bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin resistance in moderate to severe acne vulgaris
Authors: Singh Monika , Shri Dikshant
Published: August 2024

Introduction:

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit usually affects adolescents. It is seen on the face, neck, trunk and arms. The main pathogenic factors of acne are high sebaceous gland secretion, follicular hyper proliferation, high androgen effects, propionibacterium acnes colonization and inflammation.

Objectives:

To determine the presence of insulin resistance in moderate to very severe acne vulgaris.

Material and Methods:

One hundred sixty subjects were enrolled in the study consisting of 80 patients with moderate to very severe acne vulgaris and 80 age and sex-matched controls without acne. Fasting serum insulin and glucose levels were measured and insulin resistance was calculated by Homeostasis Model Assessment- Insulin Resistance (HOMA-IR) Index. The values were compared with the healthy control group.

Results:

Significant difference was observed in HOMA values and fasting insulin among the two groups (P < 0.001). The levels were significantly higher in the patient group than in the control group, whereas no significant difference was present in fasting glucose levels between the two group.

Conclusions:

In conclusion, insulin resistance was seen in majority of patients with acne. These results can add to the evidence regarding a potential association between metabolic dysregulation and acne.
Evaluating the Effect of Supplementation with Bacillus clausii on Therapeutic Outcomes in Atopic Eczema—Results of an Observer-Blinded Parallel-Group Randomized Controlled Study
Authors: Sharma Richa , Handa Sanjeev , Mahajan Rahul , De Dipankar , Sachdeva Naresh
Published: August 2024

Background:

Atopic dermatitis (AD) is an itchy, chronic or chronically relapsing, inflammatory skin condition.

Aims:

To study the effectiveness of probiotic supplementation (Bacillus clausii) in achieving clinical remission, preventing relapse and its effect on immunological profile in children with AD.

Methods:

In this randomized controlled study, 114 children with AD were randomized into two groups (57 each): Group A received conventional treatment, along with Bacillus clausii (Strains O/C, N/R, SIN and T) suspension available as Enterogermina® at the dose 2 billion spores/5 ml twice daily for 8 weeks and Group B receiving conventional treatment only. Baseline and follow-up SCORAD were assessed at 0, 4, 8, 12, 16, 20 and 24 weeks. Serum IL-17A levels were measured at baseline and 12 weeks.

Results:

There was no significant difference in mean SCORAD between the two groups at baseline, 12 weeks (p = 0.21) and 24 weeks (p = 0.26). The two groups did not differ significantly in terms of the number of patients who achieved SCORAD 90 (p = 0.19), SCORAD 75 (p = 0.59), and those who relapsed (p = 0.5). IL-17A levels were not significantly different between the two groups at baseline and 12 weeks (p = 0.7). There was no statistically significant correlation between IL-17A levels and AD severity.

Limitations:

Lack of double-blinding, lack of the use of placebo and a short follow-up period were the limitations of the present study.

Conclusion:

Administration of the probiotic Bacillus clausii in addition to conventional treatment does not offer any additional benefit in inducing remission or prevention relapse in AD.
The Impact of Tofacitinib on Quality of Life in Patients with Moderate-to-Severe Psoriasis- An Observational Study
Authors: Mohta Alpana , Nyati Asha , Ghiya Bhikam Chand , Mehta Rajesh Dutt , Jain Suresh Kumar
Published: August 2024

Background:

Global phase III trials have established the effectiveness and the safety profile of 5 and 10 mg twice-daily regimens of Tofacitinib for the management of psoriasis.

Aims and Objectives:

This study was aimed at assessing the improvement in quality of life in patients suffering from moderate-to-severe psoriasis following 12-week Tofacitinib therapy.

Materials and Methods:

50 adults with moderate to severe plaque psoriasis enrolled with informed consent. Tofacitinib was given orally for 12 weeks, as 5 mg or 10 mg twice daily based on weight. Improvement in PASI and DLQI was recorded.

Results:

We observed a statistically significant improvement in PASI (p-value < 0.001) and DLQI (p-value < 0.001) following Tofacitinib therapy. The 3 domains of DLQI with the most significant improvement were symptoms and feelings (items 1 and 2) (p-value-0.001), daily activities (items 3 and 4) (p-value-0.0001), and treatment (item 10) (p-value-0.0001)

Conclusion:

Tofacitinib demonstrated a significant improvement in psoriasis disease severity and symptoms with 12 weeks' therapy.
Effect of a Precision Cryotherapy Device with Temperature Adjustability on Pigmentation
Authors: Kwack Mi Hee , Lee Seongjin , Lee Eun Hye , Ha Gi Ung , Kim Gun-Ho , Lee Weon Ju
Published: August 2024

Background:

Pigmentary skin disorders impair the quality of life, leading to the development of therapeutic modalities. However, these treatments should focus more on effectiveness and safety.

Aims and Objectives:

To evaluate the effect of a temperature-adjustable cryotherapy device on the expression of pigmentation-related biomarkers.

Methods and Results:

A temperature- and time-adjustable cryotherapy device was employed to improve 200 mJ UVB-induced pigmentation on mice at −5°C (for 5, 10 or 20 s), 0°C (for 5, 10 or 20 s), 5°C (for 5, 10 or 20 s), or 10°C (for 5, 10 or 20 s). Expression of pigmentation-related biomarkers, such as tyrosinase, c-kit, melanocortin 1 receptor and microphthalmia-associated transcription factor before and after treatment with the cryotherapy device was investigated with real-time polymerase chain reaction and immunohistochemistry.

Results:

Expression of pigmentation-related biomarkers was decreased after the treatment of the temperature-adjustable cryotherapy device. Gene expression of the pigmentation-related biomarkers was decreased under the above conditions with some exception. Protein expression of the pigmentation-related biomarkers showed decreased tendency under the conditions with some exceptions.

Conclusion:

The temperature-adjustable cryotherapy device used in this study reduced the expression of pigmentation-related biomarkers on mice and may be used to treat patients with skin pigmentation.
Haematologic-Related Malignancy-Induced Eosinophilic Dermatoses (He Remained)
Authors: Kar Bikash Ranjan , Agarwal Akash
Published: August 2024

He remained(Hematologic Related Malignancy- induced Eosinophilic dermatoses) is a new eponym introduced to describe a dermatoses previously described under several terminologies such as eosinophilic dermatoses of haematological malignancy, exaggerated arthropod bite reactions, insect bite-like reactions and T-cell papulosis associated with B-cell malignancies. This chronic relapsing remitting disease has a pleomorphic presentation mimicking a variety of dermatological conditions. The underlying pathophysiology is however poorly understood. It is a paraneoplastic phenomenon hence an underlying haematological malignancy must always be looked for. Response to conventional modalities of treatment such as oral corticosteroids is rapid and satisfactory. Other newer modalities are also in the pipeline. In this manuscript, we present a narrative review of this recently described entity with data identified via a search on 27 September, 2021 in PubMed, EMBASE and MEDLINE using the term ‘Eosinophilic dermatoses of haematological malignancy’ AND ‘Hematologic related malignancy-induced eosinophilic dermatoses’. A total of 67 cases reported in the literature from the year 2012 onward have been included. The literatures pertaining to insect bite-like reactions and exaggerated insect bite hypersensitivity have been excluded in this review.
Comparison of Effectiveness and Safety of Immunotherapy of Warts with Intralesional Versus Subcutaneous MMR Vaccine
Authors: Saha Abanti , Bahalia Indrajit , Agarwal Sristi , Banerjee Arini , Bandyopadhyay Debabrata
Published: August 2024

Common wart, also known as verruca vulgaris is characterized by focal proliferation of keratinocytes caused by multiple strains of human papilloma virus (HPV). Conventional treatments like chemical cautery, cryotherapy, electro-cautery, etc often fail to cure verruca satisfactorily. The present work was a randomized, parallel-group, non-inferiority clinical trial with an objective of comparing the effectiveness and safety of subcutaneous MMR versus intralesional MMR vaccine in the treatment of multiple warts.

Method:

Consenting patients of both sexes of 18-65 years age, who have viral warts and did not receive anti-wart treatment in the last 4 weeks and devoid of any active bacterial or viral skin diseases were included in the study.

Interventions:

Eligible patients were randomized into either group A (receiving 0.3 ml of intralesional MMR) or group B (receiving 0.5 ml of subcutaneous MMR). A total of three injections were administered at two weeks interval.

Outcome Measure:

The response was considered complete if there was disappearance of the wart(s) and return of the normal skin markings, partial if the wart(s) was regression in size by 50-99% and no response if there was be 0-49% decrease in wart size.

Results:

Thirty patients were recruited in each group; 5 of group A and 3 of group B were lost to follow up. Modified intention to treat analysis was performed, so, the last observation of such patients was carried forward and all 60 participants were analysed. Number of warts and size of the largest wart were declined significantly (P < 0.001 and P = 0.001 respectively) in both the treatment arms. No significant difference between two groups were seen. Complete clearance including distant lesions was achieved in 22 patients; 12 (48%) in group A and 10 (37.04%) in group B, but the final outcome at the end of the study showed no significant difference between the two t groups. (P = 0.64).

Adverse Events:

Only one patient had developed mild fever with tender, enlarged parotid gland after first injection of subcutaneous MMR which resolved within two weeks.

Conclusion:

Efficacy and safety profile of Subcutaneous and intralesional MMR were almost same. Both can be considered as safe and cost effective treatment of warts while the subcutaneous route may be easier to administer.
Extragenital Lichen Sclerosus
Authors: Baklouti Massara , Sellami Khadija , Rekik Mariem , Bahloul Emna , Hammami Fatma , Slim Charfi , Masmoudi Abderahmen , Sellami Tahya , Turki Hamida
Published: August 2024

Introduction:

Lichen sclerosus is a chronic inflammatory and atrophic dermatosis affecting preferentially the anogenital region. However, the cutaneous involvement remains less known and studied.

Methods:

We collected 17 patients to study the clinical and therapeutic features of cutaneous lichen sclerosus.

Results:

We noticed that the frequency of extragenital involvement in our series is high (about 40%). There is a female predominance (76%), with two infantile cases presenting a severe involvement. On the other hand, the absence of sclerosis, in early forms, does not eliminate the diagnosis. Moreover, breast involvement was frequent (41%) and atypical locations, such as the face, were reported. There was an equal frequency between the diffuse and the localized forms. A genital involvement must imperatively be sought.

Conclusions:

Our series mention the frequency of isolated cutaneous lichen sclerosus. Clinical presentation can be misleading in the early forms because of lack of sclerosis, variability of localizations, variability of severity, and the absence of anogenital lichen sclerosus.
Impact of Machine Learning Prediction on Intraoperative Transfusion in Cranial Operation
Authors: Tunthanathip Thara , Sae-Heng Sakchai , Oearsakul Thakul , Kaewborisutsakul Anukoon , Taweesomboonyat Chin
Published: August 2024

Objective:

This study aimed to use machine learning (ML) for the prediction of intraoperative packed red cell (PRC) transfusion and the number of units of transfused PRC, as well as estimate the net benefit of the ML models through decision curve analysis.

Methods:

The retrospective cohort study was conducted on patients who underwent cranial operations. Clinical data and transfusion data were extracted. Supervised ML algorithms were trained and tested as ML classification for the prediction of intraoperative PRC transfusion and ML regression for predicting the number of transfused PRC units.

Results:

Out of 2683 patients, 42.9% of neurosurgical patients intraoperatively received PRC. Artificial neural network, gradient boosting classifier, and random forest were the algorithms that had high area under the receiver operating characteristic curve of 0.912, 0.911, and 0.909, respectively, in ML classification, while random forest with regression had the lowest root mean squared error and mean absolute error in ML regression.

Conclusions:

ML is one of the most effective approaches to developing clinical prediction tools that can enhance the efficiency of blood utilization. Additionally, ML has become a valuable tool in modern health technologies as the computerized clinical decision support systems assist the physician in decision-making in real-world practice.
Lifestyle Modification and Nutrition
Authors: Verma Prerna , Mahajan Janhavi , Kumar Sunil , Acharya Sourya
Published: August 2024

Introduction

Chronic kidney disease (CKD) is quickly becoming a global epidemic. There is an estimated annual increase of 8%, with a corresponding economic and clinical burden. Recent research into lifestyle factors has confirmed that certain dietary characteristics can help slow the progression of chronic nephropathies.

Methods:

This narrative review had focus on historical and emerging data on the role of nutrition in the course of CKD, with a particular focus on dietary patterns that have been shown to reduce the risk of ESRD. In this article, obesity, lipids, protein, diabetes, and blood pressure are all discussed in order to demonstrate how the current literature reflects the way to modify the dietary aspects of these.

Results:

Evidence strongly supports a balanced diet, good glycemic control, lipid control, modest protein reduction, and salt reduction halts the progression of CKD. The importance of these dietary strategies is not solely the role of the dietitian, but of the entire multidisciplinary team like general physician, nephrologist, exercise instructor specially yoga in providing a consistent message.

Discussion:

The mechanisms underlying causes are unknown, but the message remains consistent: there is an increased need for dietary advice in the predialysis population. This has significant implications and could be a cost-effective way to help slow the progression of the disease.
Actions of Caffeic Acid Loaded-Silver Nanoparticles on Blood Pressure, Oxidative Stress, and Antioxidants in Nitric Oxide Deficient Hypertensive Rats
Authors: Kalaiarasi Kanagaraj , Raja Boobalan , Saranya Dhanasekaran , Dhakshinamoorthi Ravi
Published: August 2024

Objectives:

This study aimed to evaluate the antihypertensive and antioxidant potential of caffeic acid-loaded silver nanoparticles (CA-AgNPs) in Nω −Nitro-L-arginine methyl ester hydrochloride (L-NAME) induced hypertension in male albino Wistar rats.

Materials and methods:

The rats have randomly divided into four groups, that is, Group I Control rats, Group II rats injected with CA-AgNPs, Group III L-NAME rats, and Group IV −L-NAME+ CA-AgNPs. Hypertension was induced in rats by oral administration of L-NAME (40 mg/kg body weight) dissolved in drinking water daily for 4 weeks. Rats were given intraperitoneal injection of CA-AgNPs (0.5 mg/kg/ml).

Results:

The results showed that L-NAME administration caused a sustained increase in blood pressure, levels of thiobarbituric acid reactive substances (TBARS), lipid hydroperoxides (LOOH), and a significant decrease in the activities of enzymatic antioxidants such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (Gpx), and levels of non-enzymatic antioxidants such as vitamin C and vitamin E in the tissues such as heart, aorta, liver, and kidney. Above pathological changes were considerably restored with the treatment of CA-AgNPs.

Conclusions:

The result confirms CA-AgNPs have enough potential to narrow down hypertension and oxidative stress in L-NAME hypertensive rats.
Managing the Cytokine Storm in COVID-19
Authors: Ganganna Aruna , Chandrashekar Byalakere Rudraiah , Venkatesh Madhugiri Prakash , Belgaumi Uzma , Shivnaikar Sachin , Bhandari Purnima
Published: August 2024

Some drugs with immunomodulatory and anti-inflammatory activity are identified as adjunctive therapy in the coronavirus disease 2019 (COVID-19) infections and researchers believe that such pathophysiologic pathway treatment approach is rational and important for future development of new therapeutic agents in managing this pandemic. This review will discuss various cytokines which go berserk and cause serious life-threatening complications in COVID-19 infections. Additionally, different therapeutic modalities in managing “cytokine storm,” with a special note on melatonin is discussed. The foundation laid by scientists on this wonder molecule may pave the path toward development of drug with satisfactory results either used alone or as an adjunct to other drugs. However, calming the angered cytokine profile seems pivotal during management of the devastating storm.
The Pattern of Food Groups in Packed Lunches among School Children of Rural Konni Block in Central Kerala, India − A Lunch Box Survey
Authors: Samuel Johnson Abel K. , Varughese Deepak , Alex Cijo , Joseph Marina Rajan , Benjamin Anoop I. , David Alice
Published: August 2024

Lunch, being the main meal, is a representation of the eating habits and dietary preferences of the children and parents. The lunch box survey was an attempt to identify the contents in the lunch box of the primary school children of the Rural Konni block. The food items brought in the lunch box were classified into cereals, vegetables, fruits, non-vegetarian foods, and fried foods. This is captured using a pre-designed questionnaire with a pictorial representation of the lunch box. A cereal-rich diet combined with vegetables with infrequent meat consumption and no fruits was the dietary consumption pattern in the school children of rural Konni. A changing trend for liking energy-dense foods is shown by the majority of the students. This calls for further novel innovations to develop a healthy school food environment.
Molecular Modeling Tool Application in Micro- and Macromolecule therapeutics − An Updated Review
Authors: Bhuvaneshwari S. , Umashankar M.S , Kirubakaran N.
Published: August 2024

Introduction:

Computational-based simulations are useful in designing better drug carriers and to solve the practical issues in the area of diffusion, dynamics, and drug delivery systems. Molecular simulation techniques allow direct visualization of the processes and rectify the interactions involved at a molecular scale level.

Aim:

Computational techniques are used for the prediction of the binding of drug molecules to receptors and dynamics between drug molecule and its carrier entailing an essential role to minimize the cost of investment in the design and development of the drug. This review will emphasize the various molecular modeling tools and its applications in micro- and macrodurg designs at therapeutics level.

Materials and methods:

Various scales of molecular modeling such as quantum scale, atomic scale, mesoscopic scale, macro scale, as well as different quantum tools such as quantum mechanics (QM), hybrid QM/molecular mechanics, and computer tooling in drug designs.

Results and discussions:

The current review emphasizes the applications of drug designs in area of design of chemical structures, visualization of molecular structure, predictions of molecular conformations, interaction of macromolecular receptors, interactions of drug–receptor, study of molecular properties, drug–excipient interactions, quantitative structure–activity relationship, lead molecule generation, pharmacophoric pattern, computational pharmaceutics in drug delivery, shape and charge for self-assembled polymer, etc.
Sinapic Acid Improves Neurotransmitter Status and Oxidative Stress-Related Changes in Mouse Model of Experimental Parkinsonism
Authors: Prabhakar Preeja , Ahmed Bakrudeen Ali , Chidambaram Saravana Babu , Ramu Arun Kumar , Pandian Arjun
Published: August 2024

Parkinsonism is a progressive neurodegenerative disease of the dopaminergic neurons in the substantia nigra. Oxidative stress is a known causative factor in the death of dopaminergic neurons. Sinapic acid (SNP or SA), a hydroxycinnamic type of the abundantly available plant-derived metabolite, is known for its antioxidant and anti-inflammatory properties. In the present study, we assessed the effects of sinapic acid against 1-methyl-4-phenyl 1,2,3,6-tetrahydropyridine (MPTP) induced Parkinson disease (PD) in a mouse model. The animals were pretreated with vehicle or SNP for a period of 5 days. On Day 5, 45 minutes after giving sinapic acid (SNP/SA) or normal saline (control/vehicle/), MPTP was administered. Motor function was tested using a beam walk test. Dopamine level was measured by HPLC. SNP-pretreated mice showed significant improvement in the levels of dopamine at the striatum and substantia nigra pars compacta regions of the brain. SNP also showed improved antioxidants like glutathione and superoxide dismutase levels. These were also corroborated by the improvement in motor function tests. Sinapic acid, with its antioxidant ability and dopamine-replenishing properties attenuated the pathological features associated with MPTP intoxicated dopaminergic degeneration in experimental PD.
Assessment of Knowledge, Practice and Treatment Adherence of Patients with Hypothyroidism in Endocrinology Department
Authors: Nagendiran Abinaya , Kalaimani Kavitha , Anantharani K
Published: August 2024

Assess the knowledge, practice, and treatment adherence of patients with hypothyroidism attending in endocrinology department in Chennai. The research design adopted for this study was descriptive. Using convenience sampling technique, a total of 120 patients both male and female who had diagnosed with hypothyroidism, Sri Ramachandra Hospital who met the inclusion criteria were recruited. The data related to background variables and assessment of knowledge, practice and treatment adherence on patients with hypothyroidism were obtained using questionnaires through interview method. The data were analyzed using descriptive and inferential statistics. The study findings showed that 61.7% of patients had moderately adequate level of knowledge on hypothyroidism, 76.7% of them had adequate level of practice and 49.2% of them had low adherence. The mean score of knowledge on hypothyroidism was 16.69, practice was 8.28, and treatment adherence was 2.09. The study showed that the knowledge, practice, and treatment adherence with hypothyroidism were moderately adequate among patients with hypothyroidism.
Determine the Arrest Factors in Survival Outcome of Patients with IHCA
Authors: Devi A. Akila , Sundaresan S. , Kanniammal C. , Ramakrishnan T.V.
Published: August 2024

Introduction:

In-hospital cardiac arrest (IHCA) is a common health problem associated with high levels of mortality. Successful defibrillation is known to improve outcomes in ventricular fibrillation/ventricular tachycardia. However, it has been hypothesized that a period of cardiopulmonary resuscitation (CPR) before defibrillation, increasing the likelihood of successful defibrillation. The order of priority of CPR versus defibrillation therefore remains in contention.

Objectives:

(1) To determine the arrest factors in survival outcome of IHCA. (2) To associate the arrest factors in survival outcome of IHCA with their selected demographic variables.

Materials and methods:

A total of 125 samples were selected and nonprobability purposive sampling technique was used for this study. Arrest factor score was used to assess prognosis of IHCA.

Statistical analysis used:

Descriptive statistics to determine the frequency and distribution, multiple regression analysis to interpret the data, and Chi-square test for associating the variables.

Results:

Percentage distribution of arrest factors determines the cardiac cause 94.4% and noncardiac cause 89.6%, and cardiopulmonary resuscitation was carried for 2 to 4 minutes (2.4%) duration, 5 to 9 minutes (15.2%), 15 to 19 minutes (8.8%), 20 to 24 minutes (17.6%), 25 to 29 minutes (32%), and ≥30 minutes (24%) among patients with IHCA. Frequency and distribution of arrest factors were increased survival outcome 0 (0.0%), moderate survival outcome 33 (26.4%), and decreased survival outcome 92 (73.6%) in survival outcome among patients with IHCA. The P-values corresponding to “total cholesterol level and low-density lipoprotein cholesterol level” at 0.01 level and “triglycerides and smoking” at 0.05 level are highly impacting the “arrest factors scores.”

Conclusion:

Determining cardiac and noncardiac causes can determine the risk of IHCA. Identification and early management and duration of CPR initiate the reversal of IHCA and increase the rate of survival outcome.
Hyponatremia in Empty Sella Syndrome: Is it a Covid Sequelae?
Authors: Nimkar Shubham , Ahuja Abhinav , Kumar Sunil , Acharya Sourya
Published: August 2024

The symptoms associated with empty sella syndrome (ESS) include headache, giddiness, vomiting, visual field deficits, and endocrine problems, as well as the radiological appearance of an enlarged sella turcica. This case report highlights a 45-year-old female who had a COVID-19 infection 2 months back and presented with chronic headache, giddiness, and lethargy having persistent hyponatremia later diagnosed as empty sella syndrome on brain magnetic resonance imaging. In this case, we tried to correlate all of these clinical and radiological features as COVID-19 sequelae due to post-Covid hypothalamic-pituitary axis dysfunction.
Inflammatory myofibroblastic tumor of the kidney in patient with nephron-sparing surgery. Case report and review of the literature
Authors: Korolczuk Agnieszka , Jarosz Piotr , Jasielski Patryk , Mitura1 Przemysław , Bar Krzysztof
Published: August 2024

According to the WHO classification, mesenchymal tumors of the kidney are divided into mesenchymal tumors occurring mainly in adults and children. Accumulating evidence suggests that renal mesenchymal tumors represent a group of histologically heterogeneous diseases. We are reporting the case of a 58-year-old man with a history of nephron-sparing surgery due to renal cell carcinoma in 2014 in his left kidney. He was urgently admitted to the hospital due to left-sided nephrotoxic and anuria. Computed tomography (CT) imaging was performed and revealed irregular tumor mass. He underwent left-sided nephrectomy. Microscopic appearance and immunoprofile allowed to diagnose the tumor as an inflammatory myofibroblastic tumor (IMT) of the kidney. According to the 2016 World Health Organization (WHO) classification of tumors of the urinary system and male genital organs, IMT is a benign mesenchymal tumor with malignant potential. Typical locations are the liver and biliary tract, lung, and gastrointestinal tract. In the urogenital system, IMT occurs mainly in the bladder. So far, 48 cases have been reported in the kidney.
Detection of MDM2 gene amplification on tissue microarray-based Fluorescence In-Situ Hybridization (FISH) in well-differentiated and dedifferentiated liposarcomas, displaying a wide morphological spectrum
Authors: Rekhi Bharat , Karnik Nupur , Agrawal Radhika , Shetty Omshree , Patkar Shraddha
Published: August 2024

Background:

Liposarcomas including atypical lipomatous tumors (ALT)/well-differentiated liposarcomas (WDLPS) and dedifferentiated liposarcomas (DDLPSs) display a histomorphological spectrum with their several diagnostic mimics. Murine double minute 2(MDM2)gene amplification characterizes ALT/WDLPS and DDLPS. Presently, there is no documented study from our subcontinent on the validation of MDM2 gene testing in these tumors.

Material and Methods:

Twenty-eight cases, diagnosed as ALT/WDLPS (n = 5) and DDLPSs (n = 23), along with 10 other tumors were tested for MDM2 gene amplification, using fluorescence in situhybridization (FISH) on tissue microarrays (TMAs). Fourteen cases, diagnosed as ALT/WDLPS and DDLPS, along with 49 other tumors were tested for MDM2 immunostaining. Twenty tumors were tested for p16INK4a immunostaining.

Results:

FISH was interpretable in 25 (89.2%) cases. Among the 20 cases diagnosed as DDLPSs, 19 displayed MDM2gene amplification. Among the 5 cases diagnosed as ALT/WDLPS, four showed MDM2gene amplification. Finally, 19 cases were confirmed as DDLPS and 4 as ALT/WDLPS. Furthermore, 7/19 cases confirmed as DDLPS and all 4 cases as ALT/WDLPS tested for MDM2 immunostaining, displayed its diffuse immunoexpression, while a single case of DDLPS showed its focal immunostaining. None of the 49 control cases displayed diffuse MDM2 immunoexpression. ALL 16 DDLPSs and 4 cases of ALT/WDLPS displayed p16INK4a immunostaining. The sensitivity for diffuse MDM2 immunostaining was 87.5% in cases of DDLPS, 100% in ALT/WDLPS, and specificity was 100%. The sensitivity for MDM2 gene amplification was 94.7% in cases of DDLPS and 100% in cases of ALT/WDLPS. The sensitivity for p16INK4a was 100%.

Conclusion:

This constitutes the first sizable study on MDM2 testing in ALT/WDLPS and DDLPS from our subcontinent using TMAs. MDM2 gene amplification testing continues as the diagnostic gold standard for ALTs/WDLPSs and DDLPSs and is useful in cases of diagnostic dilemmas. Diffuse MDM2 (IF2 clone) and p16INK4a immunostaining, together seem useful for triaging cases for FISH.
Histopathological spectrum of ocular surface squamous neoplasia
Authors: Mishra Dilip Kumar , Taneja Shikha , Singh Vivek , Veena Uppala , Kaliki Swathi
Published: August 2024

Background:

Ocular surface squamous neoplasia (OSSN) comprises neoplasm arising from the ocular surface, which includes conjunctiva, cornea, and limbus and ranges from mild dysplasia to invasive squamous cell carcinoma.

Purpose:

The aim of this work was to study the spectrum of OSSN based on histopathological analysis. Materials and

Methods:

This was a retrospective cross-sectional study comprising 776 histopathologically diagnosed cases of OSSN from January 2004 to December 2014.

Results:

The mean age of presentation of OSSN was 45 years (median, 45 years; 2 to 87 years) with male preponderance (74%). The most common age group of presentation was 41–60 years (n = 299; 39%). The most common type of OSSN was invasive squamous cell carcinoma seen in 50% (n = 383) eyes followed by severe dysplasia/carcinoma in situin 31% (n = 250) eyes. Tumor infiltration at base was seen in 16% (n = 124), positive margins in 32% (n = 248), scleral infiltration in 14% (n = 109), intraocular extension in 3% (n = 23), and orbital extension in 4% (n = 26) eyes. OSSN was associated with actinic keratosis in 21% (n = 165) cases.

Conclusion:

Based on histopathology, invasive squamous cell carcinoma is the most common form of OSSN in the Asian Indian population.
Evaluation of microsatellite instability in routine examinations of surgical samples
Authors: Wlaszczuk Pawel , Kuzbinska Aleksandra , Dobrosz Zuzanna , Palen Piotr , Pawlicki Krzysztof
Published: August 2024

Context:

Approximately 20%–30% of colon cancer cases have a hereditary basis. The genetic defect may involve mismatch repair (MMR) genes, which results in microsatellite instability (MSI). MMR-deficient colorectal cancer may occur due to germline mutation (Lynch syndrome) or be a sporadic one. A tumor's histological features, supported by a panel of immunohistochemistry stains, enables pathologists to assess the MMR status, which in turn has beneficial effects on clinical management.

Aims:

We aimed to show the relations between histopathological features identified during routine examinations and MMR genes' mutations.

Methods and Material:

We reviewed retrospectively the material of the Department of Pathology fulfilling the revised Bethesda Guidelines.

Statistical Analysis Used:

We used Chi-square test, Spearman test, and epidemiological analysis.

Results:

For the PMS2 gene, the positive predictive value (PPV) indicates that 91% of cases neither present any histological lesions nor have genetic abnormalities. The negative predictive value (NPV) indicates that only 50% of cases have both histological and genetic changes. For the MSH6 gene, the PPV indicates that 85% of tumors without specific histological features do not have genetic abnormalities.

Conclusions:

We advise universal staining for MLH1, MSH2, MSH6, and PMS2 in every newly diagnosed colon cancer, but due to costly analyses we suggest a protocol for the selection of cases for MMR examinations.
High-grade mixed neuroendocrine non-neuroendocrine neoplasm of the gastroesophageal junction
Authors: Sulaiman Mohamed , Agarwal Shipra , Mandal Amitabha , Kumar Sunil , Das Prasenjit
Published: August 2024

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNeN) is a recently described entity of the esophagus in the latest (fifth) edition of WHO Classification of Digestive System Tumors. It is often a difficult pathological diagnosis, especially in small preoperative biopsies. We herein report a case of high-grade MiNeN of gastroesophageal junction diagnosed as a squamous cell carcinoma in preoperative biopsy and subsequently as a high-grade MiNeN in esophagogastrectomy specimen comprising areas of mucoepidermoid carcinoma and large-cell neuroendocrine carcinoma (NEC). This report accentuates the importance of deeper multisite preoperative biopsies as the management is completely different in a MiNeN from esophageal squamous cell carcinoma.
PD-L1 expression in muscle invasive urothelial carcinoma
Authors: Gupta Gurudutt , Pasricha Sunil , Kamboj Meenakshi , Sharma Anila , Nayana NS , Durga Garima , Sharma Anurag , Rawal Sudhir , Meh Anurag
Published: August 2024

Introduction:

High-grade urothelial carcinoma has a different molecular pathway than superficial low grade urothelial carcinoma, and is characterized by genomic instability. The high tumor mutation burden leads to neoantigen formation, evoking an immune response. The immune response has been keenly studied in last two decades and programmed death ligand-1 (PDL-1) has emerged as acceptable immunohistochemical marker for assessment of response to therapy, prognostication and patient selection for immunotherapy. The targeting of PD-1 and PDL-1 by checkpoint inhibitors (CPIs) is an attractive strategy to unblock the inhibitor and induce cytotoxic cell death. However, the presence of complementary and companion diagnostic testing with multiple PDL-1 assays and platforms for various CPIs make a diagnostic quagmire. Thus, it is the need of hour to harmonize these assays. In this undertaken study we evaluated the concordance in PD-L1 expression between the two PD-L1 clones: SP263 and SP142, in treatment naïve muscle invasive bladder cancer (MIBC).

Methods:

We evaluated Ventana PD-L1 “SP263 and SP142” qualitative immunohistochemical assay using rabbit monoclonal anti-PD-L1 clones in evaluation of PDL-1 immunoexpression on Ventana autostainer platform. The study includes 30 muscle invasive urothelial carcinomas, with 10 of 30 having nodal metastasis.

Results:

SP263 assay was statistically more sensitive than SP142 for tumor cell (TC) scoring (P = 0.0009), whereas SP142 was more sensitive for immune cell (IC) scoring (P = 0.0067). There was no statistical significant discordance for TC or IC scoring between primary tumor and metastatic lymph node.

Conclusion:

PD-L1 testing status can be done on both primary tumor and metastatic site, however in metachronous metastatic setting, testing on recent metastatic site should be preferred. The harmonization of immunoexpression between 2 PD-L1 clones could not be achieved.
Feasibility of Indirect immunofluorescence (IIF) alone as a screening method for antinuclear antibody in connective diseases in India's sub-Himalayan region
Authors: Kalita Deepjyoti , Rekha U Sashi , Raj Anusha K. , Mahanta Putul , Gupta Pratima , Deka Sangeeta
Published: August 2024

Background:

For the management of connective tissue disorders (CTDs), antinuclear antibody (ANA) testing is essential, both from diagnostic and prognostic points of view. Usually, patterns obtained by ANA-IIF testing correlates to specific autoantibodies as obtained from the test for ENA (by LIA/ELISA, etc.). But to apply these data from western studies, we may need validation in the local population like our subjects in sub-Himalayan (Garhwal region) area where CTDs are common. Also, suppose ANA-IFA pattern's correlation is reliably known in our population, it can minimize the cost of managing CTDs by limiting ENA testing, which is 10 times costlier than ANA-IIF. Hence, this study was undertaken to know the specific autoantibody targets (ENA by LIA) against ANA-IIF patterns in our local population.

Materials and Methods:

In this retrospective cross-sectional work, serum samples of CTDs were tested for ANA by IIF (Euroimmune AG) and ENA by LIA (Euroline ANA-3G) continuously for 36 months. The manufacturer's kit insert was followed, and results were analyzed applying appropriate statistical methods.

Results:

Major ANA-IIF patterns were found to be associated with specific autoantibodies, for example, Nuclear homogenous with dsDNA, nucleosomes, histones; speckled pattern with nRNP/Sm, Sm, SSA/Ro-52, SSB; nucleolar pattern with Scl-70, Pm-Scl 100 and centromere pattern with CENP-B. Anticytoplasmic (ACA) are found to be linked with some ANA negative (by IIF) samples, emphasizing the need for careful observation for ACA especially where ANA is not found.

Conclusions:

In most subjects, specific ENA targets correlated well with ANA-IIF patterns, implying effective cost minimization in CTD management. Similar future prospective studies (with clinical data) can provide a database and reference for our population.
Diagnostic and prognostic utility of SF-1 in adrenal cortical tumours
Authors: Maity Priyanka , Mondal Akash , Das Rhituparna , Sengupta Moumita , Gargari Piyas , Kar Anish , Sarkar Debansu , Mukhopadhyay Satinath , Chowdhury Subhankar , Chatterjee Uttara
Published: August 2024

Background and Aims:

Superior imaging techniques have increased the recognition of adrenal pathology. Distinguishing benign from malignant adrenocortical tumors is not always easy. Several criteria and immunohistochemical markers have been discovered which help to differentiate between adrenocortical adenoma (ACA) and adrenocortical carcinoma (ACC). Our aim here was to evaluate the diagnostic and prognostic role of steroidogenic factor-1 (SF-1) in adult adrenocortical tumors (ACT) diagnosed using the Weiss criteria. In this cohort, we have also analyzed Ki67 and p53 expression and the extent of agreement between SF-1 and Ki-67.

Methodology:

This was a retrospective, observational study comprising 24 cases of adult ACT over 10 years. Immunohistochemical staining for SF-1, Ki67, and p53 was done in all the cases, and the results correlated with the morphological diagnosis made using Weiss criteria.

Results:

SF-1 was 100% sensitive and 80% specific as a marker of malignancy. Increased SF-1 expression correlated with worse survival. There was a moderate degree of agreement between Ki-67 labeling-index and SF-1 as a marker of malignancy with the kappa coefficient being 0.75. The sensitivity of p53 was lower than Ki67 in diagnosing ACC.

Conclusion:

In adult ACTs, SF-1 has diagnostic significance and prognostic implication. SF-1 is a crucial, dosage-dependent survival factor in ACC. There is a moderate extent of agreement between Ki-67 and SF-1 as a marker of malignancy.
Basal cell carcinoma-clinico-pathological study in Eastern India in correlation with different risk factors
Authors: Jain Chetan , Garg Neha , Singh Sulekha , Chattopadhyay Sarbani
Published: August 2024

Objectives:

To study the histological variants and mimickers of basal cell carcinoma (BCC) alongwith different risk factors among a group of patients from eastern India.

Methods:

The specimen for the study was sent by the dermatology department for histopathology after skin biopsy.

Results:

Out of 42 patients, 15 patients studied were males and the rest of the cases were females. The male to female ratio was 0.55:1. Maximum (15 cases) cases were in the age group of 50–59 years. Apart from sunlight, chronic arsenic exposure is an important risk factor of BCC. Basal cell hyperplasia and squamous cell carcinoma are the histological differential diagnosis of nodular BCC and basosquamous BCC.

Conclusion:

BCC is a disease of the older age group and with female preponderance in our study. Nodular basal cell carcinoma was the most common histologic type of basal cell carcinoma. The face was the most common site for BCC followed by the scalp. UV radiations and Arsenic do play role in the pathogenesis of BCC. CD10 helps differentiate superficial BCC from basal cell hyperplasia.
Immunohistochemical evaluation of E-cadherin in oral epithelial dysplasia and squamous cell carcinoma
Authors: Sharma Jaishree , Bhargava Manish , Aggarwal Shivani , Aggarwal Ashim , Varshney Anchal , Chopra Disha
Published: August 2024

Aim:

To evaluate the expression of E-cadherin (E-cad) in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC).

Material and Method:

Immunohistochemistry was used to detect E-cad expression in 20 cases each of normal oral mucosa, oral epithelial dysplasia and squamous cell carcinoma.

Statistical Analysis Used:

Inferential statistical methods for statistical analysis used were Chi-square test for comparison of the frequency between different severity of dysplasia and OSCC.

Results:

Upon assessing the expression of E-cad in OED and OSCC, increase in E-cad immunoreactivity was seen in early lesions. However, the expression of E-cad decreased significantly as the grade of dysplasia increased.

Conclusion:

We observed a significant decrease in E-cad expression from dysplasia to poorly differentiated squamous cell carcinoma suggesting that loss of expression of E-cad is closely related to carcinoma.
Epstein-Barr virus (EBV) DNAemia in saliva of viral encephalitis and nasopharyngeal carcinoma patients
Authors: Srinivasan Nanditha , Barani Ramya , Manickavasagan M , Srikanth Padma
Published: August 2024

Epstein-Barr virus (EBV) is a lymphotropic virus that causes diseases ranging from a flu-like illness called infectious mononucleosis to nasopharyngeal carcinoma, Burkitt’s lymphoma, and central nervous system (CNS) infection. Detection of EBV DNA is usually done using whole blood samples taken from the patients. We undertook the detection of EBV in blood, cerebrospinal fluid (CSF), and saliva by real-time quantitative PCR in two patients, one with a history of nasopharyngeal carcinoma, and the other having a case of viral encephalitis. EBV was detected only in saliva, whole blood in both patients, and CSF in the second case tested negative. This case series illustrates the importance of testing for EBV DNAemia in saliva by real-time polymerase chain reaction (PCR) to rule in a diagnosis of EBV.
COVID-19
Authors: Jothimani Dinesh , Venugopal Radhika , Manoharan Shruthi , Danielraj Silas , Palanichamy Swetha , Narasimhan Gomathy , Kaliamoorthy Ilankumaran , Rela Mohamed
Published: August 2024

COVID-19 pandemic caused by SARS-CoV-2 virus has been around for 2 years causing significant health-care catastrophes in most parts of the world. The understanding of COVID-19 continues to expand, with multiple newer developments such as the presence of asymptomatic cases, feco-oral transmission, and endothelial dysfunction. The existing classification was developed before this current understanding. With the availability of recent literature evidences, we have attempted a classification encompassing pathogenesis and clinical features for better understanding of the disease process. The pathogenesis of COVID-19 continues to evolve. The spiked protein of the SARS-CoV-2 virus binds to ACE2 receptors causes direct cytopathic damage and hyperinflammatory injury. In addition to alveolar cells, ACE2 is also distributed in gastrointestinal tract and vascular endothelium. ACE2–SARS-CoV-2 interaction engulfs the receptors leading to depletion. Accumulation of Ang2 via AT1 receptor (AT1R) binding causes upregulation of macrophage activity leading to pro-inflammatory cytokine release. Interleukin-6 (IL-6) has been attributed to cause hyperinflammatory syndrome in COVID-19. In addition, it also causes severe widespread endothelial injury through soluble IL-6 receptors. Thrombotic complications occur following the cleavage and activation of von Willebrand factor. Based on the above understanding, clinical features, organ involvement, risk stratification, and disease severity, we have classified COVID-19 patients into asymptomatic, pulmonary, GI, and systemic COVID-19 (S-COVID-19). Studies show that the infectivity and prognosis are different and distinct amongst these groups. Systemic-COVID-19 patients are more likely to be critically ill with multi-organ dysfunction and thrombo-embolic complications.
Survey of semen analysis practices in India and need for standardization and improvement
Authors: Kale Sachin , Bathe Sandeep , Agrawal Ranjan , More Purva , Bharadwaj Era
Published: August 2024

Background and Objectives:

Infertility is a sensitive subject carrying with it economic, social, and psychological implications. Work up of male infertility is often hampered by a lack of infrastructure and facilities, as well as inadequate training of pathology residents. The purpose of this research survey was to evaluate the current status of semen analysis practices and compare them to the standards laid down by the World Health Organization (WHO).

Materials and Methods:

A web-based questionnaire was designed consisting of questions related to semen analysis practices and procedures being followed currently by pathologists in India. A total of 194 pathologists responded. Questions regarding the procedures followed for semen collection, sperm count, volume, normal range, lower normal limit of sperm count, morphology, etc., were included in the survey. These data were recorded. The differences and gaps in the practice with respect to the WHO standards were analyzed.

Results:

The survey revealed that the printed instructions for semen analysis were available with 38.7% of the respondents; 58.8% of the respondents had a separate room for semen collection; 95.9% performed the analysis manually, and; only 4.1% used automated analyzers. Only 53.6 and 52.6% of the respondents were correctly reporting the normal range of semen volume and sperm counts, respectively. Only 19.6% stated as having read the WHO manual and were also practicing its guidelines, while 14.4% had not read the WHO manual even once.

Conclusion:

The present study showed a large gap between the practice of semen analysis by respondents from various parts of India and standard procedures as laid down by the WHO. Many laboratories do not follow the standard instructions. There is a need to improve the quality of practice related to semen analysis in this country through appropriate teaching and training in medical institutions as well as through Continuing Medical Education (CMEs) or regular update programs.
Intranasal glioma (Nasal heterotopia)
Authors: Narang Vikram , Jindal Saveena , Garg Bhavna , Kaur Harpreet , Soni Ankita
Published: August 2024

A 3-month-old boy presented with an intranasal polypoidal mass protruding out of the nostril which was present since birth and growing slowly. The mass was non-pulsatile and soft to firm in consistency. It did not increase in size on coughing, crying, or compression of the jugular vein. Magnetic resonance imaging and contrast-enhanced computed tomography (CT) revealed a lobulated well-circumscribed soft tissue mass in the left nasal cavity with no intracranial communication. Complete surgical excision of the mass was carried out via an intranasal endoscopic approach. Histopathological examination confirmed the diagnosis of intranasal glioma.