BRCA1 promoter methylation & its immunohistochemical correlation in sporadic breast cancer

Background & objectives: Studies have shown that apart from hereditary breast carcinomas, breast cancer susceptibility gene 1 (BRCA1) mutations conferring to its loss are seen in sporadic breast carcinomas (SBC) as well. The aim of the present study was to assess BRCA1 methylation in females presenting at King George’s Medical University, Lucknow, with SBC by both immunohistochemistry (IHC) and methylation PCR with respect to hormonal profile and various morphological prognostic parameters. The primary objective was to look for the association between BRCA1 protein expression and DNA promoter methylation. Methods: 81 mastectomy specimens from SBC of invasive breast carcinoma (no special type) were included in this study. After a detailed morphological assessment, formalin fixed paraffin embedded tissue from a representative tumour area was selected for BRCA1 IHC by heat-mediated antigen retrieval under high pH and DNA extraction and further bisulphate treatment. BRCA1 was studied for methylation by methylated and unmethylated PCR-specific primers. Results: BRCA1 promoter methylation was present in 42/81 (51.9%) participants, with significant BRCA1 protein loss (72.7%; P=0.002). A significant association between BRCA1 loss and hormonal profile was found (P=0.001); maximum in triple negative breast carcinoma (TNBC) (72%; 18/25). Most of the TNBC also harboured methylation (68%). Although not significant grade II and III tumours, lymph vascular invasion, ductal carcinoma in situ, and nodal metastasis (?3) were seen in a higher percentage in methylated tumours. Mortality in SBC was significantly associated with BRCA1 loss (30.3%; P=0.024). Interpretation & conclusions: Study results highlight the concept of “BRCAness” in SBC as well. Hence, we can confer that identification of BRCA1 loss in SBC can make it a perfect candidate for poly ADP- ribose polymerase inhibitors or cisplatin-based therapy like hereditary ones.

Cow’s Milk Protein Allergy in Children - A Case Study

Now days due to lactation failure cow milk is the first choice for an infant and accordingly is one of the first and most common causes of food allergy in early childhood. Cow milk allergy is the allergy to the protein (casein and whey protein) in cow milk. It is the leading cause of food allergy in infants and early childhood (less than 3 years). This review summarizes current evidence and recommendations regarding cow milk protein allergy (CMPA), the most common food allergy in young children, for the parents with incidence estimated as 2% to 7.5% in the first year of life. In classics, it has been mentioned that cow milk should always processed with Laghupanchmoola before it is consumed. There is no treatment for this disease in modern science as well as in Ayurveda, so there is a need to find a safe and effective remedy in the management of CMPA. A 1-year old male patient was brought to Out Patient Department of Kaumarabhritya, Rishikul campus UAU Haridwar Uttrakhand, with complaints of loose motion and vomiting after cow’s milk intake. These complaints were persisting for the past 20 days. After that he gradually developed abdominal pain for 10 days. This condition can be understood as CMPA treatments including Laghupanchmoola granules with cow milk, course of 2 months. There were significant improvements in the condition of the patient.

Correlation of age with Lung Function in Asthmatics

Background: Bronchial asthma has grown to be one of the major chronic health problem. The present study was conducted to assess correlation of age with lung function in asthmatics. Methods: The present study was conducted on 60 asthmatic patients of both genders. Patients were divided into 3 groups of 20 each. Group I were controlled asthmatics, group II had partly controlled and group III had uncontrolled asthmatics. In all patients, lung function tests were performed. Results: In age group 20-30 years had 12, group II had 10 and group III had 11 patients. Age group 30-40 years had 8 in group I, group II had 10 and group III had 9 patients. There was significant difference in FEV1 (L), FVC (L), FEV1/FVC and PEFR/Sec in all groups and in different age groups (P< 0.05). Conclusion: Authors found positive correlation of lung function test and age in uncontrolled asthmatics.

Clinicopathological and immunohistochemical analysis of Sarcomatoid carcinoma of head and neck mucosal region: a retrospective analysis

Background: Sarcomatoid carcinoma is a biphasic tumour comprising both of malignant epithelial and mesenchymal elements derived monoclonally from same stem cells. These are unusual variants of squamous cell carcinoma and constitute less than 1% of the head and neck mucosal tumors. Only few studies have been published and needs more understanding to establish treatment guidelines. The aim of this study was to review the cases of carcinosarcoma arising from mucosal sites of head and neck and study their clinical, histological and Immunohistochemical features.Methods: Retrospective data and slides of histologically proven sarcomatoid carcinoma over a period of thirty -four months between January 2016 - October 2018 were retrieved and evaluated for various clinical and histopathological parameters.Results: Total of 22 cases were included in the study and the mean age of presentation was 58years with male: female ration 2:1. Most of the patients (81.8%) presented with a mass lesion of less than 6 months duration. The most common site was oral cavity (68.1%) followed by larynx (22.7%). Clinical stage was known in eleven cases. One case presented with pulmonary metastasis. Histopathologically, epithelial differentiation was identified in nine cases (41%) on morphology and in thirteen cases could be highlighted by cytokeratin positivity. The Mesenchymal component was arranged in sheets (63.7%) and fascicles (31.8%). Marked anaplasia and brisk mitosis wereseen in 54.5% and 19.3% respectively.  On immunohistochemistry all 22 cases were positive for Vimentin, twenty cases were positive for cytokeratin/EMA and aberrant mesenchymal markers were expressed in 10% of cases.  Follow up was available in eighteen cases out of which fourteen cases died within one year of diagnosis.Conclusions: Diagnosis of sarcomatoid carcinoma is challenging especially on small biopsy because of overlapping features with other spindle cell tumors. Understanding the clinicopathological features facilitates their diagnosis and effective clinical management.

Assessment of Renal Profile in Liver Cirrhosis Patients: An Observational Study

Background: In patients with liver cirrhosis, renal function hasimportant prognostic impact along with hepatic function.Hence; we planned the present study to assess renal profile inliver cirrhosis patients.Materials & Methods: A total of 40 liver cirrhosis patients wereincluded in the present study. A total of 40 age and gendermatched healthy controls were also included in the presentstudy as study group. Mean serum creatinine levels and bloodurea levels were assessed using an auto-analyzer.Results: Mean serum creatinine levels of the subjects of thestudy group (38.13 mg/dl) were significantly higher thansubjects of the control group (21.25 mg/dl). Blood urea levelsof the subjects of the study group (1.98 mg/dl) weresignificantly higher than subjects of the control group.Conclusion: Liver cirrhosis is significantly associated withaltered renal profile.

A Comparative Evaluation of Ondansteron and Granisteron with Dexamethasone Combination in Prevention of Nausea and Vomiting Following post Operative Laparoscopic Cholecystectomy

ackground: Post operative nausea and vomiting (PONV) have been considered among most distressing symptoms after surgery under anaesthesia. Different combinations of anti-emetic drugs have been used but no drug has achieved 100% efficacy in reducing PONV after laparoscopic surgery. Therefore, the present study was designed to assess if there is any effect of granisetron and ondansetron with dexamethasone in prevention of PONV after general anaesthesia for laparoscopic cholecystectomy. Methods: The study population was divided into three groups according to introduced combination of drugs. Group I (n=50), group II (n=50) and group III (n=50) were introduced Ondansetron (4mg) & Dexamethasone 8mg, Granisetron (1mg) & Dexamethasone 8mg and Normal saline & Dexamethasone 8mg respectively. VAS scale from 0-10 was used to assess the intensity of pain after operation. PONV scoring system considering 0 as no nausea, 1 as nausea and 3 as vomiting was incorporated in this study. Results: The incidence of PONV (score-1,2,3) are tabulated at intervals of 6 hours and complete response was noted in all three groups. There was no statistical difference observed between group I and II in first 24 hours but significant difference was observed between group I, group II and control group III. Complete response score 96%, 98% and 56% respectively for group I, group II and group III correspondingly after at 6 to 12 hours. Conclusion: Findings of the present study suggest that PONV was significantly decreased in group I ondansetron & dexamethasone and group II of granisetron & dexamethasone. Therefore, we strongly suggest that combination of dexamethasone either with ondansetron or granisetron are equally effective in decreasing incidence of PONV in laparoscopic cholecystectomy patients as prophylaxis.

A Morphometric Study Of Body And Vertebral Canal Of Thoracic Vertebrae & Its Clinical Significance

Introduction: Accurate anatomical descriptions of the size, shape and orientation of the main structures of thehuman vertebrae and intervertebral discs are necessary for a variety of approaches and objectives such as theidentification of clinical situations that are related to the morphometry of the spine structures, such as theincidence of low-back pain related to the spinal canal size. So the present study was done to measure the variousmorphometric parameters of thoracic vertebral body and neural canal.Materials and Methods: Total 100 sets of dry human thoracic vertebra were obtained. These are of unknown ageand sex. All Morphometric parameters were measured by digital Vernier caliper of accuracy of 0.01mm. Anteriorheight of the body (VBAH), Posterior height of the body (VBPH), Antero-posterior Diameter of Vertebral body(VBAPD), Transverse Diameter of Vertebral body (VBTD), Anteroposterior diameter of Vertebral Canal (VCAPD) andTransverse diameter of Vertebral Canal (VCTD). All parameters were entered into excel sheet and analysis wasdone by SPSS.Results: Mean VBAH ranged from 13.17+1.35mm (T1) to 17.92+2.25mm (T12), mean VBPH from 15.01+1.27mm(T1) to 20.92+4.58mm (T12), mean VBAPD ranged from 11.62+1.96mm (T1) to 18.12+5.71mm (T12), mean VBTDfrom 24.28+5.68mm (T1) to 28.59+5.97mm (T12), mean VCAPD ranged from 12.46+1.30mm (T1) to 16.05+2.41mm(T12) and VCTD from 17.15+2.19mm (T1) to 20.11+3.74mm (T12).Conclusion: The results of the present study may help in designing implants and instrumentations; understandingspine pathologies; and management of spinal disorder

Accessory Infraorbital Foramen And Morphometric Localization Of Infraorbital Foramen In North Indian Region.

Abstract: Background: Aim of present study was to note the frequency of accessory infraorbital foramen in north Indian population and to determine the distance of infraorbital foramen from various anatomical landmarks in adult dry human crania. Methodology: 64 adult north Indian dry human crania of unknown age and gender were analysedfor the presence ofaccessoryinfraorbital foramen and their unilateral or bilateral prevalence was calculated.Shortest distance between the infraorbital foramen from midline, pyriform margin, nasion, infraorbital margin, anterior nasal spine and frontozygomatic suture was measuredon both sides in each craniawith Vernier caliper accurate to 0.1 mm for linear measurement.Observations thus made were compiled and tabulated followed by comparison using appropriate statistical tests. Results: Prevalence of accessory infraorbital foramen is 7.81%, while bilateral prevalence of accessory infraorbital foramen is only 1.56 %, however unilaterally accessory infraorbital foramen is present in 6.25% (2.34 % on right side and 3.9 % on left side). Mean shortest distance of infraorbital foramen from midline was 34.78 ± 3.19mm, while mean shortest distance between the infraorbital foramen to the pyriform margin was 21.26 ± 2.78 mm.Mean shortest distance of infraorbital foramen to the nasion andinfraorbital marginwas 44.95 ± 4.62mm. and 6.58 ± 1.59 mm respectively.Mean shortest distance of infraorbital foramen to the anterior nasal spine and frontozygomatic suture was 36.63 ± 3.16mm.and 35.62 ± 1.98 mm respectively. Conclusion: The knowledge of the distances from surgically encountered anatomic landmarks may be of assistance in locating these important maxillofacial neurologic structures during many procedures. Understanding the location of these foramina will also assist the clinician in performing local anesthetic blocks.

Variations of Mastoid Foramen in North Indian Population.

Background: Non metric cranial variants have always been a topic of considerable interest for research workers, as they possess racial, regional and sex dimorphic differences. These variants are also of anthropometric, genetic, morphological and forensic importance. Material and Methods: 71 skulls from north indian region were studied to analyse the prevalence of variations in number and location of mastoid foramen and to draw significant inferences. Results: Prevalence of absent mastoid foramen is 5.19%, while bilateral prevalence of absent mastoid foramen is only 1.29%, however unilaterally mastoid foramen is absent in 3.9%. Prevalence of single, double, triple and quadruple mastoid foramina was 75.97%, 19.48%, 1.95% and 2.6% respectively. Amongst all mastoid foramina in 71 skulls, 23.38% foramina were exsutural, out of which 20.13% were present on temporal bone and 3.25% were present on occipital bone. Conclusions: Findings are discussed and compared with other global studies and are found to be of considerable racial and regional significance. Knowledge of this variant can be valuable in some neurosurgical procedures.