Genomic miscellany and allelic frequencies of Plasmodium falciparum msp-1, msp-2 and glurp in parasite isolates.

INTRODUCTION: The genomic miscellany of malaria parasites can help inform the intensity of malaria transmission and identify potential deficiencies in malaria control programs. This study was aimed at investigating the genomic miscellany, allele frequencies, and MOI of P. falciparum infection. METHODS: A total of 85 P. falciparum confirmed isolates out of 100 were included in this study that were collected from P. falciparum patients aged 4 months to 60 years in nine districts of Khyber Pakhtunkhwa Province. Parasite DNA was extracted from 200µL whole blood samples using the Qiagen DNA extraction kit following the manufacturer's instructions. The polymorphic regions of msp-1, msp-2 and glurp loci were genotyped using nested PCR followed by gel electrophoresis for amplified fragments identification and subsequent data analysis. RESULTS: Out of 85 P. falciparum infections detected, 30 were msp-1 and 32 were msp-2 alleles specific. Successful amplification occurred in 88.23% (75/85) isolates for msp-1, 78.9% (67/85) for msp-2 and 70% (60/85) for glurp gene. In msp-1, the K1 allelic family was predominantly prevalent as 66.66% (50/75), followed by RO33 and MAD20. The frequency of samples with single infection having only K1, MAD20 and RO33 were 21.34% (16/75), 8% (6/75), and 10.67% (8/75), respectively. In msp-2, both the FC27 and 3D7 allelic families revealed almost the same frequencies as 70.14% (47/67) and 67.16% (45/67), respectively. Nine glurp RII region alleles were identified in 60 isolates. The overall mean multiplicity of infection for msp genes was 1.6 with 1.8 for msp-1 and 1.4 for msp-2, while for glurp the MOI was 1.03. There was no significant association between multiplicity of infection and age groups (Spearman's rank coefficient = 0.050; P = 0.6) while MOI and parasite density correlated for only msp-2 allelic marker. CONCLUSIONS: The study showed high genetic diversity and allelic frequency with multiple clones of msp-1, msp-2 and glurp in P. falciparum isolates in Khyber Pakhtunkhwa, Pakistan. In the present study the genotype data may provide valuable information essential for monitoring the impact of malaria eradication efforts in this region.

Frequency and correlation of molecular subtypes of breast cancer with clinicopathological features.

BACKGROUND: Traditional clinicopathological classification of breast cancer has limitations as tumours with similar clinical and histological features behave differently regarding outcome and responsiveness to chemo/immunotherapy. The objectives of the study were to determine the frequency of different molecular subtypes of breast cancer based on immunohistochemical staining and to find the correlation of each subtype with clinicopathological features. METHODS: Sixty patients with histologically diagnosed invasive ductal carcinoma were enrolled in this cross sectional study. Immunohistological staining of the tumour samples and based on receptor status tumours were classified in four subtypes, Luminal A, Luminal B, HER2/neu oncogene amplification subtype and Tripple negative subtype. Clinical features, stage of disease at presentation and histopathological grade of the tumours was also recoded in each subtype. Prevalence of each subtype was calculated and correlation with clinical and pathological features was determined. RESULTS: Mean age of tli`S patients was 47.55 years. Protective role of breast feeding was not confirmed in this study as 58 (96.67%) patients breast fed their children. Only two (3.33%) patients gave family history of breast cancer in the study. Thirty three (55%) patients had grade 2 tumours, 26 (43.33%) had grade 3 tumours while only one patient had grade 1 tumour. HER2/neu amplification subtype was the most common molecular subclass in the study, comprising 30% of all the patients. Ten patients (16.67%) in this study belonged to triple negative group. Triple negative disease was found in younger women with mean age of 40-60 years. CONCLUSION: Breast cancer particularly triple negative disease was found in younger age group and patients usually present in advanced stage of their disease.HER2fneu positive breast cancer was the most common subtype in this study.

Surgical management of tuberculous small bowel obstruction.

BACKGROUND: Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored. METHODS: Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months. RESULTS: Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%. CONCLUSION: Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery.