Effect of aluminium on lipid profile and atherogenic index in prepubertal and young adult female rats: A pilot study

Objectives: Exposure of aluminium (Al) to mankind is inescapable, and its dyslipidaemic impact is a possible contributing factor to health hazards like cardiovascular diseases. The health effects due to the metalloestrogenic property of the metal need imperative consideration. The current experimental work was undertaken to explore Al-induced dyslipidaemia due to its metalloestrogenic property. Materials and Methods: To fulfil this objective, prepubertal (PP) and young adult (YA) female Wistar rats were intraperitoneally administered to two doses of Al [5 and 10 mg/Kg body weight (BW)] once daily for 2 weeks. After the completion of the acute exposure protocol, plasma and hepatic tissue lipid profiles were estimated. Analysis of variance was carried out by the Kruskal–Wallis test and the differences between the groups were analysed by Mann–Whitney U post hoc test Results: Increased triglyceride, total cholesterol, low-density lipoprotein (LDL) cholesterol and very-LDL cholesterol in plasma were found in YAs treated with both doses of Al in a dose-dependent manner. Similar changes were not present in PP female rats. Decreased levels of lipid levels were observed in the case of hepatic lipid profile. Conclusion: The study ushers light towards the dyslipidaemic alterations in experimental female rats after acute Al exposure. Impacts of Al on the growth and organosomatic index during the vital developmental days were significantly decided by the pubertal status of the female rats. The results of this study indicate the impact of puberty on the Al-induced modifications in lipid profile parameters and cardiovascular risk factors.

A Clinicopathological Study on Cyclical Mastalgia with Special Reference to Serum Oestrogen Level and Breast Volume.

Cyclic mastalgia is defined as a breast pain that has a relationship to the menstrual cycle. As far as research studies are concerned the main etiological factors for cyclical mastalgia include dietary factors and hormonal imbalance. In this study, the clinicopathological aspect of cyclical mastalgia is studied with special reference to serum oestrogen and breast volume. This study provides valuable data on cyclical mastalgia with special reference to serum oestrogen level and breast volume.METHODSA total of 101 patients meeting inclusion criteria were selected for this prospective comparative observational study. Sample was selected from OPD patients from Surgery Department, Medical College Kolkata. A detailed history of the patients who was taken with special reference to the dietary habits and lifestyle. A thorough physical examination including breast size and volume were taken (by visual assessment method, size of the undergarments the patient wear and then breast circumference measurement) and the findings were noted. Patients underwent Tru-Cut biopsy for histopathological study and Oestrogen Receptor Status. All data was captured in a predesigned Case Data Sheet and analysis of all the data was done from the CDS using master chart or grand chart.RESULTS58.3% patients with cyclical mastalgia have h/o fatty diet. Patients with increased breast volumes had increased levels of serum oestradiol which signifies that mastalgia with medium and large size breast would respond to antioestrogens better than those patients with small sized breast volume. Majority of the patients with cyclical mastalgia in our study had medium breast volumes as per Bra-size, where the range of 32-36 has the highest frequency (42.8%). The mean measurement of bra size is 33.7 and the standard deviation is 3.737. In our study, we find positive correlation with breast volume and serum oestrogen level (Pearson correlation of breast volume as 1 and serum oestrogen level as 0.381 respectively) and negative correlation with breast volume and serum progesterone level (Pearson correlation of breast volume as 1 and serum progesterone level as -0.134 respectively).CONCLUSIONSThis study shows a significant positive correlation between breast volume, fatty diet and oestrogen level with cyclical mastalgia.

Evaluation of Role of Tru-Cut Biopsy in the Diagnosis of Clinically Palpable Breast Lumps

Many diseases affect the breast that range from inflammatory conditions, benign lesions to malignant lesions, most of which present as lumps in the breast. Breast lumps are one of the frequent complaints that we come across in surgical OPDs. Breast lumps not only create apprehension but also can cause unacceptable pain and impairment if they are found to be malignant. Fine Needle Aspiration Cytology (FNAC), Tru-Cut biopsy, incision biopsy and excision biopsy are the pathological investigations available for the diagnosis of breast lesions. This study is done to evaluate the role of Tru-Cut biopsy in diagnosing the breast lesions and compare it with FNAC and histopathology.METHODSThis prospective study is conducted in the Department of General Surgery at a tertiary care centre from September 2015 to November 2016 among patients attending surgical OPD and admitted in general surgical wards with clinically palpable breast lumps.RESULTSThe sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 86.36%, 93.75%, 90.47%, 90.90% and 90.74 % respectively. For Tru-Cut biopsy the values were 95.45%, 100%, 100%, 96.96 % and 98.14 % respectively.CONCLUSIONSTru-Cut biopsy has better efficacy over FNAC in our study. The superiority of Tru-Cut biopsy is particularly seen in Sclerosing, papillary, fibro-epithelial lesions and malignancies with inconclusive and suspicious FNAC results.

Outcomes of Breast Cancer Receptor Testing at the Georgetown Public Hospital Corporation from December 2016 to December 2018

Objectives:To review the outcomes of oestrogen receptor(ER), progesterone receptor (PR) and Human epidermal growth factor receptor 2 (HER2) in breast cancer patients at GPHC over a 2 year period from December 2016-December 2018.Hypothesis:There is a higher incidence triple negative(ER (-), PR (-), HER2 (-)) breast cancer among patients in Guyana when compared to the Caribbean.Secondary Objectives:To identify the patients who had hormone receptor testing done at the Georgetown Public Hospital Corporation (GPHC).To specify the current trends of ER, PR and HER2 in patients at GPHC from December 2016-December 2018.To enumerate the percentage of BC diagnosed in the patients under 40 years.Design and Methods:Retrospective cohort study of 90 BC patients with known receptor status from December 2016-Dcember 2018.Results:In this study of 90 patients 46% of the patients are triple negative BC, while 38% are hormone receptor positive. Of least frequency are the triple positive BC representing 3%.The persons 40years and under represent 16% of the population. Conclusion: There in a high percentage of breast cancer in patients under 40 years representing 16% of the study population.There is a higher percentage of triple negative or non-hormonal receptive breast cancerat GPHC of approximately 46% which supersedes 20% when compared to the Caribbean population.Recommendations: Further study is needed, with screening and development of protocols. Breast receptor testing in all patients need to routinely done and a formal cancer registry and Digital database established.

Oestrogen receptor Rsa I gene polymorphism in osteoporosis periodontitis patients with or without dental fluorosis

Background & objectives: There is a paucity of information on association between dental fluorosis, osteoporosis and periodontitis. The aim of this pilot study was to evaluate oestrogen receptor (ER) Rsa 1 gene polymorphism in osteoporosis periodontitis patients with and without dental fluorosis. Methods: Twenty one primary osteoporotic patients suffering from periodontitis with dental fluorosis and 20 primary osteoporotic patients suffering from periodontitis without dental fluorosis participated in this study. Periodontitis was diagnosed based on age, gender T-scores using clinical parameters such as plaque scores, gingival bleeding scores and probing pocket depth, clinical attachment level (CAL) and severity of dental fluorosis. DNA was genotyped at the RsaI RFLP (in exon 5) inside the ER gene to study ER Rsa I gene polymorphism in osteoporosis periodontitis patients with and without dental fluorosis. Results: Patients with dental fluorosis had higher degree of osteoporosis than those without fluorosis. CAL was significantly higher (P <0.05) in those with dental fluorosis compared with those without. Rr heterozygote (21.95%) was observed in patients without fluorosis whereas RR mutant homozygote was absent in both the groups. Rr wild homozygote type was seen more in the patients with fluorosis (51.21%). Significant differences were found in distribution of these genotypes between patients with and without dental fluorosis. Interpretation & conclusions: This preliminary study showed the presence of ER I gene polymorphism in osteoporosis periodontitis patients without dental fluorosis. Further studies with large sample size are needed to confirm the association shown in this preliminary study.

Retrospective Study of Clinical Outcome in 25 Patients of Common Bile Duct Calculi

Introduction: Management of common bile duct stones(CBDS) presents a surgical challenge since it is the majorcause of hepatobiliary morbidity and complications. The aimof the study was to evaluate the best line of treatment for CBDstone and complications related to every approach.Material and Methods: This retrospective study includespatients with CBDS who were treated with conservativetreatment or endoscopic stone extraction followed bylaparoscopic cholecystectomy (LC). Primary outcome wassuccessful clearance of common bile duct and secondaryoutcomes were complications, total cost and hospital stay.Results: Out of 25 patients, 13 were treated by ERCP(Endoscopic Retrograde Cholangio Pancreatography) and12 by Conservative approach. There was complete clearanceof CBDS in 10 (76%) cases out of 13, in the endoscopicretrograde cholangiopancreatography (ERCP) group and inthe remaining 3 patients, the Common bile duct stone wasremoved by the trans-cystic exploration. In the conservativegroup, there was complete clearance of CBDS in 8 (66%)cases, and in the remaining 4 (33%)patients, the common bileduct stone was removed by the transcystic exploration.Conclusion: Management of CBDS represents a surgicalchallenge. CBDS increases the technical difficulty of ERCPand increases the risk of PEP. Conservative managementof CBDS avoids the risks associated with ERCP and isalso effective in clearing CBDS so one should consider aconservative line of treatment in CBDS in order to decreasethe cost and avoid unnecessary ERCP.

The application of detecting BCAR1 (+)-circulating tumor cells in postoperative monitoring of early stage lung adenocarcinoma / 中华胸心血管外科杂志

Objective To explore the clinical significance regarding monitoring circulating tumor cells in early stage lung adenocarcinoma.Methods From November 2015 to January 2018,48 patients with stage Ⅰ lung adenocarcinoma were included in the study.BCAR1 expression in CTCs in peripheral blood were detected by using CanPatrolTM and RNA in situ hybridization detection.Results Among the 48 cases,CTCs and BCAR1 (+)-CTCs were detected in 41 cases(85.4％) and 30 cases(62.5％),respectively.Number of BCAR1 (+)-CTCs seemed to be significantly positively related to that of CTCs.BCAR1 (+)-CTCs were more likely to appear in the M-CTCS and E&M-CTCS.BCAR1 (+)-CTCs remarkably increased in three relapsed cases.Furthermore,there were 19 stable cases who had postoperative CTCs data:(1) in 12 patients,either CTCs or BCAR1 (+)-CTCs were significantly reduced or remained stable;(2) in 7 cases,CTCs increased,but BCAR1 (+)-CTCs remained stable in 2 cases,reduced in 1 case,and the other 4 cases underwent close follow-up.Conclusion Evaluation of BCAR1 (+)-CTCs possibly can be contributive to prediction of early lung adenocarcinoma recurrence or metastasis.

Estrogen and Progesterone Receptors in Breast Malignancy-Their Expression and Correlation with Histologic Parameters in Southern India

Breast carcinoma is the most common malignancy among South Indian women. Hormone receptor evaluation has become crucial for management of breast cancer. Very few studies have correlated oestrogen receptors (ERs) and progesterone receptors (PRs) with histologic parameters in Andhra Pradesh state of Southern India; therefore, the study was undertaken, and it is also to study the importance of immunohistochemistry (IHC) evaluation of ER and PR status and to evaluate and conclude the importance of modified Bloom-Richardson (MBR) grading in a routine investigation for prognosis and prediction of clinical outcomes. Aims and Objective (1) To evaluate the expression of hormone receptors in breast carcinoma and (2) to correlate their expression with other histological variables. Materials and Methods A prospective study was conducted for 2 years, at a tertiary care hospital in Vijayawada, Andhra Pradesh, India. In our study, 100 consecutive cases were included, which were reported by MBR system and evaluated for ER & PR receptor expression by Allred score. Statistical analysis was done by SPSS software, Student t-test and chi-square test. Results Majority of the age group affected was below 50 years, and mean age of the study population was 46.25 years. The most common histological variant was infiltrating duct cell carcinoma (91%), and predominant histological grade was MBR grade II (47%). ER and PR positivity were noted in 56% and 53% of cases, respectively. The common phenotypic expressions were ER+ PR+ (46%) & ER-PR-(37%). ER positivity was observed in 25% of grade I, 54.54% of grade II and 20.46% of grade III lesions (p = 0.005), and expression of PR was seen in 25.53% of grade I, 51.06% of grade II and 23.54% of grade III lesions (p = 0.001). ER+ PR+ phenotypic expression was positively correlated with low histologic grade, whereas ER-PR-correlated with high histological grade (p = 0.003). ER+ PR+ also correlated with lymphatic spread (p = 0.046) and vascular invasion (p = 0.011). However, no correlation was observed with age, tumour size and ER & PR expression (p > 0.05). Conclusion High nuclear pleomorphism, low tubule formation, high mitotic score & lymphovascular invasion were found more common in ER-PR-group than in ER+ & PR+ group with significant statistical correlation. ER & PR expression showed statistically significant correlation with MBR system and other pathological parameters. Hence, MBR grading should be incorporated as a routine investigation for prognosis and prediction of clinical ou Breast carcinoma (CA), Oestrogen receptor (ER), Immunohistochemistry (IHC), Invasive ductal carcinoma (IDC), Modified Bloom-Richardson grading (MBR), Progesterone receptor (PR) nuclear pleomorphism.

Steroids in traditional Chinese medicine: what is the evidence?

Local healthcare providers often question the possible steroidal activity of traditional Chinese medicine (TCM) herbs or herbal products and implicate them as a cause for adrenal insufficiency or Cushing's syndrome in patients with a history of TCM intake. We conducted a comprehensive database search for evidence of potential glucocorticoid, mineralocorticoid, androgenic or oestrogenic activity of herbs or herbal products. Overall, there are not many herbs whose steroidal activity is well established; among these, most cases were based on preclinical studies. Liquorice root may cause pseudoaldosteronism through interference with the steroidogenesis pathway. Although ginseng and cordyceps have some in vitro glucocorticoid activities, the corroborating clinical data is lacking. Deer musk and deer antler contain androgenic steroids, while epimedium has oestrogenic activity. On the other hand, adulteration of herbal products with exogenous glucocorticoids is a recurrent problem encountered locally in illegal products masquerading as TCM. Healthcare providers should stay vigilant and report any suspicion to the relevant authorities for further investigations.

A perspective on current research investigating the effects of hormonal contraceptives on determinants of female athlete performance

Abstract Hormonal contraceptives are used by approximately half of female athletes and may affect athletic performance as a result of their action on the endogenous hormonal milieu. In athletes, hormonal contraceptive use appears to have little effect on body composition, however further studies are needed assessing progestin-only contraceptives as they may have a negative effect in the general population. The type of progestin contained within the contraceptive may influence the anabolic response of muscle to loading although this relationship is complex as it may be due to either direct or indirect effects of exogenous hormones on protein synthesis and satellite cell proliferation. The altered hormonal milieu in hormonal contraceptive users has predominately been shown to have no effect on muscle strength and whilst maximal oxygen uptake is sometimes reduced, this does not translate into measures of performance. The majority of previous research has used cross-sectional designs and/or grouped together different types and brands of hormonal contraceptives and little research has been conducted on progestin-only contraceptives in athletes. Future research should use prospective, randomised-controlled designs to assess the effects of all types of hormonal contraceptives on athletic performance in females.(AU)

Resumo Os métodos contraceptivos hormonais são usados por aproximadamente metade das atletas do sexo feminino e podem afetar o desempenho atlético como resultado de sua ação hormonal sistêmica. Nas atletas, o uso de anticoncepcionais parece ter pouco efeito sobre a composição corporal, porém novos estudos são necessários para avaliar os efeitos dos contraceptivos derivados apenas de progestina, pois podem ter um efeito negativo na população em geral. O tipo de progestina contido dentro do contraceptivo pode influenciar a resposta anabólica do músculo, embora esta relação seja complexa em virtude dos efeitos diretos ou indiretos de hormônios exógenos na síntese da proteína e na proliferação das células satélites. A resposta sistêmica hormonal alterada em usuárias de contraceptivos parece não influenciar a força muscular e, embora o consumo máximo de oxigênio às vezes seja reduzida, isso não afeta as medidas de desempenho. A maioria das pesquisas utilizou desenhos transversais e/ou agrupou diferentes tipos e marcas de anticoncepcionais hormonais e poucos estudos têm sido realizada sobre anticoncepcionais com progestina em atletas. Futuros estudos devem usar desenhos experimentais prospectivos, randomizados e controlados para avaliar os efeitos de todos os tipos de contraceptivos hormonais no desempenho atlético em mulheres.(AU)

Relación entre estradiol plasmático, glucemia en ayunas y triglicéridos en varones con síndrome metabólico / Relationship between plasma oestradiol, fasting glucose, and triglycerides in males with metabolic syndrome

Introducción: En varones, el estradiol circula en pequeñas concentraciones (8-40 pg/ml), sin estar del todo claras aún sus funciones. En este contexto, es necesario aclarar los efectos de esta hormona en el sexo masculino. Además de estudiarse el posible papel en la reproducción masculina, en los últimos años se ha tratado de encontrar la relación entre sus niveles y los componentes del síndrome metabólico. Sin embargo, la bibliografía existente no aclara si ejerce un papel protector o perjudicial con respecto a dicha patología. Objetivos: Analizar las relaciones existentes entre el estradiol y los componentes del síndrome metabólico en una muestra de varones excedidos de peso con síndrome metabólico de la provincia de Mendoza. Metodología: Se estudió a 40 varones con sobrepeso u obesidad y síndrome metabólico residentes en la ciudad de Mendoza, con edades entre 53 y 74 años, los cuales fueron evaluados a partir de una consulta médica de rutina. Se determinaron estradiol, testosterona, glucemia en ayunas, insulina en ayunas, índice HOMA, perfil lipídico y ácido úrico. Se evaluó el estado nutricional mediante antropometría: peso, talla, circunferencias, pliegues cutáneos y medidas derivadas. El análisis estadístico se realizó mediante correlación de Pearson o Spearman según la normalidad de las variables y la prueba de la t de Student para muestras independientes. Se utilizó un nivel mínimo de significación de p < 0,05. Resultados: Los niveles de estradiol se correlacionaron negativamente con los valores de triglicéridos (r = -0,401; p = 0,013) y con la glucemia en ayunas (r= -0,333; p= 0,041). Por otra parte, los individuos normotrigliceridémicos (valor de triglicéridos < 150 mg/dl) mostraron valores mayores de estradiol que los hipertrigliceridémicos (p = 0,02). Conclusiones: Los niveles de estradiol muestran relación inversa con triglicéridos y glucemia en ayunas en varones con síndrome metabólico.

Introduction: Oestradiol circulates in low concentrations (8-40 pg/ml) in males, with its functions still not being entirely clear. In this context, there is a need to determine the effects it has on males. Apart from studying the potential role oestradiol has on male reproduction in recent years, efforts have been made to determine the relationship between oestradiol levels and metabolic syndrome components. Nevertheless, the existing bibliography does not clarify whether oestradiol plays a protective or detrimental role in this condition. Objectives: The present work aimed to analyse the relationship between serum oestradiol levels and metabolic syndrome components in overweight men from Mendoza. Methodology: The sample consisted of 40 overweight or obese males, aged 53-74, with metabolic syndrome, and living in the city of Mendoza. Based on a health routine check-up, they were evaluated by determining the levels of oestradiol, testosterone, fasting blood glucose, insulin, HOMA index, lipid profile, and uric acid. Nutritional status was assessed using anthropometric measurements: weight, height, circumferences, and skinfold thickness. Statistical analysis was carried out using Pearson or Spearman correlation according to the normality of variables and the Student t test for independent samples. A minimum level of significance of P<.05 was used. Results: Oestradiol levels negatively correlated with triglyceride values (r = -0.401; P=.013) and fasting blood glucose (r= -0.333; P=.041). Furthermore, those with normal triglycerides (triglyceride values <150 mg/dl) showed higher oestradiol levels compared to those with high triglycerides (P=.02). Conclusions: Oestradiol levels show an inverse relationship as regards triglycerides and fasting blood glucose in men with metabolic syndrome.

Prescribing Hormonal Contraception.

Millions of women are in the reproductive age group. Their age vary from 15 to 50 years. They differ in life style, culture and body mass index. They may have morbidities like high blood pressure, liver disease and other co-morbidities. They are prone to venous thrombosis, malignancies of the breast and endometrium. Therefore the prescription of contraception should be on individual basis. Over the past 40 years there had been many improvements in the contraceptive methods. The 50 microgram ethinyl oestradiol of the combined pill was reduced drastically. Many rods of the norplant had become a tiny single rod implanon. The inert Lippi’s loop has transformed into Levonorgestrel-releasing intra uterine system (LNG-IUS). When there are varieties of contraceptive methods available, it is obvious that no method is perfect and full proof to prevent conception. It is important for the caring practitioner to select the most appropriate method to suit each individual client.

Idiopathic gynaecomastia in twins: a case report.

Gynaecomastia is a common pathological condition of breast seen in men. This is defined as benign enlargement of breast tissue in males. It was first described by Palus Aegineta (AD 635-690). Herewith we are presenting cases of 14 year old twins attending the surgical O.P.D with bilateral enlarged breasts and pain. A diagnosis of pubertal gynaecomastia was made with no evidence of malignancy by histopathological examinations and mammography. One boy with 5 x 6 cm of right breast and 2 x3 cm of left breast was treated by subcutaneous mastectomy. Other boy had only enlargement of nipple and areola. He was reassured and sent home without surgical intervention. A rare case of idiopathic gynaecomastia in pubertal twins is described here.

Genistein-induced fluid accumulation in ovariectomised rats' uteri is associated with increased cystic fibrosis transmembrane regulator expression

OBJECTIVE: High genistein doses have been reported to induce fluid accumulation in the uteri of ovariectomised rats, although the mechanism underlying this effect remains unknown. Because genistein binds to the oestrogen receptor and the cystic fibrosis transmembrane regulator mediates uterine fluid secretion, we hypothesised that this genistein effect involves both the oestrogen receptor and cystic fibrosis transmembrane regulator. METHODS: Ovariectomised adult female Sprague-Dawley rats were treated with 25, 50, or 100 mg/kg/day genistein for three consecutive days with and without the ER antagonist ICI 182780. One day after the final drug injection, the animals were humanely sacrificed, and the uteri were removed for histology and cystic fibrosis transmembrane regulator mRNA and protein expression analysis using real-time polymerase chain reaction and Western blotting, respectively. The cystic fibrosis transmembrane regulator protein distribution was analysed visually by immunohistochemistry. RESULTS: The histological analysis revealed an increase in the circumference of the uterine lumen with increasing doses of genistein, which was suggestive of fluid accumulation. Moreover, genistein stimulated a dose-dependent increase in the expression of cystic fibrosis transmembrane regulator protein and mRNA, and high-intensity cystic fibrosis transmembrane regulator immunostaining was observed at the apical membrane of the luminal epithelium following 50 and 100 mg/kg/day genistein treatment. The genistein-induced increase in uterine luminal circumference and cystic fibrosis transmembrane regulator expression was antagonised by treatment with ICI 182780. CONCLUSION: Genistein-induced luminal fluid accumulation in ovariectomised rats' uteri involves the oestrogen receptor and up-regulation of cystic fibrosis transmembrane regulator expression, and these findings reveal the mechanism underlying the effect of this compound on changes in ...

Obesity-related complications: few biochemical phenomena with reference to tumorigenesis

Overweight or obesity is currently a common health problem in westernized societies globally. Obesity is linked with a sizeable number of disease aetiologies, notably type-2 diabetes, cardiovascular disorders and certain cancers, perhaps through some common mechanisms that favor persistent low-grade infl ammation. Both epidemiological and laboratory studies have demonstrated that the pathogenesis of certain cancers and the related prognosis are infl uenced by obesity. Clinically, a complex situation is present in obesity, which usually shows higher blood levels of various biomolecules, e.g., lipids like triglycerides, hormones like insulin, and fat cell-secreted adipokines like leptin. On the contrary, obesity is associated with lower concentrations of substances like sex hormone-binding globulin and adiponectin. Many of these biochemical compounds are used routinely for clinical diagnosis and assessment during the follow-up period. Nonetheless, approximately one-fi fth of the total cancer burden is associated with obesity. Excess adipose tissue and different hormonal substances possibly play a signifi cant role in this complex obesity-related carcinogenesis. A precise understanding of the pertinent pathological processes is defi nitely useful in early diagnosis, clinical management, and designing of novel pharmaceutical agents.

The prevalence and significance of oestrogen receptor (ER) positivity in breast cancer at the University Hospital of the West Indies, Jamaica / Prevalencia y significación de la positividad del receptor de estrógeno (RE) en el cáncer de mama en el Hospital Universitario de West Indies, Jamaica

OBJECTIVE: To identify the prevalence of oestrogen receptor (ER) positivity, and determine the relationship of ER status with patient and tumour characteristics, in patients with breast cancer. SUBJECTS AND METHODS: A retrospective review was conducted regarding the prevalence and clinical significance of ER in patients with breast cancer at the University Hospital of the West Indies (UHWI). Oestrogen receptor status results of 243 patients treated at UHWI were collected for the period January 1, 2002 to December 31, 2009. One hundred and ninety-nine were available for review. RESULTS: Oestrogen receptor status was positive in 125 (63%) and negative in 74 (37%) patients. Mean age at diagnosis was 52.6 ± 13.0 years for the ER positive group and 58.5 ± 14.23 years for the ER negative group. Postmenopausal women accounted for 55.2% and 64.9% of the ER positive and negative groups, respectively. Mean BMI was 28.0 kg/m² and 29.6 kg/m² for the ER positive and negative groups, respectively. Menarche occurred mainly between ages 12 and 13 years for both groups. Mean age at 1st parity was 23.4 years for the ER positive and 21.4 years for the ER negative group with median parity of two for both groups. The most prevalent risk factors were oral contraceptive pill (OCP) use (24.3% for the ER positive group, 17.1% for the ER negative group), family history of breast cancer (12.0%; 13.4%) and previous smoking (8.4%; 6.9%). Tumour node metastasis (TNM) stage was Stage II in most cases (46%; 49%). Infiltrating ductal histology was most common (81.5%; 87.7%). Her 2/ neu status was negative for most patients (91.3%; 91.5%). Most patients were disease free (77.6%; 70.0%) after an average follow-up period of 3.5 years. More persons in the ER negative group had locoregional recurrence (8%) and metastases (22%). CONCLUSIONS: Oestrogen receptor positive cohort was more prevalent. The ER negative group was older (p = 0.003).

OBJETIVO: Identificar la prevalencia del receptor de la positividad de receptor de estrógeno (RE), y determinar la relación del estatus de RE con el paciente y las características del tumor, en las pacientes con cáncer de mama. SUJETOS Y MÉTODOS: Se realizó un estudio retrospectivo con respecto a la prevalencia e importancia clínica del RE en los pacientes con cáncer de mama en el Hospital Universitario de West Indies (UHWI). Se recogieron los resultados del estatus del receptor de estrógeno de 243 pacientes tratados en UHWI en el periodo del 1 de enero de 2002 al 31 de diciembre de 2009. Ciento noventa y nueve estuvieron disponibles para examen. RESULTADOS: El estatus del receptor de estrógeno fue positivo en 125 (63%) y negativo en 74 (37%) pacientes. La edad promedio al momento del diagnóstico fue 52.6 ± 13.0 años para el grupo de RE positivo y 58.5 ± 14.23 años para el RE grupo negativo. Las mujeres menopáusicas representaron el 55.2% y el 64.9% del RE de los grupos positivos y negativos respectivamente. El índice de masa corporal (IMC) promedio fue 28.0 kg/m2 y 29.6 kg/m2 para el RE de los grupos positivos y negativos respectivamente. La menarquia ocurrió principalmente entre las edades de 12 y 13 años para ambos grupos. La edad promedio en la primera paridad fue 23.4 años para el grupo de RE positivo y 21.4 años para el de RE negativo, siendo la paridad mediana igual a dos para ambos grupos. Los factores de riesgo de mayor preponderancia fueron el uso de anticonceptivos orales (ACO) (24. 3% para el grupo de RE positivo, 17.1% para el grupo RE negativo); historia familiar de cáncer de mama (12.0%; 13.4%); y hábito de fumar con anterioridad (8.4%; 6.9%). De acuerdo con la estadificación tumor-nódulo-metástasis (TNM), se trataba de la Etapa II en la mayor parte de los casos (46%; 49%). La histología ductal infiltrante fue la más común (81.5%; 87.7%). El estatus Her2/neu fue negativo para la mayoría de las pacientes (91.3%; 91.5%). La mayoría de las pacientes se hallaban libres de enfermedad (77.6%; 70.0%) después de un periodo promedio de seguimiento de 3.5 años. En el grupo de RE negativo había más personas con recurrencia locoregional (8%) y metástasis (22%). CONCLUSIONES: La cohorte positiva del receptor de estrógeno positiva fue más prevaleciente. El grupo negativo de RE fue de mayor edad (p = 0.003).

An analysis of predictive biomarkers in routine histopathological reporting of infi ltrating ductal breast carcinoma in a tertiary hospital in Malaysia with a focus on limitations and directions for future development

Predictive biomarkers such as oestrogen (ER) and progesterone (PR) receptors and c-erbB-2 oncoprotein have become a staple in breast cancer reports in the country as they increasingly play an important role in the treatment and prognosis of women with breast cancers. This study reviews the practice of histopathology reporting of these biomarkers in a Malaysian tertiary hospital setting. Retrospective data on demographic, pathological and biomarker profi les of patients with invasive ductal carcinoma who had undergone mastectomy or lumpectomy with axillary node clearance from 2005 to 2006 were retrieved from the Department of Pathology, Penang Hospital and analysed. The prevalence of ER positivity (55.8%), PR positivity (52.5%), c-erbB-2 oncoprotein overexpression (24%) and triple negativity (ER negative, PR negative, c-erbB-2 negative) (15%) by immunohistochemistry were comparable with other studies. Notably, c-erbB-2 overexpression was equivocal (2+) in 15% of cases. Since about a quarter of equivocal (2+) cases usually show amplifi cation by FISH, a small but certain percentage of patients would miss the benefi t of anti-cerbB- 2 antibody therapy if FISH is not performed. New ASCO/CAP guidelines on the quantitation of ER and PR will probably increase the prevalence of ER/PR positivity, invariably leading to signifi cant ramifi cations on the management of patients as more patients would be deemed eligible for endocrine therapy, as well as categorisation of triple negative breast cancers.

The anticancer drug tamoxifen is active against Trypanosoma cruzi in vitro but ineffective in the treatment of the acute phase of Chagas disease in mice

The activity of the antineoplastic drug tamoxifen was evaluated against Trypanosoma cruzi. In vitro activity was determined against epimastigote, trypomastigote and amastigote forms of CL14, Y and Y benznidazole resistant T. cruzi strains. Regardless of the strain used, the drug was active against all life-cycle stages of the parasite with a half maximal effective concentration ranging from 0.7-17.9 µM. Two experimental models of acute Chagas disease were used to evaluate the in vivo efficacy of treatment with tamoxifen. No differences in parasitemia and mortality were observed between control mock-treated and tamoxifen-treated mice.

Immunohistochemical expression of oestrogen and progesterone receptors during experimental acute and chronic murine Schistosomiasis mansoni / Expressão imunohistoquímica de receptores para estrogênio e progesterona nas fases aguda e crônica da esquistossomose mansônica experimental em camundongos

INTRODUCTION: The responsibility of Schistosoma mansoni in female infertility is still controversial. This study was conducted to evaluate the effect of acute and chronic schistosomiasis mansoni infection on the endometrium using immunohistochemical analysis of uterine hormone receptor expression. METHODS: Twenty-four nonpregnant swiss albino mice were divided into three groups: control, noninfected; acute; and chronic Schistosoma mansoni infection. Histological sections of uterine specimens were examined by light microscope with an image analyzing system to detect structural histological, estrogen receptor (ER) and progesterone receptor (PR) expression in the endometrium. RESULTS: No secretory phase was detected in the endometrium in acute and chronic Schistosoma infection. Hormone receptor expression (ER and PR) showed statistically significant differences among the groups (p< 0.05), with significant low ER hormone expression in chronic infection, compared to control proliferative, control secretory and acute infection cases, and statistically significant high PR expression in both acute and chronic infection cases compared to the control secretory cases (p< 0.05). CONCLUSIONS: Schistosomiasis mansoni seems to have an important impact on the hormone expression of affected women. Further studies to explore the mechanism of such changes are recommended.

INTRODUÇÃO: A responsabilidade do Schistosoma mansoni em esterilidade feminina é ainda controversa. Este estudo é conduzido para avaliar o efeito da esquistossomose mansoni aguda e crônica no endométrio usando análise de imuno-histoquímíca da expressão de receptor hormonal uterina. MÉTODOS: Vinte e quatro camundongos fêmeas albinas suíças não grávidas foram divididas em 3 grupos (controle não-infectado, grupos agudos e crônicos infeccionados com Schistosoma mansoni). As seções histológicas de espécimes uterinos foram examinadas por microscópio leve com imagem, analisando sistema para detectar no endométrio expressões histológicas estruturais, receptor de estrogênio (ER) e receptor de progesterona (PR). RESULTADOS: Nenhuma fase secretora foi detectada no endométrio com infecção aguda e crônica de Schistosoma. A expressão hormonal de receptor (ER e PR) mostrou diferenças estatisticamente significantes entre grupos diferentes (p<0,05) com baixa significativa hormonal de ER com infecção crônica (comparado com controle proliferativo, controle secretório e casos agudos de infecção) e alta expressão de receptor de PR estatisticamente significativa em casos tanto agudos e crônicos de infecção como comparado com os casos de controle secretório (P <0,05). CONCLUSÕES: A esquistossomose mansoni parece ter um maior impacto em expressão hormonal das mulheres afetadas. Mais estudos para explorar o mecanismo de tais mudanças são recomendados.

Papel de la inmunología en la endocrinología ginecológica: revisión de la literatura / The role of immunology in gynaecological endocrinology: a literature review

Objetivos: revisar la asociación que existe entre los diferentes mecanismos inmunes y los eventos endocrinos necesarios para la regulación de la reproducción humana. Metodología: el presente trabajo es una revisión sistemática cualitativa, para la cual se consultaron las bases de datos de Ovid y PubMed/Medline, seleccionando artículos publicados entre 1984 y 2009 referentes a estudios en animales y humanos que demostraran la relación existente entre los esteroides y la hormona liberadora de gonadotropinas con el sistema inmune, así como su expresión en algunas enfermedades de tipo autoinmune. Resultados: muchos estudios experimentales en animales han demostrado una asociación entre el sistema inmune y los diferentes ejes neuroendocrinos que regulanla reproducción humana. Aunque en el hombre no han sido dilucidados los mecanismos definitivos, se ha observado que la Hormona Liberadora de Gonadotropinas (Gonadotropin-Releasing Hormone [GnRH]) y los esteroides sexuales tienen efectos a nivel de la programación del sistema inmune y su modulación. De la misma forma, se advierte que sistemas inmunes como el de la interleucina-1 juegan un papel importante en la regulación del eje hipotálamo-hipófisis-gónada y de otros ejes involucrados en la reproducción. Conclusiones: la GnRH y los esteroides son moduladores de la respuesta inmune de manera que pueden estimularla o suprimirla. Los sistemas inmunes como el de interleucinas (IL-1) tienen efectos antigonadotróficos a nivel central, y esteroidogénicos a nivel ovárico, relacionándose así con otros sistemas como el adrenal y el tiroideo con respecto a la ovulación y a la formación del cuerpo lúteo y su regresión; procesos importantes en la reproducción.

Objectives: reviewing the association between different immune mechanisms and endocrine events necessary for regulating human reproduction. Methodology: this was a qualitative systematic review which involved consulting databases like OVID, Medline(Pubmed-MeSH), selecting articles from 1984 to 2009 referring to animal and human studies demonstrating the relationship of steroids and the gonadotrophin-releasing hormone (GnRH) with the immune system, as well as their expression in some autoimmune illnesses. Results: many experimental studies in animals have demonstrated an association among the immune system and different neuroendocrine axes regulating human reproduction. Even though the definitive mechanisms have not yet been elucidated in humans, it has been found that GnRH and sexual steroids have an effect at immune system programming level and on their modulation. Interleukin-1 also plays an important role in regulating the hypothalamus-hypophysis-gonad axis and other axes involved in the reproduction. Conclusions: the sexual steroids and GnRH are immune response modulators in such a way that they may stimulate it or have an immunosuppressor role. Immune systems like interleukin (IL-1) have antigonadotropic action at central level and a steroidogenic effect at ovarian level; they are related to the adrenal axis and thyroid activity, ovulation, luteous body formation and regression, all being important processes in reproduction.