Association of lymphovascular invasion with metastasis (loco-regional lymph node or distant) among adult Filipino patients with papillary thyroid carcinoma: A case control study

Background/Objective@#Papillary thyroid carcinoma is the most common type of thyroid cancer. Treatment includes surgery and remnant ablation with radioactive iodine theraphy while follow-up monitoring includes I- 131 whole body scans land thyroglobulin monitoring. Lymphovascular invasion (LVI) has been used as a predictor of metastasis in different cancers. Therefore, it might be useful in predicting metastasis in patients with papillary thyroid carcinoma since metastasis in this type of carcinoma travels via the lymphatic route. The purpose of this study was to determine the association of LVI with metastasis among patients with papillary thyroid carcinoma@*Methodology@#Records of patients with papillary thyroid carcinoma (histopathologic reports, thyroglobulin levevls and I-131 whole body scans) were reviewed. Univariate and multivariate anlyses were performed. @*Results@#A total of 108 subjects were recruited for this study, 47 (43.5%) of which had LVI. There was no association found between LVI and metastasis on baseline (p=0.72) and follow-up scans (p=0.07). However, there was an association between metastasis resolution on follow-up scans and high-dose radioactive treatment (p=0.02) regarless of presence or absence of LVI.@*Conclusion@#There was a significant association of the presence of LVI with elevated thyroglobulin levels (p-value<0.0001). A significant association was also seen with LVI and dose of activity with resolution of thyroid remnant, locoregional lymph node and distant metastasis (p=0.02). Even though no association jwas seen between LVI and metastasis, a robust percentage of patients with LVI were positive for metastasis on whole body scans.

Comparative study of the effectiveness between balancing exercises and strengthening exercises with common use of TENS to improve functional ability in Osteoarthritis involving knee joint.

Background and purpose: People with knee Osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. Proprioception and balance are important aspects of osteoarthritis treatment because of their strong correlation with function in the knee. The purpose of this study is to evaluate the effects of balancing exercises and strengthening exercises to improve functional ability in knee osteoarthritis patients and also it may be helpful to identify the use of best treatment protocol for OA knee. Material and methods: Thirty OA knee patients randomly allocated into two groups and received either balancing exercises (Group A) or strengthening exercises (Group B). Both the groups received TENS and taken treatment for 4 days a week for 4 weeks. The outcome measures were VAS and WOMAC. VAS was used to measure intensity of knee pain and WOMAC was used for assessment of perceived pain, stiffness and functional ability. Results: After 4 weeks of treatment, significant reduction in the WOMAC score and VAS was found in both the Groups. The result showing statistical improvement is more in Group A than Group B. Conclusion: The results of the study shows that balancing exercise is more effective than strengthening exercise to improve the functional ability of OA involving knee joint. The improvement in Group A is more than Group B and having statistically highly significant.

Serum lipoprotein ratios as markers of insulin resistance: A study among non-diabetic acute coronary syndrome patients with impaired fasting glucose.

Background & objectives: Recent data suggest that insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity or dyslipidaemia. However, the majority of available methods to evaluate insulin resistance are complicated to operate, expensive, and time consuming. This study was undertaken to assess whether serum lipoprotein ratios could predict insulin resistance in non-diabetic acute coronary syndrome (ACS) patients. Methods: Ninety non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. At the time of admission fasting glucose and insulin concentrations were measured. The homeostatic model assessment-insulin resistance (HOMA-IR) was used for insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) levels were checked, and then TC/HDL-C and TG/HDL-C ratios were calculated. The areas under the curves (AUC) of the receiver operating characteristic (ROC) curves were used to compare the power of these serum lipoprotein ratios as markers. Results: Lipoprotein ratios were significantly higher in patients with HOMA-IR index > 2.5 as compared to patients with index <2.5 (P < 0.05). Both TG/HDL-C and TC/HDL-C ratios were significantly correlated with HOMA-IR (P<0.05). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratio for predicting insulin resistance was 0.80 (95% CI, 0.67 to 0.93), 0.78 (95% CI, 0.65 to 0.91), respectively. Interpretation & conclusions: The findings of this study demonstrate that serum lipoprotein ratios can provide a simple means of identifying insulin resistance and can be used as markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.

Seasonal distribution of Isotomina thermophilan in a secondary succession and a homegarden in Cachar, Assam.

Present investigation was carried out in Cachar district of Assam over a period of two years (May 2007 - April 2009) to understand the seasonal ecology of Isotomina thermophila (Axelson, 1900) in secondary succession and homegarden ecosystems. Population was found to be maximum during July 2008 (7949.05 No. m-2) and September 2008 (7949.05 No. m-2) in homegarden whereas the peak was recorded in secondary succession during September 2008 (13656.05 No. m-2). Least population was encountered during March 2008 (1222.93 No. m-2) and April 2008 (1630.57 No. m-2) in homegarden and secondary succession, respectively. It may be due to the fact that, vital activity of this species effected in the dry period or migrate towards lower soil profile in search of food and moisture. Linear regression analysis established the hypothesis that all the environmental variables showed positive and significant influence on the population dynamics whereas in homegarden, rainfall (r= 0.36, p>0.05) did not show any influence. In multiple regression analysis positive and significant influences (p<0.05) were recorded for both the investigated sites. Rainfall, relative humidity and temperature facilitated the soil moisture, microbial activity, litter decomposition may favour the reproduction and growth rate of the species. Among microclimatic conditions except soil pH all other parameters exhibited significant correlations (p<0.05) with population. Based on the present investigation, it can be concluded that I. thermophilia does not differ much with the general ecology of collembolans in this sub humid climate.

Elimination of iodine deficiency disorders--current status in Purba Medinipur district of West Bengal, India.

BACKGROUND AND OBJECTIVES: Towards sustainable elimination of iodine deficiency disorders (IDD), the existing programme needs to be monitored through recommended methods and indicators. Thus, we conducted the study to assess the current status of IDD in Purba Medinipur district, West Bengal. METHODS: It was a community based cross-sectional study; undertaken from October 2006-April 2007. 2400 school children, aged 8-10 years were selected by '30 cluster' sampling technique. Indicators recommended by the WHO/UNICEF/ICCIDD were used. Subjects were clinically examined by standard palpation technique for goitre, urinary iodine excretion was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. RESULTS: The total goitre rate (TGR) was 19.7% (95% CI = 18.1-21.3 %) with grade I and grade II (visible goitre) being 16.7% and 3% respectively. Goitre prevalence did not differ by age but significant difference was observed in respect of sex. Median urinary iodine excretion level was 11.5 mcg/dL and none had value less than 5 mcg/dL. Only 50.4% of the salt samples tested were adequately iodised (> or = 15 ppm). CONCLUSION: The district is in a phase of transition from iodine deficiency to iodine sufficiency as evident from the high goitre prevalence (19.7%) and median urinary iodine excretion (11.5 mcg/dL) within optimum limit. But, salt iodisation level far below the recommended goal highlights the need for intensified efforts towards successful transition.

Temporal bone carcinoma with intradural extension.

A case of temporal bone carcinoma having intradural extension is reported. To the best of our knowledge, no such case has been reported so far.

Follicular carcinoma of thyroid with synchronous bony and soft tissue metastases.

A 65 years old lady presented with a large thyroid swelling along with a soft, non-tender mass over the left parietal region and a small, hard, non-tender swelling over the volar aspect of right forearm. FNAC reports from the thyroid gland and the swellings over head and forearm all revealed features of follicular neoplasm. Excision biopsy of the forearm swelling showed histology of metastatic poorly differentiated follicular adenocarcinoma of thyroid. The patient underwent total thyroidectomy followed by excision of the mass over the head, a week later. She was discharged in favourable condition with advice to attend oncology department for subsequent management. She is yet to attend surgical outdoor for follow-up.

Diffuse neurofibroma of scalp.

Diffuse neurofibroma is an uncommon but distinct variety of neurofibroma, usually affecting trunk, head and neck regions of adolescents and young adults. The clinical features, gross macroscopic and histopathological findings are enunciated and the criteria for instituting the preferred modality of treatment for such lesions has been reviewed, stressing upon the need to exclude the neurofibromatoses preoperatively.

Detection of Theileria annulata carrier cattle by PCR.

A simple method for treating bovine blood samples for direct detection of T. annulata in carriers, after polymerase chain reaction (PCR) amplification of small subunit ribosomal RNA (SSU rRNA) gene is described. The threshold of detection of the PCR-assay was an erythrocytic parasitaemia of 0.00008% corresponding to 16 infected bovine erythrocytes. In 50 known carriers, 42 were positive in PCR, in which 8 cattle revealed presence of T. annulata in stained blood smear under microscope.

A 5-yr prospective epidemiological study of chronic obstructive pulmonary disease in rural south India.

In a prospective epidemiological study from 1981 to 1986 in four villages belonging to the KV Kuppam block of North Arcot Ambedkar district in Tamil Nadu, we detected 328 patients of chronic obstructive pulmonary disease (COPD) amongst the 9946 inhabitants who were aged 30 yr or more. Majority of the population was from the lower income group and they were agricultural workers residing in these villages which were generally free from atmospheric pollution. Of the 328 patients with COPD, 198 were males and 130 were females showing an overall age specific prevalence of 33.0/1,000 with a prevalence of 40.8/1,000 for males and 25.5/1,000 for females, respectively. In nearly half of the patients who had chest radiography, changes consistent with COPD were observed; only one patient had clinical, radiological and electrocardiographic evidence of cor-pulmonale. Peak expiratory flow rate (PEFR) along with height (cm) were measured in 258 patients and compared to the predicted normal values. Most of those tested showed evidence of airways obstruction; severe defect was observed in 106 patients. Among the males, 122 gave a history of smoking; majority of the heavy smokers amongst them had severe impairment of PEFR. Females from these villages denied any history of smoking. Cooking for long hours using firewood and cowdung cakes could have contributed to the development of COPD in these village women.

Raised serum IgE levels in chronic inflammatory lung diseases.

OBJECTIVE: To study the serum IgE response in nonallergic subjects with chronic inflammatory lung diseases. SETTING: Christian Medical College Hospital, Vellore. SUBJECTS: Twenty six patients with bronchiectasis, five with pulmonary mycosis referred from all over India and 30 healthy subjects. MAIN OUTCOME MEASURES: Serum IgE value (determined by radioimmuno assay) above the upper limit of normal control range (136 to 948 iu/ml) was considered as raised level. RESULTS: Of the 26 patients with bronchiectasis 13 had pyogenic infections, six had pulmonary tuberculosis; in six patients sputum culture was sterile while another patient had herpes zoster. Five cases of mycosis included one each of actinomycosis, aspergillosis, blastomycosis, cryptococcosis and nocardiasis. The serum IgE levels were raised in 20 (65%) of the 31 patients. CONCLUSION: Associated bacterial, fungal and parasitic infections were probably responsible for inducing an hyper-IgE response in these non-allergic subjects.

Hypereosinophilia in association with pulmonary tuberculosis in a rural population in south India.

In a prospective study conducted in four villages of North Arcot Ambedkar district of Tamil Nadu in south India over a 5 yr period from 1981-86, 279 patients were detected to have pulmonary tuberculosis (PTB). Thirty one of them were found to have associated hypereosinophilia (HE) with total blood eosinophil level of > or = 2000 per cumm; besides cough with expectoration they also complained of dyspnoea and wheeze. Twelve of the 18 patients with intestinal parasites had remission with deworming agents alone. The other 6 non responsive patients like the 13 who did not have parasitic infestation, needed treatment with diethylcarbamazine for eosinopenic remission and thus could be classified as patients of tropical pulmonary eosinophilia (TPE). The association of hypereosinopilic state as a whole as well as TPE with tuberculosis as compared to that prevalent in the general population was found to be highly significant (P < 0.001). The frequent association of TPE with tuberculosis as observed by us suggests the possibility of an early hypersensitivity reaction to mycobacterial antigens triggering a florid TPE state in susceptible patients from an area endemic for filariasis. A similar mechanism may also operate in cases of pulmonary eosinophilia induced by other helminths in areas where they are endemic.

An evaluation of the assess peak flow meter on human volunteers.

The Assess peak flow meter was tested by comparing PEF values obtained on it for 49 normal subjects, with the values obtained for the same subjects on the Wright and mini-Wright meters. Its reproducibility was tested by comparing its coefficient of variation with that of the other 2 instruments. PEF values on the Assess were 5% lower in lower ranges and 9% higher in higher ranges tested as compared with those on the Wright. Values from the mini-Wright and Wright paralleled each other with the former values 3-5% higher. Variabilities on the Assess were 20-50% higher than those of the other 2 meters. Further, PEF values > 670 L/min could not be read by the Assess. Although the Assess fulfils necessary criteria for accuracy and reproducibility, it appears to be less reliable than the other 2 instruments, and its range limits and utility.

Resolution of cryptococcal meningitis and associated granuloma lung with antifungal therapy: report of a case.

A 49-year-old diabetic male had been unsuccessfully treated with antitubercular therapy for a granulomatous lesion of the left lung detected elsewhere nine months ago. He presented with evidence of meningitis which was found to be due to infection with Cryptococcus neoformans. Both the meningeal and lung lesions resolved after 6 weeks of combined therapy with amphotericin B and flucytosine. The report of the case along with a brief review of the relevant literature is presented.

alpha 1-Antitrypsin deficiency in Indian patients with chronic obstructive airways and other pulmonary diseases.

OBJECTIVE: To determine alpha 1-antitrypsin (A1AT) deficiency in patients with chronic obstructive airways disease (COAD) and other pulmonary diseases. DESIGN: Observation study. SUBJECTS: 45 patients with COAD, 20 with bronchiectasis, 11 with pulmonary tuberculosis, 25 with chest malignancies and 42 healthy subjects. SETTING: Christian Medical College Hospital, Vellore, India. MAIN OUTCOME MEASURE: Serum A1AT level of 10% or less of the mean serum value of the control group was recognised as severe deficiency and A1AT level between 10 and 60% was considered as intermediate deficiency. RESULTS: 26 patients (18 with COAD, 2 with bronchiectasis, 3 with tuberculosis and 3 with chest malignancies) had intermediate A1AT deficiency. CONCLUSION: The finding of an A1AT deficiency in over a quarter of the patients comprising various categories of pulmonary diseases emphasises the need to explore the possibility of an underlying acquired cause existing either alone or in association with genetic defect in patients showing such a deficiency.

Chest malignancies & serum immunoglobulin E.

Serum IgE levels were measured by the radioimmunoassay technique in the sera of 53 patients with neoplastic chest diseases. Forty seven patients had malignant chest tumours and another 6 had benign tumours or mediastinal cysts. They included 33 smokers and 20 non-smokers. For comparison, 30 normal non-smoking controls matched for age and sex were included. The serum IgE levels in patients with chest malignancies showed an increase as compared to controls. The IgE levels increased significantly in adenocarcinoma (P < 0.01) and squamous cell carcinoma (P < 0.001), while they were not raised in poorly differentiated carcinoma. There was no significant difference between the serum IgE levels of 32 smokers and 15 non-smokers with malignant chest tumours.