Case Report of Primary Synovial Sarcoma of the Thyroid Gland: An Unusual Histology at Atypical Location.

Primary synovial sarcoma of the thyroid gland is extremely rare, aggressive, and has a dismal prognosis. We report the case of a 15-year-old male who presented with a progressively increasing neck mass, which was excised and the histopathological and immunohistochemical study suggested biphasic synovial sarcoma of the thyroid gland which was confirmed by synovial sarcoma translocation. There are 14 cases of primary synovial sarcoma of the thyroid reported in the literature so far. This study aimed to document the occurrence of synovial sarcoma histology at an unusual anatomical location with a review of the literature on this rare entity.

Can dual staining with p16 and Ki67 be biomarkers of epithelial dysplasia in oral lesions?

Background: Oral carcinogenesis is a multistage process with epithelial dysplasia as a premalignant condition. There is a significant inter-observer variation in diagnosing and grading the oral epithelial dysplasia. As human papillomavirus (HPV) is believed to have à strong relationship with oral carcinogenesis, using P16 as a biomarker may help in identifying the cells which may be undergoing the malignant transformation. However, due to the low specificity of P16, dual staining test P16INK4/Ki67 might be a better promising marker for identifying the transformed cells. This study was designed to evaluate the dual expression of P16 and Ki67 as a promising biomarker for dysplasia and their correlation with clinicopathological factors. Materials and Methods: Immunohistochemical analysis for p16 and ki67 was performed on 30 premalignant oral lesions and 36 oral squamous cell carcinoma (OSCC) by dual staining using the CINtec PLUS kit. Results: CINtec positivity was observed only in leukoplakia with dysplasia (46.7%) and squamous cell carcinoma (25%). None of the cases of leukoplakia without dysplasia or oral submucosal fibrosis stained positive for CINtec plus staining. In leukoplakia with dysplasia, there was no significant association with any of the clinicopathological parameters studied. In OSCC cases, alcohol intake showed statistically significant association with CINtec positivity. Conclusion: P16INK4/Ki67 assessment by dual staining is a promising biomarker for identifying dysplasia in cases with diagnostic dilemmas.

Effect of Postsurgical Nurse-led Follow-ups on Quality of Life in Head-and-Neck Cancer Patients: A Pilot Randomized Controlled Trial.

OBJECTIVE: Burden of head-and-neck cancer is disproportionately bigger in India and can be regarded as "tip of iceberg" situation. Postoperatively, head-and-neck cancer patients report tremendous challenges conversely, affects quality of their life. Oncology nurses contribute significantly in supportive care issues encountered by patients in the postoperative period. However, there is a paucity of the literature on effect of nurse-led postsurgical education program on quality of life (QOL) of head-and-neck cancer patients. METHODS: In this pilot randomized controlled, parallel group trial, 64 head-and-neck cancer patients; who were electively planned for surgery were randomized in experimental (n1 = 32) and control group (n2 = 32). In the experimental group, participants received structured nurse-led postsurgical education program through virtual mode and control group participants received standard of care. The QOL as an outcome variable was assessed through face-to-face interview at baseline on first postoperative day and postoperative day-4, 15, and 30 follow-ups by using standardized instruments, i.e., EORTC QLQ-C30 and H and N35 questionnaire. RESULTS: The experimental group had a significant improvement in global health (P = 0.02), role functioning (P = 0.02), emotional functioning (P = 0.01), swallowing (P = 0.01), and opening mouth (P = 0.02). Postoperative pain and speech problems were most distressing symptoms in participants of both groups. CONCLUSIONS: The nurse-led postsurgical virtual education programme was found effective to improve the selected domains of QOL and may be used as an adjuvant intervention for head-and-neck cancer patients.

Fungal Rhinosinusitis: Microbiological and Histopathological Perspective.

INTRODUCTION: On the basis of histopathology Fungal Rhinosinusitis (FRS) is categorized into non-invasive (allergic fungal rhinosinusitis, fungal ball) and invasive (acute invasive, chronic invasive and granulomatous invasive fungal sinusitis). This differentiation helps to decide the treatment. Role of latest molecular methods such as PCR and conventional methods such as KOH microscopy and culture also needs to be evaluated. Therefore, in this study we planned to categorise fungal rhinosinusitis on the basis of histopathology and compare it with other methods such as PCR, culture and KOH microscopy. AIM: To analyse fungal rhinosinusitis cases by both histopathologically and microbiologically. MATERIALS AND METHODS: A total of 76 clinically suspected fungal rhinosinusitis cases were included in the study. The tissue of suspected cases were processed and examined by KOH microscopy, histopathologically, culture and PCR. Histopathological examination was done by PAS, GMS and H&E stain. RESULTS: FRS was diagnosed in 37 (48.68%) cases out of 76 clinically suspected cases of FRS. In which 17 (22.3%) cases were positive by direct microscopy, 21 (27.6%) by culture, 27 (35.5%) by PCR and 14 (18.42%) by histopathology. Approximately 14 cases of FRS were classified according to histopathology; 10 (71.3%) as non-invasive FRS. Out of these 10, 9 (64.2%) were classified as AFRS and 1 (7.14%) as fungal ball. Only 4 cases (28.5%) were diagnosed with invasive FRS. Out of these 4 cases, 2 (14.2%) were of chronic invasive fungal rhinosinusitis, 1 (7.14%) was of granulomatous invasive fungal rhinosinusitis and 1 (7.14%) was of acute fulminant invasive fungal rhinosinusitis. Allergic Fungal Rhinosinusitis (AFRS) is the most common type of FRS. Aspergillus flavus was found to be the most common fungi causing FRS. CONCLUSION: Diagnosis should not be based on the single method. It should be done by both histopathological and microbiological methods, especially for those cases which are difficult to diagnose.

Huge Osteoclastoma of Hyoid Bone: A Case Report.

Giant cell tumors (GCT) of hyoid bone are very rare, and only few individual cases were reported in literature. We present such a case of GCT arising from left cornu of hyoid bone. The patient underwent trans-cervical complete excision of the tumour. Postoperatively, patient did well without recurrence or metastasis for 2 years follow up.

Fibroblast Growth Factor (FGF-2) and Its Receptors FGFR-2 and FGFR-3 May Be Putative Biomarkers of Malignant Transformation of Potentially Malignant Oral Lesions into Oral Squamous Cell Carcinoma.

There are several factors like angiogenesis, lymphangiogenesis, genetic alterations, mutational factors that are involved in malignant transformation of potentially malignant oral lesions (PMOLs) to oral squamous cell carcinoma (OSCC). Fibroblast growth factor-2 (FGF-2) is one of the prototypes of the large family of growth factors that bind heparin. FGF-2 induces angiogenesis and its receptors may play a role in synthesis of collagen. FGFs are involved in transmission of signals between the epithelium and connective tissue, and influence growth and differentiation of a wide variety of tissue including epithelia. The present study was undertaken to analyze expression of FGF-2 and its receptors FGFR-2 and FGFR-3 in 72 PMOLs, 108 OSCC and 52 healthy controls, and their role in risk assessment for malignant transformation of Leukoplakia (LKP) and Oral submucous fibrosis (OSMF) to OSCC. Immunohistochemistry was performed using antibodies against FGF-2, FGFR-2 and FGFR-3. IHC results were validated by Real Time PCR. Expression of FGF-2, FGFR-2 and FGFR-3 was upregulated from PMOLs to OSCC. While 90% (9/10) of PMOLs which showed malignant transformation (transformed) expressed FGF-2, only 24.19% cases (15/62) of PMOLs which were not transformed (untransformed) to OSCC expressed FGF-2. Similarly, FGFR-2 expression was seen in 16/62 (25.81%) of untransformed PMOLs and 8/10 (80%) cases of transformed PMOLs. FGFR-3 expression was observed in 23/62 (37.10%) cases of untransformed PMOLs and 6/10 (60%) cases of transformed PMOLs. A significant association of FGF-2 and FGFR-2 expression with malignant transformation from PMOLs to OSCC was observed both at phenotypic and molecular level. The results suggest that FGF-2 and FGFR-2 may be useful as biomarkers of malignant transformation in patients with OSMF and LKP.

Promoter region hypermethylation and mRNA expression of MGMT and p16 genes in tissue and blood samples of human premalignant oral lesions and oral squamous cell carcinoma.

Promoter methylation and relative gene expression of O(6)-methyguanine-DNA-methyltransferase (MGMT) and p16 genes were examined in tissue and blood samples of patients with premalignant oral lesions (PMOLs) and oral squamous cell carcinoma (OSCC). Methylation-specific PCR and reverse transcriptase PCR were performed in 146 tissue and blood samples from controls and patients with PMOLs and OSCC. In PMOL group, significant promoter methylation of MGMT and p16 genes was observed in 59% (P = 0.0010) and 57% (P = 0.0016) of tissue samples, respectively, and 39% (P = 0.0135) and 33% (P = 0.0074) of blood samples, respectively. Promoter methylation of both genes was more frequent in patients with OSCC, that is, 76% (P = 0.0001) and 82% (P = 0.0001) in tissue and 57% (P = 0.0002) and 70% (P = 0.0001) in blood, respectively. Significant downregulation of MGMT and p16 mRNA expression was observed in both tissue and blood samples from patients with PMOLs and OSCC. Hypermethylation-induced transcriptional silencing of MGMT and p16 genes in both precancer and cancer suggests important role of these changes in progression of premalignant state to malignancy. Results support use of blood as potential surrogate to tissue samples for screening or diagnosing PMOLs and early OSCC.

Cephalometric evaluation of mandibular advancement at different horizontal jaw positions in obstructive sleep apnoea patients: a pilot study.

BACKGROUND: The aim of this study was to comparatively evaluate the efficacy of the mandibular advancement device (MAD) at 50% (P2) and 75% (P3) of maximum mandibular advancement, relative to maximum intercuspation (P1) subjectively and objectively. METHODS: Eighteen subjects previously diagnosed with obstructive sleep apnoea (OSA) were selected for the study. ESS score, VAS score, soft palate angle, MP-H distance, S-H distance, a C4 -H distance, a Pu -p Pu distance and total pharyngeal area were calculated at P1, P2 and P3 positions with the help of an adjustable MAD. The results were statistically analysed. RESULTS: ESS score, VAS score, soft palate angle, MP-H distance, S-H distance and radius of curvature of airway at P2 and P3 were significantly lower compared to P1, but there was no significant difference between P2 and P3. CONCLUSIONS: The MAD produced significant improvement in objective signs and subjective symptoms at both 50% and 75% of the maximum mandibular protrusion positions at comparable comfort levels. Therefore, MAD may be given at 50% of maximum advancement in order to reduce dental or temporomandibular joint disturbances.

The effect of mouth breathing on dentofacial morphology of growing child.

BACKGROUND: The oral mode of respiration cause postural adaptations of structures in the head and neck region producing the effect on the positional relationship of the jaws. AIM: The aim of this study is to verify the skeletal relationship of mouth and nose breathing child. STUDY DESIGN: A cross sectional study was performed to assess the association of changed mode of respiration with dentofacial growth. MATERIALS AND METHODS: One hundred children among which 54 were mouth breathers and 46 were nasal breathers of 6-12 years of age were submitted to clinical examination and cephalometric radiographical analysis. Statistical analysis : Chi-square test for proportions and independent sample's "t" test for parametric data is used. RESULT: The mean values of N-Me (P<0.001) ANS-Me (P<0.001) and SN-GoGn (P<0.001) for mouth breathers is significantly higher. ArGo-GoMe (P=0.003) and (P<0.011) for 6-9 and 9-12 years age group, respectively, were significantly low in nasal breathers group. CONCLUSIONS: Changed mode of respiration was associated with increased facial height, mandibular plane angle and gonial angle.

VEGF-A immunohistochemical and mRNA expression in tissues and its serum levels in potentially malignant oral lesions and oral squamous cell carcinomas.

The aim of the study was to investigate whether the estimation of circulating Vascular endothelial growth factor-A (VEGF-A) levels by ELISA could be used as surrogate of VEGF-A expression in tissues of pre-malignant oral lesions (PMOLs) and oral squamous cell carcinoma (OSCC) as compared to that in healthy controls. The study samples comprised of tissue and blood samples from 60 PMOLs, 60 OSCC, and 20 healthy controls. Serum VEGF-A levels were determined by an ELISA based assay (Quantikine human VEGF; R & D System, Minneapolis USA). Tissue VEGF-A expression and microvessel density (MVD) were assessed by immunohistochemistry (IHC) using antibodies against VEGF-A and CD-34 on formalin fixed paraffin embedded (FFPE) tissue sections. VEGF-A mRNA expression was analyzed by real-time PCR in snap frozen tissues. Serum VEGF-A levels and immunohistochemical VEGF-A expression were significantly high in PMOLs and OSCC in comparison with controls. VEGF mRNA gene expression showed more than 50-fold increase in PMOLs and OSCC. VEGF-A levels in serum correlated in a linear fashion with the tissue expression in oral pre-malignant and malignant lesions, suggesting that the serum levels may serve as surrogate material for tissue expression of VEGF-A.

Preparation, characterization, and in vitro antimicrobial assessment of nanocarrier based formulation of nadifloxacin for acne treatment.

The objective of the present study was to develop a nanocarrier based formulation of nadifloxacin and to investigate its in vitro antimicrobial effect against Propionibacterium acnes. Nanocarrier based microemulsion formulations were prepared by aqueous titration method, using oleic acid as oil phase, Tween-80 as surfactant and ethanol as co-surfactant in different ratios. This procedure yielded monodisperse microemulsions exhibiting a mean droplet size in the range of 95-560 nm. This range of particle size is good to treat follicle related disorders like acne vulgaris because the size of follicles is in the range of 50-100 microm. Furthermore the optimized formulations were characterized for surface morphology by transmission electron microscopy and refractive index. The permeation studies were carried out using rat skin mounted in Franz diffusion cells. Flux of the optimised formulation was 2.24 times that of control. The diameter of inhibition zone of the microemulsion was found good but smaller than that of a clindamycin disc because of the higher therapeutic efficacy of clindamycin against P. acnes. The results indicated that the developed microemulsion shows promising results against P. acnes bacteria and may be a good approach for acne treatment.

Compliance of Bhabhatron-II telecobalt unit with IEC standard - Radiation safety.

Bhabha Atomic Research Centre, Mumbai, India designed and developed a telecobalt unit, which was named as Bhabhatron-II. In this paper, the results pertaining to radiation safety of indigenously developed Bhabhatron-II telecobalt unit are reported. The various tests were carried out as per requirements of International Electrotechnical Commission standard and acceptance criteria developed nationally. Various devices such as CaSO4:Dy based thermoluminescent dosimeters, farmer type ionization chamber, water phantom and radiographic films were used. All the parameters pertaining to radiation leakage/transmission were within the tolerance limits as per IEC-60601-2-11 standard except the collimator transmission through X collimators (upper jaw), which marginally exceeds the tolerance limit.

Determination of Artemisinin in Bulk and Pharmaceutical Dosage Forms using HPTLC.

A new, simple, rapid, accurate and precise HPTLC method was developed. The detector response was linear for concentrations between 100-600 ng/spot (r =0.9931). The limits of detection and quantitation were 25 ng/spot and 75 ng/spot, respectively. The recovery study was carried out by standard addition method and was found to be 99.60+/-0.27. Statistical analysis proved that the method was precise, accurate and reproducible, and hence was suitable for the routine analysis of artemisinin.

A study of skin sensitivity to various allergens by skin prick test in patients of nasobronchial allergy.

OBJECTIVE: To study skin sensitivity to various allergens in patients of nasobronchial allergy. MATERIALS AND METHODS: 2880 skin prick tests with 60 allergens were performed in 48 patients of nasobronchial allergy. RESULTS: Most common offending allergens were insects (21.2%), followed by dusts (12.0%), pollens (7.8%), animal dander (3.1%), and fungi (1.3%). The common insect antigen were locust female (33.3%) followed by locust male (25%), grasshopper (20.8%), cricket (16.7%), cockroach female (16.7%) and cockroach male (14.6%). Common dust allergens were house dust, wheat dust, cotton mill and paper dust. Among pollens, Amaranthus spinosus, Argemone mexicana, Adhatoda vasica, Ailanthus and Cannabis were found to be common allergens. In animal danders common offending allergens were cow dander and dog dander. Among fungi Aspergillus fumigatus, Aspergillus flavus, Alternaria teneis and Fusarium sodani were common allergens. Patients of bronchial asthma had associated allergic rhinitis in 80% cases. CONCLUSION: Common allergens in patients of nasobronchial allergy were identified. The data may prove useful in of allergen avoidance and immunotherapy in these patients.

Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001.

BACKGROUND & OBJECTIVE: The viral encephalitides caused by animal or human viruses are characterized by sudden outbreaks of neurological disease in both tropical and temperate regions. An outbreak of acute encephalitis occurred in Siliguri (West Bengal) town of India between January 31 and February 23, 2001. This outbreak was investigated by a team of scientists from four major institutions, and the findings are presented here. METHODS: Detailed information about the outbreak was collected with the help of local health authorities. Limited entomological investigations were also done. Samples collected from cases and contacts were sent for analysis. RESULTS: A total of 66 probable cases and 45 deaths were reported. Epidemiological linkages between cases point towards person-to-person transmission and incubation period of around 10 days. There was neither any concurrent illness in animals nor was there any exposure of cases to animals. Centres for Disease Control and Prevention, Atlanta, USA concluded on the basis of tests carried out on serum specimen from four cases and two contacts that the causative pathogen appears to be Nipah/ Hendra or closely related virus. INTERPRETATION & CONCLUSION: This outbreak highlights the importance and urgency of establishing a strong surveillance system supported by a network of state-of-the-art laboratories equipped to handle and diagnose new pathogens and including patient isolation techniques, use of personal protective equipment, barrier nursing and safe disposal of potentially infected material in the prevention and control measures for Nipah/Hendra virus infection.

Prompt laboratory diagnosis in timely containment of a plague outbreak in India.

A focal outbreak of pneumonic plague occurred in a hamlet of village Hatkoti, district Shimla, Himachal Pradesh in the first fortnight of February, 2002. A total of 16 cases with 4 deaths were reported. Diagnosis of plague was confirmed by the laboratory in 10 (63%) cases. Y. pestis was isolated from clinical samples of 3 cases and confirmed by bacteriophage lysis. Molecular tests confirmed the presence of Y. pestis specific pla and F1 genes in 4 cases; DNA fingerprinting had identity with the known sequence of plague bacilli. Paired samples from 5 cases showed more than 4 fold rise and 1 case showed more than 4 fold fall in antibodies against F1 antigen of Y. pestis. The present communication emphasises that timely and systematic laboratory investigations give confirmatory diagnosis in shortest possible time which forms the backbone of the outbreak control in a timely fashion and prevents confusion and controversy.