Expression of anaplastic lymphokinase and HER2/neu immunostaining in patients with breast carcinoma

Background: The diagnosis and prognosis of breast cancer is done with various immunomarkers including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2/neu), and Ki-67. The diagnostic utility of Anaplastic Lymphokinase (ALK) and HER2/neu should be explored for better management of breast carcinoma patients. So, the present study was designed to determine the expression of immunostaining with ALK and HER2/neu in patients with breast cancer and to compare the association of ALK expression and HER2/neu with clinicopathological parameters.Methods: This is a cross sectional multicenter study carried out from October 2016 to March 2017. A total of 140 subjects having breast carcinoma by using non-probability purposive sampling technique were selected. After taking informed consent, tissue samples were taken from received specimen of mastectomy for hematoxylin and eosin stain. The immunohistochemistry for ALK and HER2/neu were assessed on the paraffin blocks of the tumor.Results: Out of total 140 cases invasive ductal carcinoma (89%), invasive lobular carcinoma (8%), invasive medullary carcinoma (2.1%) and papillary carcinoma (0.7%) were seen. ALK expression was positive in 81 patients (58%) while HER2/neu expression was positive in 53 cases (38%). Significant association was observed between ALK expression with histological grade, lymph node involvement, skin involvement and necrosis. There was also a significant association was seen between HER2/neu expression with lymph node metastasis and necrosis.Conclusions: Present study shows higher expression of ALK when compared to HER2/neu expression in breast cancer patients

The diagnostic utility of ancillary CD117 immunomarker compared with cell block cytology of thyroid lesions based on Bethesda grading system

Background: This is a cross sectional multicenter study carried out from July 2017 to December 2017. The aim of the present study is to evaluate the fine needle aspiration cytology and cell block of thyroid lesions on the basis of Bethesda grading system. Also, expression of CD117 immunostaining in thyroid lesions was evaluated. Finally, the results of cell block were compared with expression of CD117 immunomarker for diagnostic confirmation of different thyroid lesions.Methods: Total one hundred (100) patients presenting with thyroid swelling underwent fine needle aspiration, cell block preparation to diagnose and categorize thyroid lesion on the basis of Bethesda grading system and finally immunostaining with CD117 was carried out.Results: FNAC results showed 71% patients with benign thyroid morphology and about 23% cases were categorized as atypical to fairly malignant. In cell block study benign lesions diagnosed were 77%, 17% cases as suspicious and 6% were malignant thyroid nodules. Whereas expression of ancillary CD117 immunomarker, confirmed 83% as benign lesions and 17% cases as malignant. Overall ancillary CD117 immunomarker established the better diagnosis to manage and differentiate thyroid lesions.Conclusions: Cell block results are more accurate than FNAC in thyroid patients. The CD117 immunomarkers can be used as better diagnostic tool for confirmation of thyroid lesions and thus it can reduce unnecessary surgical intervention

Serum malondialdehyde and adiponectin in albuminuric kidney disease patients

Background: Diabetes, hypertension, oxidative stress, obesity, adipocytokine dysfunction, and dyslipidemia are causative factors in development of Chronic Kidney Disease (CKD). Adiponectin secreted from adipose tissue, has Reno protective effect against development of albuminuria in animal studies. The previous studies investigated the relationship between serum adiponectin level and urinary albuminuria in kidney disease patients, but the results are conflicting.Methods: The pre diagnosed kidney disease patients were divided into microalbuminuria and macroalbuminuria groups, while control subjects were called as normoal buminuria group. The pre diagnosed adult kidney disease patients of both genders with age matching control subjects with no known comorbidity were included in the study. Whereas pregnant female patients and the patients with comorbidity were excluded from the study. The demographic data and the anthropometric data of control and kidney patients were recorded. The blood was analyzed for Glycosylated Hemoglobin (HbA1c), electrolytes, glucose, calcium, total protein, albumin, urea, creatinine adiponectin and malondialdehyde. The Urine was analyzed for Creatinine and albuminuria. The glomerular filtration rate was estimated.Results: The blood pressure, blood urea, creatinine, glycated hemoglobin, malondialdehyde, adiponectin levels were higher in albuminuric kidney patients as compared to normal control subjects. The mean glomerular filtration rate was lowest in macroalbuminuric patients as compared to micro and normoalbuminuric patients. The serum adiponectin and serum malondialdehyde both showed positive correlation with serum creatinine, and with albuminuria/urinary creatinine ratio.Conclusions: The study concludes that, positive correlation of serum malondialdehyde with adiponectin and albuminuria

Comparative analysis of postpartum IUDC versus interval IUCD insertion: a study conducted in a tertiary care hospital in Karachi, Pakistan

Background: To compare the effectiveness of postpartum intrauterine contraceptive device (PPIUCD) with interval IUCD in terms of effectiveness, expulsions, bleeding pain and other complications at Tertiary care Hospital.Methods: Current study was conducted among 224 women, at Gynaecology and Obstetrics of Reproductive Health Services-A (RHS-A) Centre of Jinnah Post Graduate Medical center, Karachi, for a period of Six months. Approval from Ethical committee and informed consent was taken from women and her husband before starting the study. The WHO medical eligibility criteria for contraceptive use (MEC) were followed and IUCD was inserted in 112 women in PPIUCD group and in 112 women in interval IUCD group. These cases were followed at 15 days, 6 weeks and 6 months. Results of PPIUCD group were compared with interval IUCDs group. Data was analyzed by using SPSS version 18.0. Continuous variables like age, parity, hemoglobin level were analyzed as mean±standard deviation. Frequencies and percentages were calculated for infection, expulsion, bleeding per vagina and effectiveness. Chi-square was applied to assess the difference between the categories. p value <0.05 was taken as significant.Results: The two groups were identical in mean ± SD age, parity, residence and baseline hemoglobin level. PPIUCD (Group-A) was more effective i.e., 87.5% as compared to interval IUCD (Group-B) i.e., 83.9%. Pain, PID, bleeding and expulsion of IUCD were more prevalent with interval IUCD (Group-B) than PPIUCD (Group-A) patients. Stratified analysis showed that age, parity & mean baseline hemoglobin were non-significant effect modifiers on the effectiveness among the two groups.Conclusions: Postpartum IUCD use was found to be a safe, simple, inexpensive and reversible procedure with higher chances of retention for a longer period. Additionally, there is decreased risk of complications and lower expulsion rates when compared with interval IUCD

Prevalence of HER-2/ neu receptor amplification and its effects over prognosis of the patients with breast cancer

Background: The diagnosis and prognosis of patients with breast cancer is routinely carried out with biopsy of growth by H&E staining but it is not commonly practice with various immunomarkers including HER2/neu. However HER2/neu association in breast tumour patients with prognosis has not been studied much, so this study is aim to evaluate the frequency of HER2 (human epidermal growth factor receptor) amplification and its effects over prognosis among the patients with breast cancer.Methods: After ethical approval, retrospective observational study was conducted from October 2014 to September 2017. All operated patients with biopsy proven breast cancer, the patients having any stage of disease, with sufficient data present in hospital record and patients who received neo-adjuvant chemo-therapy/radio-therapy were included. Patients unfit for surgery due to co-morbidities like cardio renal diseases and patients having insufficient hospital record or who missed follow-ups were excluded. SPSS version 20.0 was used for data analysis for data analysis with qualitative data presented as frequency and percentages.Results: A Total 120 patients, 48(40%) had HER-2/ neu positive. Among the HER2 +ve patients, 17(35.4%) had local recurrence within 03 years while 21(43.7%) cases had distant recurrence. The disease free survival rate in 03 years was observed in 22(45.83%) out of 48 HER2 +ve cases.Conclusions: Study reveals 40% patients had HER-2/neu positive expression and was associated with poor outcomes and disease free survival time period in comparison to patient with HER-2/ neu negative

Frequency of early post operative complications of modified radical mastectomy within period of four weeks

Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Cost-Based Optimization of Isolated Footing in Cohesive Soils Using Generalized Reduced Gradient Method

This study presents a cost-based optimization model for the design of isolated foundations in cohesive soils. The optimization algorithm not only incorporates safety requirements in the form of ultimate limit state (ULS) and serviceability limit state (SLS) criteria but also deals with the economics simultaneously. In that regard, the generalized reduced gradient (GRG) method is used for the optimization purpose to achieve the least construction cost of an isolated foundation along with the integration of design parameters as optimization variables. The optimization technique is elaborated using a design example in silty clayey soil and the results of the optimized design are compared with those of the conventional design. The optimization model shows that the optimized design can reduce the construction cost by up to 44% as compared to the conventional design cost for the particular example. Moreover, a sensitivity analysis is also performed to evaluate the quantitative impact of cohesive soil properties, design load, and groundwater table on the construction cost. The results indicate that the construction cost majorly depends on the combined effect of four key parameters: Young’s modulus, recompression index, design load, and groundwater table

Cost-Based Optimization of Isolated Footing in Cohesive Soils Using Generalized Reduced Gradient Method

This study presents a cost-based optimization model for the design of isolated foundations in cohesive soils. The optimization algorithm not only incorporates safety requirements in the form of ultimate limit state (ULS) and serviceability limit state (SLS) criteria but also deals with the economics simultaneously. In that regard, the generalized reduced gradient (GRG) method is used for the optimization purpose to achieve the least construction cost of an isolated foundation along with the integration of design parameters as optimization variables. The optimization technique is elaborated using a design example in silty clayey soil and the results of the optimized design are compared with those of the conventional design. The optimization model shows that the optimized design can reduce the construction cost by up to 44% as compared to the conventional design cost for the particular example. Moreover, a sensitivity analysis is also performed to evaluate the quantitative impact of cohesive soil properties, design load, and groundwater table on the construction cost. The results indicate that the construction cost majorly depends on the combined effect of four key parameters: Young&rsquo;s modulus, recompression index, design load, and groundwater table