miRNAs: Small but deadly

microRNAs (miRNAs) are unique class of global gene regulators identified both in plants and animals. They can reduce protein levels of their target genes with a minor impact on the target genes mRNA. Levels of some miRNAs are found altered in cancers, so we might expect these regulatory molecules to be involved in the development of different carcinomas. The differential expression of certain miRNAs in various tumors might become a powerful tool to aid in the diagnosis and treatment of cancers. The precise biological roles of most miRNAs are still poorly understood and therefore, this review is an attempt to highlight the role and connections of human miRNA with different aspects of cancers.Key words: microRNA, cancer, tumour, metastasis, upregulation, miRNA

Respiratory arrest in a child after flushing of pancuronium from the dead space of intravenous cannula

It is common practice for patients admitted to Intensive Care Units to have indwelling intravenous cannulae. Sometimes these cannulae are used only for the administration of drugs and are closed otherwise. Residual drugs in the deadspace of these intravenous cannulae as well as connected stoppers or 3-way stopcocks can later be flushed unknowingly. We would like to report a case in which inadvertent flushing of residual pancuronium caused complete muscle paralysis and respiratory arrest in a young child

Giant ganglioneuroma in a 5-year child

ABSTRACT We report a 5-year boy presenting with pain in the lower chest and upper abdomen. On evaluation with computed tomography scan of the chest, he was found to have a large 16 x 14 cm posterior mediastinal mass compressing the inferior vena cava and liver, and shifting the heart to the opposite side. Tumor was approached via right postero-lateral thoracotomy and dissected off from esophagus, heart, inferior vena cava and lungs. The entire tumor was resected without any complications. Postoperative course was unremarkable. Resection of the tumor was successful. The histopathology showed it to be giant ganglioneuroma with no evidence of malignancy

Giant aortic root aneurysm associated with postductal coarctation of aorta

The aorta is a large blood vessel that carries blood from the heart to the rest of thebody. The aortic root consists of the aortic valve and the openings for thecoronary arteries (the coronary ostia). An aortic aneurysm is an abnormal bulgein the wall of the aorta. If an aneurysm develops in the aortic root, the aorta candilate and the aortic valve can leak. If the aneurysm continues to expand, it canrupture and can cause life-threatening internal bleeding.Aneurysms of the aortic root are often due to degenerative disease of media.Aneurysm of the aortic root often affects patients in their second to fourthdecades of life. These aneurysms can cause aortic insufficiency, dissection,and/or rupture.Small and slow-growing thoracic aortic aneurysms may not everrupture, but large, fast-growing aneurysms may rupture.Depending on the size and growth rate of aortic aneurysm, treatment may varyfrom watchful waiting to emergency surgery. Ideally, surgery for a thoracic aorticaneurysm can be planned if necessary. Current guidelines recommend surgicaltreatment when the diameter of the aneurysm exceeds 50 mm. Here we report acase of thoracic aneurysm with postductal coarctation of aort

Prenatal Diagnosis of Maternal Serum from Mothers Carrying β-thalassemic Fetus

Background Current study focused on discovering protein biomarkers from the maternal serum of β-thalassemic trait mothers carrying the normal fetus and β-thalassemic major fetus. Method Serum samples from β-thalassemic trait mothers carrying major (N=5) and normal fetuses (N=5) were studied. IVS1-5 thalassemia mutation was common among β-thalassemic trait mothers who were carrying homozygous β-thalassemic fetus (IVS1-5/ IVS1-5 mutation) or normal fetus (no mutation). We employed two-dimensional gel electrophoresis and mass spectrometric analysis to explore differentially expressed maternal serum proteins from thalassemia carrier couples having the same β-thalassemia mutation. Western blotting was performed for one of the identified proteins to validate our data. Results Ten proteins were identified in maternal serum of β-thalassemic trait mothers carrying the β-thalassemic major fetus and normal fetus. Among these, Serotransferrin, Haptoglobin, Alpha-1 anti-trypsin (A1AT), Apo-lipoprotein A1, and Fibrinogen-beta chain were found to be up-regulated in mothers carrying major fetuses and are known to be associated with pregnancy-related disorders. The expression of A1AT was validated through western blotting. Conclusion Proteins identified in the current study from maternal serum are reported to contribute to hereditary disorders. We suggest that these can serve as putative screening markers for non-invasive prenatal diagnosis in β-thalassemic pregnancies

Delayed presentation of forgotten thyroid goiter - 25 years after thyroidectomy

Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy was a novel experience. The mass was completely excised and the patient\u27s symptoms alleviated after the surgery. The patient recovered without any complications and there was no recurrence at 1 year of follow-up

The effects of semicon on space charge behavior under different temperature conditions for HVDC cable insulation

One of the major concerns related to HVDC applications is the presence of space charge within the dielectrics, which distorts the electric field distribution and contributes to accelerated ageing and consequent failure of the cable insulation. In this paper, an attempt is made to explore the space charge characteristics using different electrode materials and temperature conditions to highlight the variation in space charge formation and distribution in the system using pulsed electro acoustic (PEA) technique. To simulate a real cable manufacturing process, XLPE insulation was sandwiched between two layers of thermal bonded semicon material. The experimental results revealed that the semiconductive materials has a greater influence on the space charge formation. It was found the electrode materials play a vital role in determining the charge distribution in the insulation and significant dependence on the electrode materials under the same applied stress and temperature conditions. Thermal bonded semicon samples have a stronger charge injection and greater charge amount within the bulk and high temperature can greatly increase the charge mobility for both polarities as well as enhances charge injection. These findings are discussed in conjunction with unbonded sample (conventional setup) for the space charge measurements

Retrograde bullet migration from inferior vena cava into right common iliac vein following gunshot: a case report

Abstract Bullet embolization cases are rare and even rarer are its retrograde migration in the veins. We report the case of a 14 year old male with a gunshot wound to the left side of his chest. CT scan revealed bilateral haemothorax and foreign body in the right common iliac vein. The patient was immediately taken to the operating theatre and median sternotomy performed. Bullet entry tear was found in the inferior vena cava however, the bullet was found lodged in the right common iliac vein and slipped down against the flow of blood. The bullet was left in situ and after the necessary repair the chest was closed and the patient shifted to the CICU and discharged after 4 days in stable condition. Patient was followed after 1 week and reassured and advised for one year follow-up

Management of penetrating injury to thoracic inlet and lower neck with retained foreign body using video assisted thoracoscopic surgery

Penetrating neck and chest injuries are a common form of occupational injuries. We hereby report a unique case in which a metallic rod had penetrated the left chest and neck of a plastic factory worker. The patient was vitally stable when he presented to Emergency Room. Chest X-ray was performed and the patient was rushed to the operating room. VATS (video assisted thoracoscopic surgery) and neck dissection was done for retrieval of the metallic rod. On table, endoscopy was also done to rule out injury to oesophagus. No injury to vital structures was found and the subsequent recovery was uneventful

Patterns of Admission in Intensive Care Unit of Tertiary Care Hospital

Background: It is well known that early appropriate referrals of critically ill patients to an ICU can significantly reduce the mortality. At the same time, improper admissions to ICU limits bed availability that adversely affects ICU functioning. Objective: To determine the patterns of admissions and outcome in Medical and Surgical Intensive care Units.Material & Methods: A retrospective review of all patients admitted in medical and surgical ICU of Pakistan Institute of Medical Sciences, Islamabad from 2014 to 2016 was done. Data was collected from admission registers and patients’ files. Data was analyzed using SPSS software version 20.0. Chi-square test was applied and P-value < 0.05 was considered significant.Results: Study recruited data of 1652 patients admitted to intensive care unit of PIMS hospital. There were 769(46.5%) males and 883(53.5%) females. Among all the patients, 503(30.4%) were admitted to medical intensive care unit while 1149(69.6%) were admitted to surgical intensive care Unit. 684(41.4%) had undergone mortality while 968(58.6%) remained alive. Overall mean length of hospital stay was 7.4±4.1SD, mean length of mechanical ventilation 4.1±2.1SD and mean length of supplemental ventilation was 1.5±0.11SD. Acute abdomen (13.1%) and head injuries (12%) were most common causes for admission in ICU. Statistically significant association between years (2014, 2015 & 2016) and disease (p=0.000), years and mortality (p=0.000), years and age (p=0.000), intensive care unit and gender (p=0.01), intensive care unit and age (p=0.02) was reported.Conclusion: Acute abdomen and Head injuries had highest number of admissions in Medical and Surgical intensive care unit of PIMS hospital. Developing a well-equipped trauma ICU with adequately trained staff will help improve the outcome of patients