HISTO-PATHOLOGICAL CORRELATION BETWEEN SENTINEL LYMPH NODE BIOPSY AND AXILLARY LYMPH NODE BIOPSY IN PATIENTS WITH CARCINOMA OF BREAST

Introduction: The present study was aimed at mapping of lymphatic passage of sentinel lymph node in patients of carcinoma of breast and to correlate pathology of Sentinel lymph node biopsy (SLNB) and Axillary Lymph node Dissection (ALND). Material and methods: Patients presenting with palpable breast carcinoma without clinically palpable or suspicious axillary lymph nodes, potentially curable breast carcinoma (T1, T2 tumours) who were undergoing ALND and willing to participate in the study were included in the study. Patients with prior axillary operations, large & locally advanced invasive breast cancers, ductal carcinoma in situ, prior breast surgery, prior chemotherapy, distant metastases and pregnant women were excluded from the study. The histopathology of SLNB and ALND were correlated in the patients and sensitivity and specificity of SLNB was calculated. Results: 50 patients were included in the study. The blue staining sentinel lymph node was identified in 30 of 50 (60%) procedures. Of the 30 patients in whom SLN was identified, 1(3.33%) had histologically negative nodes and 29(96.66%) had histologically positive nodes; of 20 patients who had negative sentinel nodes, 19(95%) had histologically negative evidence of axillary metastasis, while 1(5%) showed histologically positive evidence of axillary metastasis. The sensitivity of sentinel lymph node status with comparison to the gold standard i.e., histopathology report, was 96.6% while the specificity was 95%. The overall positive and negative predictive values were 96.67% and 95%, respectively. Conclusion: Although further studies are requires to confirm the findings of the present study, the SLN accurately reflects the status of axillary lymph nodes in most patients with breast cancer, and for those with early stage disease it is rapidly emerging as an alternative to conventional axillary dissection. Key words: Carcinoma Breast, Histopathology, Mapping, Axillary Lymph node Dissection, Sentinel lymph node biops

HISTO-PATHOLOGICAL CORRELATION BETWEEN SENTINEL LYMPH NODE BIOPSY AND AXILLARY LYMPH NODE BIOPSY IN PATIENTS WITH CARCINOMA OF BREAST

Introduction: The present study was aimed at mapping of lymphatic passage of sentinel lymph node in patients of carcinoma of breast and to correlate pathology of Sentinel lymph node biopsy (SLNB) and Axillary Lymph node Dissection (ALND). Material and methods: Patients presenting with palpable breast carcinoma without clinically palpable or suspicious axillary lymph nodes, potentially curable breast carcinoma (T1, T2 tumours) who were undergoing ALND and willing to participate in the study were included in the study. Patients with prior axillary operations, large & locally advanced invasive breast cancers, ductal carcinoma in situ, prior breast surgery, prior chemotherapy, distant metastases and pregnant women were excluded from the study. The histopathology of SLNB and ALND were correlated in the patients and sensitivity and specificity of SLNB was calculated. Results: 50 patients were included in the study. The blue staining sentinel lymph node was identified in 30 of 50 (60%) procedures. Of the 30 patients in whom SLN was identified, 1(3.33%) had histologically negative nodes and 29(96.66%) had histologically positive nodes; of 20 patients who had negative sentinel nodes, 19(95%) had histologically negative evidence of axillary metastasis, while 1(5%) showed histologically positive evidence of axillary metastasis. The sensitivity of sentinel lymph node status with comparison to the gold standard i.e., histopathology report, was 96.6% while the specificity was 95%. The overall positive and negative predictive values were 96.67% and 95%, respectively. Conclusion: Although further studies are requires to confirm the findings of the present study, the SLN accurately reflects the status of axillary lymph nodes in most patients with breast cancer, and for those with early stage disease it is rapidly emerging as an alternative to conventional axillary dissection. Key words: Carcinoma Breast, Histopathology, Mapping, Axillary Lymph node Dissection, Sentinel lymph node biops

Combining insulins for optimal blood glucose control in type 1 and 2 diabetes: Focus on insulin glulisine

Normalization of blood glucose is essential for the prevention of diabetes mellitus (DM)-related microvascular and macrovascular complications. Despite substantial literature to support the benefits of glucose lowering and clear treatment targets, glycemic control remains suboptimal for most people with DM in the United States. Pharmacokinetic limitations of conventional insulins have been a barrier to achieving treatment targets secondary to adverse effects such as hypoglycemia and weight gain. Recombinant DNA technology has allowed modification of the insulin molecule to produce insulin analogues that overcome these pharmacokinetic limitations. With time action profiles that more closely mimic physiologic insulin secretion, rapid acting insulin analogues (RAAs) reduce post-prandial glucose excursions and hypoglycemia when compared to regular human insulin (RHI). Insulin glulisine (Apidra®) is a rapid-acting insulin analogue created by substituting lysine for asparagine at position B3 and glutamic acid for lysine at position B29 on the B chain of human insulin. The quick absorption of insulin glulisine more closely reproduces physiologic first-phase insulin secretion and its rapid acting profile is maintained across patient subtypes. Clinical trials have demonstrated comparable or greater efficacy of insulin glulisine versus insulin lispro or RHI, respectively. Efficacy is maintained even when insulin glulisine is administered post-meal. In addition, glulisine appears to have a more rapid time action profile compared with insulin lispro across various body mass indexes (BMIs). The safety and tolerability profile of insulin glulisine is also comparable to that of insulin lispro or RHI in type 1 or 2 DM and it has been shown to be as safe and effective when used in a continuous subcutaneous insulin infusion (CSII). In summary, insulin glulisine is a safe, effective, and well tolerated rapid-acting insulin analogue across all BMIs and a worthy option for prandial glucose control in type 1 or 2 DM

Retained Percutaneous Tube—A Misery of Illiteracy

Percutaneous catheter drainage of liver abscesses is an established technique. Intracavitatory knotting of the tube is a rare and potentially preventable complication that can involve significant morbidity. However, because of the rarity of this complication, there remains a persistent lack of awareness in the clinical community. The risk of tube knotting can be reduced with proper technique and correct choice of tubes

Pharmacokinetics and bioavailability of ofloxacin following single intramuscular and subcutaneous administration in goats

Comparative disposition kinetics of ofloxacin following intramuscular (i.m.) and subcutaneous (s.c.) administration was studied in goats @ 10 mg/kg. Ofloxacin was determined by HPLC method and kinetic parameters using a software. Appreciable plasma concentrations were observed within 2.5 min of drug administration and peaked at 1 h. t1/2ka and t1/2β values were 13.59 and 78.41 min after i.m. administration while 17.89 and 103.59 min after s.c. administration and the corresponding bioavailability values were 75.43±5.00 and 102.07±7.00 %. Ofloxacin may be adiministered to goat @10 mg/kg at 12 h interval by s.c. route

Polimorfizam gena za adiponektin (ADIPOQ) i njegova povezanost s proizvodnim i rasplodnim svojstvima indijskog mliječnog goveda

The present investigation was performed to explore the SNP in the promoter of the adiponectin (ADIPOQ) gene and its association with production and reproduction traits in Indian Sahiwal cows. A portion of the promoter (ADIPOQ) region of the ADIPOQ gene was amplified which revealed a 977 bp amplicon, and its PCR-RFLP assay with the restriction enzyme TasI revealed three genotypes, in which the CT genotype was the most frequent (62.32%), followed by CC (24.64%) and TT (13.04%). The frequency of the C and T alleles was 0.558 and 0.442, respectively. The ADIPOQ/TasI genotypes revealed a significant association with calving interval (CI) in the first and fourth lactations, in which the CC genotype showed a significantly (P<0.05) longer CI compared to the TT genotype, while in the fourth lactation the TT genotype showed a longer CI compared to the CC genotype. In the fourth lactation, the TT genotype showed a significantly (P<0.05) longer lactation period (LP) and greater total milk yield (TMY) as compared to CC and CT genotypes. In conclusion, the SNP identified in the promoter of the ADIPOQ gene and its association with production and reproduction traits suggests that this gene might serve as a candidate genetic marker for selection of dairy cattle with better milk yield. However, further studies are needed to explore these SNPs in other regions of this gene, and in other breeds and populations.Cilj ovoga rada bio je istražiti polimorfizam pojedinačnog nukleotida (SNP) u promotoru gena za adiponektin (ADIPOQ) i njegovu povezanost s proizvodnim i rasplodnim svojstvima indijskog goveda Sahiwal pasmine. Dio promotora (ADIPOQ) regije gena ADIPOQ je umnožen i prikazan produktom 977 bp, a PCR-RFLP metodom s restrikcijom enzimom TasI dobivena su tri genotipa. Među njima najčešći je bio CT genotip (62,32 %), zatim CC (24,64 %) i TT (13,04 %). Učestalost C-alela bila je 0,558, a T-alela 0,442. ADIPOQ/TasI genotipovi su pokazali znakovitu povezanost s međutelidbenim intervalom (CI) u prvoj i četvrtoj laktaciji u kojima je CC genotip pokazao znakovito duži interval između teljenja (P<0,05) u usporedbi s TT genotipom, dok je u četvrtoj laktaciji TT genotip pokazao duži interval teljenja u usporedbi s CC genotipom. U četvrtoj laktaciji TT genotip pokazao je znakovito duže trajanje laktacije (LP) (P<0,05) i ukupan prinos mlijeka (TMY) u usporedbi s CC i CT genotipovima. Zaključno, SNP identificiran u promotoru gena ADIPOQ i njegova povezanost s proizvodnim i reproduktivnim svojstvima upućuju na to da ovaj gen može poslužiti kao kandidatni genski biljeg za selekciju mliječnih krava s većim prinosom mlijeka. Potrebna su daljnja istraživanja polimorfizama pojedinačnih nukleotida u drugim regijama ovoga gena kao i u drugih pasmina i populacija

Utjecaj jednokratne intravenske primjene ofloksacina na kinetiku raspodjele meloksikama u koza.

The objective of the present study was to investigate the effect of ofloxacin (10 mg/kg) on the pharmacokinetics of meloxicam (0.5 mg/kg) in goats, when administered concurrently by intravenous route. Meloxicam concentration in plasma was measured using HPLC assay. The pharmacokinetics of meloxicam were best described by the two-compartment open model. Following concurrent administration of meloxicam and ofloxacin, the mean plasma level of meloxicam was only found to be significantly higher (P<0.05) at 15 min compared to its alone administration. Statistical analysis of data revealed that there were no statistically significant differences in PK parameters between the two treatments, except K21. Therefore, the results of the present study suggest that concurrent administration of ofl oxacin and meloxicam in goats does not require any adjustment in dosage regimens. Based on PK determinants, meloxicam may be administered by i.v. route at 0.86 and 0.65 mg/kg, as loading and maintenance doses respectively, and is to be repeated at 8 h intervals.Istražen je učinak ofloksacina (10 mg/kg) na farmakokinetiku meloksikama (0,5 mg/kg) u koza pod uvjetima istodobne intravenske primjene. Koncentracija meloksikama u plazmi utvrđena je visokotlačnom tekućinskom kromatografijom. Kao najbolji model za opis njegove farmakokinetike korišten je otvoreni model s dvama odjeljcima. Istodobnom primjenom meloksikama i ofloksacina, srednja razina meloksikama u plazmi bila je statistički značajno viša (P<0,05) samo 15 minuta u usporedbi s primjenom samog meloksikama. Statistička analiza podataka pokazala je da između dva načina primjene ne postoje značajne razlike farmakokinetičkih pokazatelja, osim za K21. Rezultati istraživanja pokazuju da kod koza doziranje ofloksacina i meloksikama prilikom njihove istovremene primjene ne treba mijenjati. Na temelju farmakokinetičkih pokazatelja, meloksikam se može primijeniti intravenski u početnoj dozi od 0,86 mg/kg, te u dozi za održavanje od 0,65 mg/ kg, uz ponavljanje u vremenskim razmacima od 8 sati

Future Path Toward TB Vaccine Development: Boosting BCG or Re-educating by a New Subunit Vaccine

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (Mtb), kills 5,000 people per day globally. Rapid development and spread of various multi drug-resistant strains of Mtb emphasize that an effective vaccine is still the most cost-effectives and efficient way of controlling and eradicating TB. Bacillus Calmette-Guerin (BCG), the only licensed TB vaccine, still remains the most widely administered human vaccine, but is inefficient in protecting from pulmonary TB in adults. The protective immunity afforded by BCG is thought to wane with time and considered to last only through adolescent years. Heterologous boosting of BCG-primed immune responses using a subunit vaccine represents a promising vaccination approach to promote strong cellular responses against Mtb. In our earlier studies, we discovered lipopeptides of ESAT-6 antigen with strong potential as a subunit vaccine candidate. Here, we have investigated that potential as a booster to BCG vaccine in both a pre-exposure preventive vaccine and a post-exposure therapeutic vaccine setting. Surprisingly, our results demonstrated that boosting BCG with subunit vaccine shortly before Mtb challenge did not improve the BCG-primed immunity, whereas the subunit vaccine boost after Mtb challenge markedly improved the quantity and quality of effector T cell responses and significantly reduced Mtb load in lungs, liver and spleen in mice. These studies suggest that ESAT-6 lipopeptide-based subunit vaccine was ineffective in overcoming the apparent immunomodulation induced by BCG vaccine in Mtb uninfected mice, but upon infection, the subunit vaccine is effective in re-educating the protective immunity against Mtb infection. These important results have significant implications in the design and investigation of effective vaccine strategies and immunotherapeutic approaches for individuals who have been pre-immunized with BCG vaccine but still get infected with Mtb

Optimizing postprandial glucose management in adults with insulin-requiring diabetes: Report and recommendations

Faster-acting insulins, new noninsulin drug classes, more flexible insulin-delivery systems, and improved continuous glucose monitoring devices offer unprecedented opportunities to improve postprandial glucose (PPG) management and overall care for adults with insulin-treated diabetes. These developments led the Endocrine Society to convene a working panel of diabetes experts in December 2018 to assess the current state of PPG management, identify innovative ways to improve self-management and quality of life, and align best practices to current and emerging treatment and monitoring options. Drawing on current research and collective clinical experience, we considered the following issues for the ∼200 million adults worldwide with type 1 and insulin-requiring type 2 diabetes: (i) the role of PPG management in reducing the risk of diabetes complications; (ii) barriers preventing effective PPG management; (iii) strategies to reduce PPG excursions and improve patient quality of life; and (iv) education and clinical tools to support endocrinologists in improving PPG management. We concluded that managing PPG to minimize or prevent diabetes-related complications will require elucidating fundamental questions about optimal ways to quantify and clinically assess the metabolic dysregulation and consequences of the abnormal postprandial state in diabetes and recommend research strategies to address these questions. We also identified practical strategies and tools that are already available to reduce barriers to effective PPG management, optimize use of new and emerging clinical tools, and improve patient self-management and quality of life