Successful Conservative Treatment of Massive Infective Endocarditis with Severe Mitral Valve Regurgitation and Septic Emboli

@#Management of complicated massive infective endocarditis (IE) in patients who are contraindicated for surgical valve replacement has long been a dilemma for many clinicians. Studies have shown that massive IE patients who were treated conservatively generally result in poorer prognosis. We report two cases of massive native valve infective endocarditis with severe mitral valve regurgitation and septic emboli that has been successfully treated conservatively. Interestingly, despite having a large vegetation and multiple septic emboli complications, none of these two cases had any positive culture or serology. Managing culture negative IE without surgical intervention pose an even greater challenge to the choice and duration of antibiotics with further long-term plans. We hope to share these case series to aid in the management dilemma of similar cases in the future.

MCM - 2 and Ki - 67 as proliferation markers in renal cell carcinoma: A quantitative and semi - quantitative analysis

ABSTRACT Introduction/Background: Fuhrman nuclear grade is the most important histological parameter to predict prognosis in a patient of renal cell carcinoma (RCC). However, it suffers from inter-observer and intra-observer variation giving rise to need of a parameter that not only correlates with nuclear grade but is also objective and reproducible. Proliferation is the measure of aggressiveness of a tumour and it is strongly correlated with Fuhrman nuclear grade, clinical survival and recurrence in RCC. Ki-67 is conventionally used to assess proliferation. Mini-chromosome maintenance 2 (MCM-2) is a lesser known marker of proliferation and identifies a greater proliferation faction. This study was designed to assess the prognostic significance of MCM-2 by comparing it with Fuhrman nuclear grade and Ki-67. Material and Methods: n=50 cases of various ages, stages, histological subtypes and grades of RCC were selected for this study. Immunohistochemical staining using Ki-67(MIB-1, Mouse monoclonal antibody, Dako) and MCM-2 (Mouse monoclonal antibody, Thermo) was performed on the paraffin embedded blocks in the department of Morbid anatomy and Histopathology, University of Health Sciences, Lahore. Labeling indices (LI) were determined by two pathologists independently using quantitative and semi-quantitative analysis. Statistical analysis was carried out using SPSS 20.0. Kruskall-Wallis test was used to determine a correlation of proliferation markers with grade, and Pearson's correlate was used to determine correlation between the two proliferation markers. Results: Labeling index of MCM-2 (median=24.29%) was found to be much higher than Ki-67(median=13.05%). Both markers were significantly related with grade (p=0.00; Kruskall-Wallis test). LI of MCM-2 was found to correlate significantly with LI of Ki-67(r=0.0934;p=0.01 with Pearson's correlate). Results of semi-quantitative analysis correlated well with quantitative analysis. Conclusion: Both Ki-67 and MCM-2 are markers of proliferation which are closely linked to grade. Therefore, they can act as surrogate markers for grade in a manner that is more objective and reproducible.

Immune mechanisms in type-2 diabetic retinopathy

To enumerate CD4+CD25+ Treg cells and determine serum IL-6 and IL-17 in type 2 diabetes mellitus patients with retinopathy. The case-control study was conducted at the Department of Immunology, University of Health Sciences, Lahore, from November 2009 to January 2012 and comprised diabetic patients and healthy controls who were divided into three groups. Group 1 had controls, while Group 2 had diabetic patients without retinopathy and Group 3 had diabetic patients with retinopathy. Flowcytometre and enzyme-linked immunosorbent assay were used for CD4+CD25+ Tregs and serum IL-6 and IL-17 respectively. SPSS 20 was used for statistical analysis. Of the 212 subjects in the study, 30[14%] were Group 1, 30[14%] in Group 2 and 152[72%] in Group 3. There were 25[83%] women in Group 2 and 101[66%] in Group 3 compared to 9[30%] in Group 1. Higher mean age was in Group 3 [50.88 +/- 8.9 years] and Group 2 [49.46 +/- 9.94 years] compared to Group 1 [34.66 +/- 8.78 years] while longer mean disease duration was in Group 3 [10.51 +/- 5.24 years] than Group 2 [7.76 +/- 4.14 years]. Highest median ratio of IL-6 was in Group 1 [1468.62] [Q1-Q3: 1229.9-1543.35], followed by Group 2 [1455.32] [Q1-Q3:1214.22-158.9] and Group 3 [469.84] [Q1-Q3: 206.53-1231.33] whereas IL-17 was the highest in Group 1 [339.38] [Q1-Q3: 159.89-1174.93], followed by Group 3 [216.60] [Q1-Q3: 141.87-410.25] and Group 2 [174.17] [Q1-Q3: 138.77-458.17]. Higher percentage of Tregs was in Group 2 [3.07 +/- 0.43] followed by Group 1 [2.91 +/- 0.04] and Group 3 [2.88 +/- 0.38]. Significant difference was observed in gender, age, disease duration, level of IL-6 and IL-17 [p<0.05 each], while no difference was found in glycated haemoglobin, CD4+CD25+ and Tregs [p>0.05 each]. Age, gender and duration of diabetes contributed to diabetic retinopathy, while CD4+CD25+ T cells and Treg cells did not. Serum IL-6 and IL-17 were inversely associated with diabetic retinopathy

Nuclei segmentation of leukocytes in blood smear digital images

The Leukocytes are differentiated from each other on the basis of their nuclei, demanded in many Medical studies, especially in all types of Leukemia by the Hematologists to note the disorder caused by specific type of Leukocyte. Leukemia is a life threatening disease. The work for diagnosing is manually carried out by the Hematologists involving much labor, time and human errors. The problems mentioned are easily addressed through computer vision techniques, but still accuracy and efficiency are demanded in terms of the basic and challenging step segmentation of Leukocyte's nuclei. The underlying study proposed better method in terms of accuracy and efficiency by designing a dynamic convolution filter for boosting low intensity values in the separated green channel of an RGB image and suppressing the high values in the same channel. The high values in the green channel become 255 [background] while the nuclei always have low values in the green channel and thus clearly appear as foreground. The proposed technique is tested on 365 images achieving an overall accuracy of 95.89%, while improving the efficiency by 10%. The proposed technique achieved its targets in a realistic way by improving the accuracy as well as the efficiency and both are highly required in the area

Negative association of serum IL-6 and IL-17 with type-II diabetes retinopathy

Diabetes mellitus [DM] is a health concern which leads to complications such as retinopathy. Pakistan has 6.9 million people living with DM and this toll will be doubled by 2025. To determine serum IL-6 and IL-17 of type 2 diabetes mellitus [T2DM] patients with retinopathy. In this cross-sectional case- control study, 212 subjects enrolled which were categorized into 3 groups. Group-I included 30 subjects without diabetes, group-II consisted of 30 subjects with T2DM without retinopathy and group-III consisted of 152 subjects with T2DM and retinopathy. Serum IL-6 and IL-17 levels were determined by ELISA. Data was analysed using SPSS 17.0 and one way ANOVA to observe group mean differences. Longer mean duration of disease was detected in group-III than group-II [p=0.007]. Highest IL-6 level was detected in group-II and highest IL-17 level was detected in group-I. For IL-6, significant differences were detected among groups in total, between Group-I and Group-III and between Group-II and Group-III [p<0.0001 each]. Regarding IL-17, significant differences were found among groups in total [p=0.002] and between Group-I and Group-III [p=0.001]. No significant difference in the percentages of HbA1c observed between groups. Age, gender and duration of diabetes contribute to T2DM retinopathy. Serum IL-6 and IL-17 were inversely associated with T2DM retinopathy

Comparative study of [Leuko-off coded herbal formulation] vs. metronidazole [allopathic medicine] for bacterial vaginosis and trichomonal infections

Vulvovaginitis is one of the common problems that women's has to face in their lifetime. The women are more susceptible of these infections and that they are increasingly vulnerable to infection from the anatomic as well as hormonal point of view. Bacterial vaginosis and trichomoniasis are common examples that occur after the change in the vaginal ecosystem1o Single-line therapy is often inadequate and recurrence is common. So there is a need of treatment, which should be safe and effective. A random controlled clinical trial was conducted to compare the anti-bacterial and anti-trichomonal activity and safety of coded herbal medicinal treatment Leuko-off with Metronidazole. All subjects were clinically studied and completed the assigned therapy during the period May 2001 to June 2004. The clinical evaluation was carried out on 45 patients of ages between 14-48 years with the complaint of vaginal discharge at Department of Gynecology and Obstetrics in Shifa-ul-Mulk Memorial Hospital for Eastern Medicine at Hamdard University, Hamdard Matab Aram Bagh in Karachi and Civil Hospital, Karachi

Objective of Study: To investigate the efficacy and safety of coded herbal medicine "Leuko-ofr' for the treatment of bacterial vaginosis and trichomonas infections and provide a comparison between herbal medicine and current allopathic treatment Metronidazole" for bacterial vaginosis and trichomonal infections

Conclusion: Consequently the generated data offered support to the null hypothesis [when P>0.05] hence the null hypothesis was rejected on the basis of statistical findings with regard to efficacy, safety, drug compliance and cost effectiveness [P<0.05]