Pseudo-neoplastic Lesions of Prostate and the Diagnostic Deception

Introduction: Many pseudo-neoplastic lesions of the prostate gland are recognized. Histologically these lesions mimic the adenocarcinoma of prostate. Pseudo-neoplastic lesions comprise of different glandular and non-glandular or solid patterns. Largely emphasized on the epithelial origin but some stromal and solid lesions are also important. In developing countries, the routine Hematoxylin and eosin (H&E) stain is most commonly used to stain the histological tissue sections. The other stains and molecular studies are not frequently used. The pseudoneoplastic lesions are so obscure and deceptive that sometimes it become very difficult to recognize. The diagnostic facilities both in government and private sector should have at least the facility of immunohistochemical staging to avoid misinterpretations. Methodology: This retrospective study performed at Muhammad Medical College Mirpurkhas Sindh. 192 specimens of radical prostatectomy (RP) and transurethral resection of the prostate (TURP) received between January 2015 to December 2017 were retrieved for review. All retrieved blocks processed as per standard histopathological techniques. Fresh tissue sections taken and stained with H&E. Results: All tissue sections reviewed to observe the glandular patterns, their architectural morphology, cytological changes and inflammatory process. The lesions were distinguished on epithelial origin and glandular patterns. Cases of benign prostatic hyperplasia were 169 (88 %), adenosis 06 (3.12 %), reactive hyperplasia 06 (3.12 %), Post atrophic hyperplasia 05 (2.6 %), benign stromal proliferation 02 (1 %) and prostate carcinoma 04 (2%). Conclusion: Many pseudoneoplastic lesions of the prostate are the mimicker of adenocarcinoma. On H&E stains it sometimes become difficult to differentiate the lesions. The histomorphological diagnosis of these lesions should be facilitated at least by immunohistochemical stains at diagnostic tcenters.t   Keywords: Immunohistochemistry, Transurethral resection of prostate (TURP), Radical prostatectomy (RP). Hematoxylin and Eosin (H&E)

Epigenetic effects of in utero bisphenol A administration: Diabetogenic and atherogenic changes in mice offspring

Objective(s): Bisphenol A (BPA) that is a monomer of plastic products may possibly interfere with epigenetics and be involved in onset and progression of several diseases. This study was aimed to detect the epigenetic effects of in utero BPA exposure in mice offspring.Materials and Methods: All experiments were performed according to the national guidelines for laboratory animals and after ethical approval. Thirty adult BALB/c female mice were divided into 3 equal groups, G1 (controls), G2 (ethanol 0.10 ml/100ml of PBS so that final concentration would be 0.01%) vehicle control and G3 (BPA 10 mg/kg). Chemicals were given twice a week throughout the pregnancy. Once delivered at term, female offspring were observed for body weight, behavior and movements. Blood glucose, serum insulin, cholesterol and high-density lipoprotein cholesterol (HDLc) were measured at 5 and 15 months postnatal. Animals were sacrificed at 15 months and pancreas, kidney, adipose tissue and uterine tissue were taken and stained with either Hematoxylin and eosin (H & E) or immunostaining and examined under light microscope.Results: Offspring of group G3 revealed abnormal changes of body weight, behavior and movements. Blood glucose, serum insulin, cholesterol and HDLc were high in group G3 offspring compared to controls. H & E staining showed changes in the parenchyma of pancreas, kidneys and uterus, which were confirmed by staining with anti- islet-1, kidney-specific (Ksp) cadherin, and anti- MLH antibody. Conclusion: In utero exposure of BPA exerts diabetogenic and atherogenic effects with less parenchymal tissue in endocrine pancreas, kidney and uterus

Incidence of Right Ventricular Dysfunction In Patients of LV Dysfunction with Coronary Artery Disease and Short Term Outcome

Objective: To determine the incidence of RV dysfunction in patients of LV dysfunction with coronary artery disease and short term outcome. Methodology: This prospective study was carried out on 168 patients of LV dysfunction with coronary artery disease in the Echocardiography Unit of the departments of Cardiology, Liaquat University Hospital, Hyderabad from 1st October 2017 to 31st October 2018 and followed for three months. All patients with documented CAD were included. RV evaluation was performed on echocardiography through visual evaluation of RV function, RV region measured in four-chamber perspective and RV duration in a lengthy parasternal perspective. RV dysfunction was characterized as TAPSE of less than 1.2 cm. (RV ejection fraction < 35%). All the data was calculated on SPSS version 16.0. Results:  A total of 168 patients were included in this study based on inclusion criteria, out of the 92(54.7%) were male and 76 (45.3%) were female. The mean ± SD (range) was 52.36 ± 10.44 (30 to 60 years). The mean ± SD of RV ejection fraction was 40.73  ± 8.23% (range 25 to 52). The incidence of RV dysfunction was present in 30(17.8%) patients. Conclusion: In patients with LV dysfunction with coronary disease, in our pateints. It is an independent predictor of death and the development of HF in patients with LV dysfunctio

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

The effect of individualized education with support on breast cancer patients\u27 anxiety and depression during radiation therapy: A pilot study

Purpose: This study was undertaken to determine the effects of individualized education with support intervention on breast cancer patients\u27 anxiety and depression while undergoing radiation therapy (RT). Moreover, the intervention was assessed for its feasibility in the context of Pakistan.Methods: A quasi-experimental design was used to conduct this study in RT department of a public hospital in Karachi. A total of 61 breast cancer patients receiving radiation as adjuvant therapy participated in the study. The experimental group (n = 31) received individualized education with support in the form of face-to-face sessions and information booklet prior to the commencement of RT. In addition, the nurse remained available for the consultation during the RT sessions and on telephone throughout the RT period. However, the control group received only information booklet. Patients\u27 anxiety and depression were measured in both of the groups before the commencement of RT, and at the completion of RT by using the Aga Khan University Anxiety and Depression Scale (AKUADS).Results: A significant reduction was found in the overall mean anxiety and depression scores of the experimental group (p = 0.000) from pre-test to post-test. The overall mean anxiety and depression scores of the control group showed no significant difference (p = 0.187). The effect size of the intervention was large (Cohen\u27s d = 2.5).Conclusion: The intervention was effective in reducing anxiety and depression among breast cancer patients receiving RT. Replication of the study on a larger scale in multiple settings on other cancer patients is recommended

Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

Background and Objectives: COVID-19 is a global pandemic. In our study, we aimed to utilize the hematological parameters in predicting the prognosis and mortality in COVID-19 patients. Materials and methods: A retrospective, observational study was conducted to include all the admitted patients (n = 191) having COVID-19 Polymerase chain reaction (PCR) positive, and evaluated those for prognosis and disease outcome by utilizing several biochemical and hematological markers. Results: Amongst the patients admitted in the ward versus in the intensive care unit (ICU), there were significant differences in mean hemoglobin (P = 0.003), total leukocyte count (P = 0.001), absolute neutrophil and lymphocyte counts (P < 0.001), absolute monocyte count (P = 0.019), Neutrophil-to-Lymphocyte ratio (NLR) and Lymphocyte-to-Monocyte ratio (LMR) (P < 0.001), Platelet-to-Lymphocyte ratio (PLR) and Lymphocyte-to C-reactive protein ratio (LCR) (P = 0.002), and C-reactive protein (CRP) levels (P < 0.001). Amongst the deceased patients, there was significant leukocytosis (P = 0.008), neutrophilia and lymphopenia (P < 0.001), increased NLR (P = 0.001), decreased LMR (P < 0.001), increased PLR (p = 0.017), decreased LCR (p = 0.003), and elevated CRP level (P < 0.001). A receiver operating characteristic curve obtained for the above parameters showed NLR (AUC: 0.841, PPV: 83.6%) and PLR (AUC: 0.703, PPV: 81.8%) for ICU patients, while NLR (AUC: 0.860, PPV: 91.1%) and PLR (AUC: 0.677, PPV: 87.5%) for the deceased patients had significant accuracy for predicting the disease severity of COVID-19 in comparison to survivors. Conclusion: The inflammatory markers and hematological indices are a good guide for predicting the severity and disease outcome of coronavirus disease. NLR and PLR are elevated in severe disease while LMR and LCR are inversely correlating with disease severity

Effect of alcoholic and nano-particles additives on tribological properties of diesel–palm–sesame–biodiesel blends

This study focused on evaluating the lubricity of diesel–biodiesel fuel with oxygenated alcoholic and nano-particle additives. Fuel injection system lubrication depended primarily on the fuel used in the diesel engine. Palm–sesame oil blend was used to produce biodiesel using the ultrasound-assisted technique. B30 fuel sample as a base fuel was blended with fuel additives in different proportions prior to tribological behavior analysis. The lubricity of fuel samples measured using HFRR in accordance with the standard method ASTM D6079. All tested fuels’ Tribological behavior examined through worn steel balls and plates using scanning electron microscopy (SEM) to assess wear scar diameter and surface morphology. During the test run, the friction coefficient was measured directly by the HFRR tribometer system. The results exhibited that B10 (diesel) had a very poor coefficient of friction and wear scar diameter, among other tested fuels. The addition of oxygenated alcohol (ethanol) as a fuel additive in the B30 fuel sample decreased the lubricity of fuel and increased the wear and friction coefficient, among other fuel additives. B30 with DMC showed the least wear scar diameter among all tested fuels. B30 with nanoparticle TiO2 exhibited the best results with the least wear scar diameter and lowest friction coefficient among all other fuel samples. B30+DMC demonstrated significant improvement in engine performance (BTE) and carbon emissions compared to different tested samples. B30+TiO2 also showed considerable improvement in engine characteristics

Association of the 9p21.3 locus with risk of first-ever myocardial infarction in Pakistanis: Case-control study in South Asia and updated meta-analysis of Europeans

Objective: To examine variants at the 9p21 locus in a case-control study of acute myocardial infarction (MI) in Pakistanis and to perform an updated meta-analysis of published studies in people of European ancestry.Methods and results: A total of 1851 patients with first-ever confirmed MI and 1903 controls were genotyped for 89 tagging single-nucleotide polymorphisms at locus 9p21, including the lead variant (rs1333049) identified by the Wellcome Trust Case Control Consortium. Minor allele frequencies and extent of linkage disequilibrium observed in Pakistanis were broadly similar to those seen in Europeans. In the Pakistani study, 6 variants were associated with MI (P\u3c10(-2)) in the initial sample set, and in an additional 741 cases and 674 controls in whom further genotyping was performed for these variants. For Pakistanis, the odds ratio for MI was 1.13 (95% CI, 1.05 to 1.22; P=2 x 10(-3)) for each copy of the C allele at rs1333049. In comparison, a meta-analysis of studies in Europeans yielded an odds ratio of 1.31 (95% CI, 1.26 to 1.37) for the same variant (P=1 x 10(-3) for heterogeneity). Meta-analyses of 23 variants, in up to 38,250 cases and 84,820 controls generally yielded higher values in Europeans than in Pakistanis.Conclusions: To our knowledge, this study provides the first demonstration that variants at the 9p21 locus are significantly associated with MI risk in Pakistanis. However, association signals at this locus were weaker in Pakistanis than those in European studies