensitivity, 70% specificity, 72% positive predictive value and 88% negative predictive value within 95% confidence interval. Conclusion: EEG is a sensitive method for identifying and quantifying electrical activity in febrile seizures. EEG is useful as a diagnostic and prognostic tool in febrile seizures and can provide information regarding presence of abnormalities, degree of encephalopathy and electrographic features but like all diagnostic tool it is not fully infallible and requires further alternative diagnostic and clinical support.
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CONTEXT: Carcinoma of the breast is one of the most common malignant tumors and is the most common cause of death from cancers in females. Early diagnosis and assessing the prognosis for each patient is essential for a better therapeutic plan and management. AIMS: To evaluate the significance of various prognostic indicators of breast carcinoma by correlating with Nottingham modification of Scarff Bloom‑Richardson’s grading system (NMBGS). MATERIALS AND METHODS: Eighty four patients who underwent mastectomy for breast carcinoma at a tertiary care centre in South India over a period of 2 years have been evaluated to note the importance of the various prognostic factors correlating them with NMBGS. STATISTICAL ANALYSIS: A Chi‑square test was used to determine possible association between the various prognostic factors. RESULTS: Eighty percent of the tumors were infiltrating ductal carcinoma (IDC), and it is seen that the larger tumor size, higher histopathological grade, increased lymphovascular invasion, lymphnode metastasis, tumor necrosis, microvessel density, estrogen and progesterone receptor negativity, and HER‑2/neu positivity were associated with higher grade of tumor. CONCLUSIONS: The traditional morphological factors including the histological type, grade, tumor size, lymphovascular invasion, lymph node status, presence of necrosis, stromal reaction, and microvascular density (MVD) count are relatively simple but robust prognostic factors to assess, while the hormonal and genetic status not only have prognostic value but are useful predictive marker for adjuvant chemotherapy. Hence, the status of these various prognostic factors should form the basis of all routine histopathological reports in cases of breast cancer for better management.
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BACKGROUND AND PURPOSE: Few studies have analyzed the clinical course and functional outcome in Leigh syndrome (LS). The aim of this study was to determine the clinical, radiological, biochemical, and genetic features of patients with LS, and identify prognostic indicators of the disease progression and neurological outcome. METHODS: Thirty-nine patients who had been diagnosed with LS at the Seoul National University Children's Hospital were included. Their medical records, neuroimaging findings, and histological/biochemical findings of skeletal muscle specimens were reviewed. Targeted sequencing of mitochondrial DNA was performed based on mitochondrial respiratory chain (MRC) enzyme defects. RESULTS: Isolated complex I deficiency was the most frequently observed MRC defect (in 42% of 38 investigated patients). Mitochondrial DNA mutations were identified in 11 patients, of which 81.8% were MT-ND genes. The clinical outcome varied widely, from independent daily activity to severe disability. Poor functional outcomes and neurological deterioration were significantly associated with early onset (before an age of 1 year) and the presence of other lesions additional to basal ganglia involvement in the initial neuroimaging. CONCLUSIONS: The neurological severity and outcome of LS may vary widely and be better than those predicted based on previous studies. We suggest that age at onset and initial neuroimaging findings are prognostic indicators in LS.
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Humans , Basal Ganglia , Disease Progression , DNA, Mitochondrial , Electron Transport , Leigh Disease , Medical Records , Muscle, Skeletal , Neuroimaging , SeoulABSTRACT
Scorpion sting envenomation is a common medical emergency accounting for nearly 2.8% of annual intensive cardiac care unit admissions and much more outpatient visits. Symptomatology and severity of envenomation varies greatly. Autonomic storm may end up in loss of life. Methods: This is a clinical study conducted between April 2011 and February 2013. Patients with moderate to severe envenomation were examined at frequent intervals for various autonomic manifestations. Various demographic, clinical and electrocardiogram (ECG) changes were studied for their association with severity of envenomation. Results were statistically evaluated for their significance. Results: A total of 106 patients were studied with a mean age of 27.25 years and peak incidence between 11 and 30 year age groups. 91% reached the hospital within 12 h. 7.55% of the patients had Grade 2, 74.53% had Grade 3 and 17.92% had Grade 4 disease, all grades were common in 11-30 age group. Autonomic disturbances; profuse sweating seen in 72.6% of the patients that showed a strong correlation with pulmonary edema and ECG manifestations (p ≤ 0.0001). Pulmonary edema was present in 37.7% of the patients. Excessive salivation was seen in 28.3%, and persistent nausea and vomiting were seen in 24.5%, both were associated with severe cardio-pulmonary manifestations. Hypotension was present in 14.2% of patients that was associated with poor prognosis (p ≤ 0.0001). Conclusions: Scorpion sting envenomation is a life-threatening problem requiring immediate attention. Presence of autonomic dysfunctions; profuse sweating, excessive salivation, persistent nausea and vomiting, hypotension at presentation are poor prognostic factors.
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This was a case-control study to identify prognostic indicators of bacterial meningitis in a reference hospital in Pernambuco/Brazil. The data were collected from charts of 294 patients with bacterial meningitis between January 2000 and December 2004. Variables were grouped in biological, clinical, laboratory and etiologic agent/treatment. Variables selected in each step were grouped and adjusted for age. Two models were created: one containing clinical variables (clinical model) and other containing laboratory variables (laboratory model). In the clinical model the variables associated with death due to bacterial meningitis were dyspnea (p = 0.006), evidence of shock (p = 0.051), evidence of altered mental state (p = 0.000), absence of headache (p = 0.008), absence of vomiting (p = 0.052), and age >40 years old (p = 0.013). In the laboratory model, the variables associated with death due to bacterial meningitis were positive blood cultures (p = 0.073) and thrombocytopenia (p = 0.019). Identification of prognostic indicators soon after admission may allow early specific measures, like admission of patients with higher risk of death to Intensive Care Units.
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Meningitis, Bacterial/mortality , Case-Control Studies , Prognosis , Risk FactorsABSTRACT
Objective To analyze the causes of death and prognostic indicators of rheumatoid arthritis (RA).Methods A retrospective investigation was performed on 91 RA patients who were admitted into our hospital from 1990 to 2011.The clinical features and laboratory data were studied to assess the causes of death and the relationship between causes of death and disease activity and treatment.T test and x2 test were used for statistical analysis.Prognostic indicators of mortality were studied by Cox propor-tional hazards models.The prognostic indicators of RA were also analyzed.Results The three most common causes of death in patients with RA were infection (57％),cardiac-cerebral vascular diseases (13％) and cancer (12％).Severe disease activity and presence of extra-articular manifestations were more common among the patients who died.Seventy-five percent patients presented with systemic symptoms including fever,fatigue and weight loss,followed by pulmonary fibrosis (32％) and pleural effusion (27％).Cox regression analysis revealed that the presence of extra-articular features was independent risk determinant for mortality while DMARDs treatment was the independent protect determinant.Conclusion Infection,cardiac-cerebral vascular diseases and cancer are the main causes of death in RA.The presence of extra-articular features is the independent risk factor of RA.
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Objective To analyze the 5-year survival rate,causes of death and prognostic indicators of systemic lupus erythematosus (SLE).Methods A retrospective analysis was performed on 243 newly diagnosed SLE patients who Were admitted into our hospital from 1998 to 2005.The clinical features and serologic data were studied.Survival rate of SLE patients over time was studied by the Kaplan-Meier method,and prognostic indicators of mortality were studied by Cox proportional hazards models.Results The 1-,3- and 5-yr survival rate was 96%,94% and 91%,respectively.Renal failure and infection were the main causes of death,followed by lupus encephalotmthy and pulmonary hypertension.Cox regression analysis revealed that lupus nephritis and lupus encephalopathy at the diagnosis were independent risk determinants for mortality.However,age,sex,low C3 level,positive anti-dsDNA antibody,hematological abnormalities,lupus lung involvement and heart damages at diagnosis and immunosuppressant treatment had no strong association with survival.Conclusion Early diagnosis,control of SLE organ damage and infection prevention are critical to improve survival of SLE patients.