Measles Surveillance in Kashmir: A Mixed Methods Study

Background: Measles surveillance serves as the means of monitoring program success. The quintessential purpose of measles surveillance is to identify gaps and garner effective public health responses to achieve measles elimination. Objectives: There were two key objectives: (i) to conduct an in-depth review of the existing measles surveillance system in Kashmir and highlight its strengths and weaknesses and (ii) to assess the pattern of measles?containing vaccine (MCV1) coverage and MCV2 coverage among under?5 years children and describe the health-seeking patterns of suspected cases of measles. Methods: The mixed methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design was followed using individual face?to?face interviews with thirty-two (n = 32) different stakeholders from the state, district, medical block, and primary health center (PHC) levels. To complement the qualitative study, a quantitative survey was done in two districts, Srinagar and Ganderbal, which consist of 5 and 4 medical blocks, respectively. Results: Among the suspected cases of measles, 52% had visited PHCs. Sixty?four suspected cases of measles (64) were immunized with two doses of MCV. None of the clinically suspected cases of measles were further investigated. In the qualitative analysis, five themes were generated viz, “measles surveillance description of Kashmir valley;” “factors affecting measles surveillance, perceptions, and experiences of stakeholders;” “barriers to measles surveillance;” “measles surveillance activities need to be intensified;” and “respondent recommendations for building an effective and sensitive measles surveillance system.” Conclusion: The current measles surveillance system in Kashmir was not effectively functioning; case-based measles surveillance is not being done as per the WHO guidelines. There is a lack of planning, advocacy, awareness, and communication of measles surveillance among the stakeholders. The visible barriers in measles surveillance included lack of training, logistics, incentives, and monitoring by internal and external agencies.

The Lived-In Experience and Psychological Recount of Dog Bite VictimsVisiting the Anti-Rabies Clinic in Kashmir: A Qualitative Study

Introduction: There is a necessitated need for canvassing and prioritizing measures towards rabies elimination beyond existing statuesque post-exposure prophylaxis. Moreover, there is a need to characterize the psychological and intrusive experiences of dog-bite victims to portray a picture beyond the public health perspective. To get an expressive understanding of the psychological and lived-in experience ofObjective: dog bite victims' to complement existing concepts. The study was conducted at the anti-rabiesMethod: clinic(ARC) of SMHS hospital which receives animal bite cases from the whole of Kashmir valley. Participants were selected by purposive sampling based on the inclusion criteria, and data saturation was reached with eleven participant interviews. One to one in-depth interviews were conducted with eleven (11) dog bite victims, using a preformed interview guide. Data analysis was performed using Colaizzi's phenomenological method to describe the individualistic experiences faced in peculiar conditions with familiar phenomena embedded in them. Data analysis yielded three overarching themes and nine subthemes viz:-Results: 1.Spiritual and emotional ineffectualness. (Suffering and affliction, Spiritual sulkiness, Emotional emergence) 2. Flashbacks of being hindered and defenseless. (Lack of focus in one's work, lacking the courage to protect, Being shaky) 3. Social and economical implications. (Financial loss, group and peer detachment, preferring isolation) The results of this study showed that dog bite patients experience an unpleasantConclusion: phenomenon in the face of being bitten by the dogs and are subjected to severe psychological pressures that require attention and support of medical professionals, psychologists and government authorities.

Morbidity pattern in patients attending an OPD clinic at a health subcenter in Srinagar, Jammu and Kashmir

A retrospective descriptive study was carried out at subcenter Abidal, Srinagar to assess morbidity pattern among the population who visited this center. Secondary data was taken and analyzed using Microsoft excel. Results showed female population more often visited the center. Among the majority of recorded cases acute infections and fevers, hypertension, musculoskeletal disorders and anemia were a major contributing ailment.

Assessment of Delivery of Routine Immunization in Kashmir: A Qualitative Study

Introduction: Immunization is one of the splendid public health interventions that remarkably reduced child morbidity, mortality, and disability. Despite attaining substantial immunization coverage in Kashmir, assessment of the immunization system is quintessential for sustaining the gains and exploring the gaps. Objective: To assess the gaps in the delivery of routine immunization services in Kashmir Valley. Method: In-depth face-to-face interviews were conducted with thirty-two (32) important stakeholders, who were purposively selected as they play an active role in the planning and implementation of the Immunization Program and devise strategies at different levels of healthcare delivery. At the state level, SEPIO and SMO were interviewed at the District level, DIO/Deputy CMO was interviewed in all ten (10) districts of Kashmir Valley. From all ten Districts, two Medical-Blocks were selected from each District, and one Block Medical Officer and one Medical Officer were interviewed alternatively from each Medical-Block. Results: The thematic qualitative analysis approach was used and the analysis process generated five themes. Each of these themes included many sub-themes. 1. Factors facilitating the implementation of Routine Immunization (RI), 2. Limitations and deficits related to knowledge, attitude, monitoring, 3. Constraints encountered in the implementation of (RI) program, 4. Difficulties in the implementation of RI revealed by respondents, 5. Transformational steps to bridge gaps in the delivery of Immunization (RI) Conclusion: There were visible deficits related to knowledge, attitude, and monitoring among health professionals. Certain constraints encountered in the implementation of the program were financial constraints in the training of health care professionals and human resources constraints. The study showed the need for transformational steps to bridge gaps in the delivery of the Immunization (RI), which included regular monitoring and review meetings, teamwork and peer learning, training, and improvement in cold chain maintenance

Vaccine usage and wastage in a designated Yellow Fever Vaccination Centre in North India

Purpose@#Yellow fever is a viral hemorrhagic fever transmitted through the bite of mosquitoes. World Health Organization guidelines advocate a single dose of vaccine for life-long protective immunity against yellow fever. Yellow fever vaccine is included in routine childhood immunization schedules in countries at medium or high risk of yellow fever. For some travelers, visiting endemic countries, yellow fever vaccination is recommended to protect the travelers. We calculated the yellow fever vaccine wastage rate at a designated center in North India. @*Materials and Methods@#This is a record-based study. The data for the study was obtained from the immunization center of Government Medical College, Srinagar, Jammu and Kashmir. The particulars for every vaccine recipient were present in the register. The vaccine wastage rate was calculated. The analysis was done in IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and results were presented as numbers and frequencies. @*Results@#A total of 136 doses were issued out of which 111 doses were administered from November 2017 till October 2020. The maximum number of travelers was young adults (26.1%). In 83.7% of cases, the area of the visit was Africa. The vaccine wastage rate was 18.4%. @*Conclusion@#The vaccine wastage rate was not very high and was within that recommended for vaccines in routine immunization.

Evaluation and identification of medication errors in diabetic and general medicine departmentof Chandka medical College hospital Larkana

Objective: To assess and find out the events of medication errors and to classify the medication error in the diabetology and general medicine department.

Study Design: The longitudinal cohort prospective observational study

Place and Duration of Study: Diabetes and general medicine department of Chandka Medical College Hospital larkana from Jan 2017 to May 2017

Material and Methods: Data was gathered from 1255 prescriptions of both inpatient and outpatient department of diabetology and general medicine after ensuring the ethical approval. This prospective observational study was made in tertiary care chandka medical college hospital larkana

Results: Male 730 [58.10 percent] and 525 [41.8 percent] Females and medication error recorded was 513 to both genders .In male 289 [56.3 percent] errors and in females 224 [43.7 percent] prescriptions were found

Conclusion: From the present study the conclusion can be made that there is huge ratio of medication error in practice and the possible contributors of medication deviation are incorrect dosage forms, incorrect strengths, lack of diabetes counseling and others. Pharmacist is the key role to prevent such errors

Proliferative index and p53 expression in breast carcinoma and their correlation to clinico-pathological parameters

Background: Breast cancer is the most frequently diagnosed cancer and the most common cause of cancer deaths in women worldwide. Ki67 is a biomarker that reflects cell proliferation. Despite a clear understanding of the structure and properties of this protein, its functional role remains elusive. Gene expression alteration confers the potential for invasive growth in the preinvasive stages of breast cancer. Altered expression of the tumor suppressor gene p53 is frequently seen in carcinomas of the breast and correlates with poor prognosis. This study aims to investigate Ki67 and p53 expressions in benign, preinvasive and invasive breast lesions and to correlate their expressions with the clinico-pathological parameters

Materials and Methods: This study included 74 specimens of breast lesions. Ki67 and p53 immunostaining expression was detected using avidin-biotin peroxidase method

Results: Ki67 and p53 increased progressively along the continuum of neoplastic changes from normal breast epithelium to invasive ductal carcinomas; IDC [P<0.000 and 1:1<0.01 respectively]. There was significant positive correlation between Ki67-labeling index [LI] and either tumor grade or lymph node metastasis in IDC [11<0.03 and P<0.02 respectively]. P53 expression increased with increasing grade of both ductal carcinoma in situ [DCIS] and IDC [P<0.01 and P<0.002 respectively]. There was significant correlation between p53 and tumor size, lymphovascular invasion, and lymphocytic infiltration [P<0.05, P<0.02. P<0.03 respectively]. There was positive correlation between Ki67 and p53 in both DCIS [r= 0.845, P<0.001] and in IDC [r-0.697, P<0.02] of the breast

Conclusion: Ki67 and p53 increased progressively along the continuum of neoplastic changes from normal breast epithelium to DCIS and IDC. Ki67 and p53 were increased with poor prognostic parameters; tumor size, tumor grade, lymphovascular invasion, lymphocytic infiltration, and lymph node metastasis

Correlation of micro vessel density [MVD] and proliferation index [PI] with clinico-pathological parameters in breast carcinoma

Background: One of the greatest challenges in breast cancer management is to accurately predict the outcome for each patient. Microvessel density [MVD] correlated closely with increasing number of tumor cells shed into the bloodstream and development of metastasis. Because proliferation status closely correlates with tumor aggressiveness, proliferation index [PI] is considered as an established prognostic marker for various tumors. We aimed to: 1. Study WVD and PI by assessing immunohistochemical profiles of CD31 and Ki67 respectively and their probable role in breast cancer progression. 2. Assess values of CD31 and Ki67 in relations to clinico-pathological prognostic parameters

Subjects and methods: Immunostaining was done to detect CD31 and Ki67 expressions in 74 specimens of breast lesions

Results: Both CD31 and Ki67 increased progressively along the continuum of neoplastic changes from normal breast epithelium to invasive ductal carcinomas; IDC [P<0.000 for each]. CD31 expression was positively correlated with minor size [p< 0.04], increasing grade [P<0.01], lymphovascular invasion [p<0.01] and lymph node metastasis [P< 0.05] in IDC. There was significant positive correlation between Ki67 expression and increasing grade [P<0.03] and lymph node metastasis [P<0.02] in IDC. Positive correlation was present between Ki67 and CD31 in ductal carcinoma in situ [DCIS] and in IDC [P<0.02 and P<0.001 respectively]

Conclusion: Our findings indicate that aggressive tumors are more capable of angiogenesis and proliferation which are poor prognostic signs in IDC. These findings might open the door for new therapeutic strategies to prevent progression of DCIS to IDC

Immunohis1ochemical cyclooxygenase-2 [COX-2] and cd31 expression in breast carcinoma with correlation to clinico-pathological parameters

Breast cancer is the most'common cancer in Egyptian women. COX-2 seems to be involved in malignant transformation and tumor progression by affecting cell proliferation, mitosis, cell adhesion, apoptosis, immune surveillance, and angiogenesis. Angiogenesis is an important key step in tumor progression. Microvascular density [MVD], a surrogate marker of angiogenesis can be assessed by CD31 staining. This study aims to: 1. Evaluate COX-2 and CD31 expressions in breast cancer. 2. Determine the correlation between COX-2 and CD31 with the clinico-pathological parameters in ductal breast carcinoma. This study included 74 specimens of breast lesions. Patient's age, tumor size and local aggressive changes, history of recurrence and/or presence of distant metastasis were obtained. Hematoxylin and Eosin [HandE] stained sections were evaluated for histopathological tumor type, tumor grade, presence or absence of normal hyperplastic, in situ component, lymphocytic infiltration, lymphovascular invasion, and axillary lymph node status. COX-2 and CD31 immunostaining was done to detect their expression using the avidin-biotin peroxidase method. COX-2 increased with increasing grade of ductal carcinoma in situ [DC1S] and invasive ductal carcinomas [IDC] [P< 0.05 and P< 0.002 respectively]. COX-2 expression increased progressively along the continuum of neoplastic changes from normal breast epithelium to IDC [P< 0.01]. There was significant correlation between COX-2 and tumor size [P< 0.05], tumor grade [P< 0.002], lymphovascular invasion [P< 0.03] and lymph node metastasis [P< 0.02]. CD31 staining was observed along the cell membrane of endothelial cells of microvessels in all breast specimens. The median CD31 MVD count was 10 for normal breast, increased insignificantly to 17 in hyperplastic lesions, and reached 19 for DCIS, and 66.5 in IDC [P < 0.000]. There was significant increase in MVD between different grades of IDC [P < 0.01] but not in DCIS. Positive correlation was present between COX-2 and CD31 in DCIS and in IDC [P< 0.000 for each]. COX-2 was increased with poor prognostic parameters; tumor size, tumor grade, lymphovascular invasion and lymph node metastasis. CD31 increases with increasing grade of IDC. These findings might imply for new therapeutic strategies in order to prevent progression of DCIS to IDC and to improve cancer therapy

Evaluation of some histochemical and immunohistochemical criteria of round cell tumors of bone

The differential diagnosis of round cell tumors of bone [RCTB], Ewing sarcoma, smallcell osteosarcoma, mesenchymal chondrosarcoma, osteoblastoma, chondroblastoma, primary bone lymphoma, and multiple myeloma still remains a challenge. Given the significant differences in treatment, an accurate diagnosis is crucial. This study aimed to evaluate some histochemical and immunohistochemical criteria of RCTB. Periodic acid-Schiff [PAS], CD99, CD138, osteocalcin, and leukocyte common antigen [LCA] were evaluated in 113 patients with RCTB. PAS was positive in neoplastic cells of all Ewing sarcomas, 27% of osteosarcomas, 92% of chondrosarcomas, all osteoblastomas and chondroblastomas, and the osteoid tissue of all osteosarcomas and osteoblastomas. CD99 was positive in all Ewing sarcomas, in 11, 4, and 11% of osteoblastomas, multiple myelomas, and bone lymphomas, respectively. CD99 was higher in Ewing sarcoma than in other RCTB [Po0.0001]. Osteocalcin was positive in neoplastic cells of all osteosarcomas, osteoblastomas, and 20% of chondroblastomas, 84, and 78% of osteoid of osteosarcomas and osteoblastomas, respectively. CD138 was positive in all multiple myelomas, 12% of Ewing sarcomas, 20% of osteosarcomas, 44% of osteoblastomas, 8% of chondrosarcomas, and 40% of chondroblastomas. CD138 was higher in multiple myeloma [Po0.0001] than in other RCTB. LCA positivity was higher [Po0.01] in bone lymphomas [100%] than in multiple myelomas [73%]. PAS negativity excludes multiple myeloma and bone lymphoma from other RCTB that could be differentiated by LCA and CD138. CD99 positivity confirms the diagnosis of Ewing sarcoma. PAS could detect areas of osteoid in osteosarcoma and osteoblastoma. Osteocalcin suggests an osteogenic tumor origin: osteosarcoma/ osteoblastoma. Double negativity of CD99 and osteocalcin suggests a chondrogenic tumor origin: chondrosarcoma/chondroblastoma

A CHILD WITH EPISTAXIS, REDUCED HEARING AND CERVICAL LYMPHADENOPATHY: A RARE CASE OF NASOPHARYNGEAL CARCINOMA IN A CHILD

Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.

Testicular abscess caused by salmonella para-typhi

This case is the first report of a bacteriologically proven testicular abscess in a child caused by Salmonella paratyphi 'A' in Pakistan that clinically simulates a testicular tumour. The case also emphasises that a course of 2 weeks antibiotic is sufficient for testicular abscess if complete surgical debridement is done. Keywords: Salmonella paratyphi 'A', Testicular Abscess, Tumour

Serum prohepcidin, iron and hepatic iron status in chronic hepatitis C in Egyptian patients

Patients with chronic hepatitis C [CHC] often have increased liver iron. Hepcidin has recently emerged as a key regulator for iron homeostasis. Therefore, we aimed to study the relationship between serum prohepcidin, serum iron indices, hepatic necro-inflammation, fibrosis and hepatic iron density and to determine the predictors of advanced fibrosis in these patients. Fifty CHC treatment naive patients and 20 healthy controls were enrolled in this study. Complete blood count, liver function tests, serum iron indices and serum prohepcidin were assayed. Liver biopsy was performed for all patients for assessment of necro-inflammatory activity, fibrosis and liver iron density. Thirty-four patients [68%] had mild fibrosis [stage 0, 1,2] and sixteen [32%] had advanced fibrosis [stage 3, 4]. All cases were positive for liver iron stain [68% mild, 32% advanced]. Mean serum prohepcidin level was significantly lower in CHC patients than healthy controls. In univariate analysis, prohepcidin was significantly associated with necro-inflammatory activity [P<0.05] and advanced fibrosis [P<0.05]. Multivariate analysis revealed that necro-inflammatory activity and liver iron density arc independently associated with stage of fibrosis. No significant correlations were found between prohepcidin and serum iron indices or liver iron score. Scrum prohcpcidin is reduced in CHC which may be one -not the only- factor leading to iron overload in these patients. Histological grading and hepatic iron density are independent predictors of advanced fibrosis. Further studies are needed to clarify the role of viral and host genetic factors in hepatic iron deposition

Immunohistochemical study of inducible nitric oxide synthase [iNOS] in peritoneal Tuberculous granuloma

Nitric Oxide [NO] is important in host defense against Mycobacterium tuberculosis in rodents, but the presence of high-output NO production in human tuberculosis has been controversial. This study aimed to investigate iNOS expression by peritoneal macrophages in TB peritonitis and to gain insights into the structural properties of peritoneal TB granuloma. Peritoneal biopsies were obtained from 28 undiagnosed cases of ascites and examined histopathologically by H and E stain. Accordingly, specimens proved to be TB peritonitis were then immunohistochemically stained for iNOS, the macrophage marker CD68 and CD3 and CD20 as markers of T and B lymphocytes respectively. Eight control cases of normal peritoneum were included. TB peritonitis was diagnosed in 16 cases. TB granulomas were found in 9/16 cases [56%] and a diffuse granulomatous reaction was found in the remaining7/16 cases [44%]. Immunoreactivity to iNOS and CD68 were intensely expressed in macrophage rich TB granuloma and in the diffuse granulomatous TB reaction. Most Langhans cells [multinucleated giant cells] showed strong reactivity to both CD68 and iNOS. In TB granuloma, CD3[+] cells were found at the periphery with few CD20[4] cells in its center. Control cases showed complete negativity for iNOS, CDS, very small number of CD68 and/or CD20 cells. In TB peritonitis, an increased local expression of iNOS in granuloma associated macrophages of untreated patients indicating excess NO production in the active stage of this form of Tuberculosis. Further studies are needed to test the therapeutic implications of NO in different forms of TB

Expression of adhesion molecule CD44V6 in salivary gland tumors

Salivary gland tumors are a morphologically and clinically diverse group of neoplasms which may present significant diagnostic and management challenges. Cell adhesion molecules [CAMs] are glyco-proteins that are present on the external surface of the cell membrane. CD44 is a cell adhesion molecule belonging to systemic IgCAMs family, and is remarkable for its ability to generate alternatively spliced forms, many of which differ in their activities. This remarkable flexibility has led to speculation that CD44, via its changing nature, plays a role in some of the methods that tumor cells use to progress successfully through growth and metastasis. To investigate the expression of CD44v6 in different types of salivary glands tumors and to correlate the results with some established prognostic factors. Sixty cases were studied. 21 were pleomorphic adenomas,, 9 Warthin's tumors, 6 monomorphic adenomas, 9 mucoepidermoid carcinomas, five adenoid cystic carcinomas, in addition to 10 normal controls. Clinical data were obtained from the referring clinical departments. The biopsy specimens were obtained by excision, true cut needle biopsy, or punch biopsy. Cases were selected by reviewing the hematoxylin and eosin [H and E] stained slides. Immunohistochemistry was done using the CD44v6 mouse monoclonal antibody raised against human species. CD44v6 was +ve in 46/60 [76, 7%] of salivary gland tumors studied; 35/40 [87.5%] benign salivary glands tumors and 11/20 [55%] malignant salivary gland tumors and this difference was statistically significant [P < 0.01]. CD44v6 was +ve in 16/21 [76%] of pleomorphic adenoma, in 9/9 [100%] of Warthin's tumors and in 6/6 of monomorphic adenoma. CD44v6 was +ve in 5/ 9 of mucoepidermoid carcinoma; 4/5 [80%] of low and intermediate grade mucoepidermoid carcinoma and in 1/4 [25%] of high grade malignant mucoepidermoid carcinoma. The 4 studied high grade malignant mucoepidermoid carcinoma were lymph node metastasis +ve. CD44V6 was +ve in 4/5 [80%] of adenoid cystic carcinoma. There was a statistically significant decrease in CD44v6 positivity [P < 0.03] in high grade malignant salivary gland tumors compared to low and intermediate grade tumors. There was also a statistically significant decrease in CD44v6 positivity [P < 0.01] in malignant salivary gland tumors received with lymph node metastasis compared with those lymph node metastasis negative cases. 1] Down regulation of CD44v6 plays an important role in malignant transformation of salivary gland tumors. 2] The degree of down-regulation is correlated, with progression towards higher grades and also with lymph node metastasis

Role of apoptosis proteins survivin, BAX and BCL-XL in laryngeal squamous cell carcinoma progression

We used immunohistochemistry to investigate a potential role of SVV as an early predictor of malignant transformation in precancerous and cancerous lesions of the larynx, we also sought to examine the expression of Bcl-X[L] and Bax in laryngeal SCC analyze the relationships between their expression and prognostic factors including site, histological grade, clinical staging and lymph node metastasis. This study included 6 normal laryngeal mucosae, 7 dysplastic laryngeal epithelia, 5 in situ laryngeal carcinomas, and 32 hiopsied laryngeal SCC. Clinical evaluation was done. Specimens were forma I in-fixed, paraffin-embedded, stained with H and E, classified and graded according to WHO classification, [2005] and immunostained to detect Survivin and Bcl-X[L]. and Bax proteins using the avidinbiotin peroxidase method. Survivin expression gradually increased significantly 'with advance of laryngeal carcinoma through the sequence of dysplasia, in situ carcinoma and infiltrating carcinoma [P < 0.04]. There is a statistically significant increase in Survivin expression with increasing tumor grade [P < 0.03] and with advance in clinical staging [P < 0.01]. Regarding lymph node metastasis SVV was more expressed in laryngeal SCC exhibiting lymph node metastasis [P < 0.02]. Bax expression was decreased significantly in infiltrating laryngeal carcinoma [P < 0.04] compared with premalignant lesions of the larynx. In contrast, Bcl-X[L] was increased significantly with the advance of laryngeal. carcinoma through dysplasia, carcinoma sequence [P < 0.02]. There was no statistically significant difference in either Bax or Bcl-X[L] expression considering tumor differentiation, advanced clinical staging or lymph node metastasis. Survivin plays cm important role in the initiation of laryngeal cancer and its progression towards higher grades, invasion and metastasis. Bax and Bcl-X[L] play their role early in cancer initiation but have nothing to do as the tumor progresses to higher grades, infiltrates deeply, or giving lymph node metastasis

Role of survivin in glioma progression: a clinico-pathological study

Gliomas are among the most aggressive of all human malignancies. Glioblastoma multitbrme is the most malignant histopathological subtype. Survivin is one of the inhibitors of apoptosis. It is over-expressed in many human cancers. We performed clinical and pathological study aimed to clarify its role in glioma progression. Gliomas are among the most aggressive of all human malignancies. Glioblastoma multiforme is the most malignant histo-pathological subtype. Survivin is one of the inhibitors of apoptosis. It is over-expressed in many human cancers. We performed clinical and pathological study aimed to clarify its role in glioma progression. This study included 34 glioma patients. Clinical evaluation including age, sex, clinical presentation and location of the tumor, was done. Sections from glioma specimens were stained with H and E, classified and graded according to WHO classification, [2000] and then immunostained to detect Survivin protein expression. The study included 34 glioma cases. Survivin was expressed to a variable extent in most groups of gliomas [in 21/24, 1/4, 1/1 and 5/5 cases of astrocytomas, oligodendrogliomas, mixed oligoastrocytoma and ependymomas respectively]. Survivin expression showed gradual up-regulation with increasing grade of astrocytomas from pilocytic astrocytomas [66.7%] [right arrow] diffuse astrocytomas [77.8%] [right arrow] anaplastic astrocytomas [100%] [right arrow] glioblastoma multiforme [100%]. This study showed that there is a strong correlation between the distribution and staining intensity of Survivin protein expression and the tumor grade [P< value< 0.01 and < 0.00 respectively]. Also there is a strong correlation hetueen Survivin protein expression as evidenced by immunoreactivity score [IRS] and tumor grade and proliferative activity [P value< 0.00 and <0.002 respectively]. Survivin plays an important role in the initiation of gliomas and their progression towards higher grades

Immunohistochemical study of INOS in peritoneal tuberculous granuloma

The human tuberculous granuloma provides the morphological basis for local immune processes central to the outcome of tuberculosis. Nitric Oxide [NO], produced by the inducible nitric oxide synthase [INOS], is important in host defense against Mycobacterium tuberculosis in rodents, but the presence of high-output NO production in human tuberculosis has been controversial. Because of the scarcity of information in human patients especially in peritoneal tuberculosis, the present study aimed to: 1-investigate iNOS expression by peritoneal macrophages in TB peritonitis. 2- gain insights into the structural properties of peritoneal TB gronuloma. Laparoscoy was done for 28 patients with undiagnosed ascites and peritoneal biopsies were obtained and examined histopathologically by H and E stain. Accordingly, specimens proved to be TB peritonitis were then iminunohistochemically stained for iNOS, the macrophage marker CD 68 and CD 3 and CD 20 as markers of T and B lymphocytes respectively. Eight Control cases of peritoneum removed with surgically excised organ specimens [e.g. with excised tumors] were included. TB peritonitis was diagnosed in 16 cases. TB granulomas were found in 9/16 cases [56%] and a diffuse granulomatous reaction was found in the remaining 7/16 cases [44%]. Immunoreactivity to iNOS and the macrophage marker CD 68 were intensely expressed in macrophage rich TB granuloma and in the diffuse granulomatous TB reaction. Most Langhans cells [multinucleated giant cells] showed strong reactivity to both CD 68 and iNOS. The expression intensity of iNOS and/or CD 68 was stronger in diffuse and premature-stage granulomas than in late-stage granulomas [caseating granuloma]. In TB granuloma, CD 3 cells were found at the periphery with few CD 20[+] cells in its center. While in diffuse granulomatous TB reaction, CD 3[+] lymphocytes were diffusely dispersed in the lesion with few CD 20[+] lymphocytes. Control cases showed complete negativity for iNOS, CD 3, very small number of CD 68 and/or CD 20 cells. In TB peritonitis, the distribution of different immune cells in the granuloma is similar to that described in pulmonary TB granulomas. An increased local expression of iNOS in granulomas associated macrophages of untreated patients indicating excess NO production in the active stage of this form of Tuberculosis. Further studies are needed to test the therapeutic implications of NO in different forms of TB

Immunohistochemical analysis of the immune cells in bilharzial granuloma of the urinary bladder

Urinary bilharziasis represent a major health problem in Egypt. It is characterized by the formation of localized collection of immune cells i.e. granulomas. In this investigation, we hypothesized that the evolution of the bilharzial ganuloma is associated with recruitment of immune cells of diverse cell lineage. To explore this hypothesis and to fill this existing gap in the literature, We carried out this investigation. Granuloma cell population was immunohistologically examined in thirty cases of cellular bilharzial granulomas using immunoperoxidase staining methods and antibodies targeting antigens for B cells [CD20]. T cells [CD3]. Histiocytes [CFD68] and cytotoxic T cells [Granzyme B]. The mean values of positive cells in the cellular bilharzial granulomas were: 45.5 +/- 5.6 for CD68 cells: 14.8 +/- 1.1 for CD3 T cells; 9.1 +/- 1.1: for CD20 B cells and 1.5 +/- 0.8: for Granzyme B T cells with cytotoxic activity. The numerical dominance of CD68 cells suggests their critical role in the evolution of these lesions. Our study was the first to report immunophenotypic profile of the bilharzial grnauloms

Inflammatory bowel disease: diagnostic and therapeutic modalities

Inflammatory bowel disease [IBD] is chronic conditions of unknown origin that result from continuous or intermittent inflammation of a part of the intestinal wall. The main classic types of IBD are ulcerative colitis [UC], Crohn's disease [CD] and indeterminate colitis that cannot be classified accurately as UC or CD with pure colonic involvement. The aim of this study is to highlight this rare disease in our locality including; clinical feature, investigations, indication of surgical interference, operative procedures, histopathological examination, and postoperative complications. Twenty nine patients were included in this study from January 2000 to May 2006. Histopathological examination proved to be UC in 18 patients and CD of the intestinal tract in 11 patients. Patients were subjected to history, tarnsclinical examination, and routine laboratory investigation, abdominal X-ray in an erect position, barium enema, intravenous urography, sigmoidoscopy and colonoscopy. Biopsy was taken, and CT and MRI were done in selected cases. All patients subjected to medical and/or surgical treatment according to their finding. Their mean age was 49.4 +/- 2.1 years [range 12 -65 ys]. Female to male ratio was 2:1. The main clinical manifestations were abdominal pain in 27 patients [93.1%], bleeding per rectum in 14 patients [48.3%], mucus discharge in 10 patients [34.5%], and chronic diarrhea in 6 patients. Palpable abdominal mass was found in 3 patients. Extra-abdominal manifestations were loss of weight in 15 patients [51.7%], pallor in 11 patients [37.9%], lower limb edema in 7 patients and skin changes 4 patients. Twenty three patients [79.3%] were received medical treatment; 18 patients [62.1%] UC and 5 CD but the remaining 6 patients [20.7%] admitted to emergency department. Successful treatment with complete cure was achieved in 12 patients [41.4%]; 10 patients had UC and 2 CD while surgery was done in 17 patients [58.6%]; 9 patients had CD and 8 UC. Right hemicolectomy was done for 7 of them and limited resection anastomosis was performed in the other 2 patients. Total colectomy with terminal ileostomy was carried out in one patient and subtotal colectomy with ileorectal anastomsis in 7 patients. Postoperative intestinal fistula detected in one patient and right hemicolectomy was done. Wound infection occurred in 3 patients and one of them developed burst abdomen. IBD is not rare in our locality and its treatment still remains the challenge despite growing knowledge about the disease, advances in medical treatment and surgical techniques. Proper assessment of IBD requires cooperation of gastroenterologists, radiologists, histopathologists and surgeons