Role of Interleukin-18 in Thyroid tumorigenesis

Purpose: Although the significance of Interleukin-18 (IL-18) has been studied in pathogenesis of different cancers including, ovarian, gastric, breast, lung carcinoma and melanoma, its role in thyroid cancer- the most common endocrine malignancy has not yet been looked at extensively. Hence, this study intended to examine the role of IL-18 in thyroid tumorigenesis.Methods: Sixty seven patients with benign thyroid diseases and 106 thyroid cancer patients (including 83 papillary, 6 follicular, 9 medullary and 8 anaplastic thyroid carcinoma patients) were enrolled in the study. To accomplish the aim, the circulating levels of IL-18 were estimated by enzyme linked immunosorbent assay (ELISA) from all patients and compared with controls. Further, protein expression of IL-18 was determined from the primary tumors of the patients using immunohistochemistry.Results: It was observed that the circulating levels of IL-18 were significantly higher in all patients: benign thyroid diseases (p = 0.006), papillary (p < 0.001), follicular (p = 0.023), medullary (p = 0.002) and anaplastic thyroid cancer (p < 0.001) than the controls. In addition to this, IL-18 could well discriminate papillary (AUC = 0.627, p =0.008) and anaplastic thyroid carcinoma patients (AUC = 0.777, p = 0.011) from patients with benign thyroid diseases. However, the difference between tumoral protein expression of IL-18 in patients with benign thyroid diseases and thyroid carcinoma was not significant. The Kaplan - Meier survival analysis revealed that neither the circulating nor the tumoral protein expression of IL-18 was the significant predictor of disease free survival (DFS) or overall survival (OS) in papillary thyroid cancer patients.Conclusion: Though not a significant prognosticator, circulating IL-18 may be useful as a differentiating factor in thyroid tumorigenesis and the increase in serum IL-18 levels may be provoked in response to the tumor. Thus, including IL-18 along with the current treatment practice may have a significant role in better management of the disease. However, further exploration of this interleukin is required in a larger series of patients with longer follow up period

Significance of TNF- α

Circulating levels of TNF-α and the adhesion molecules L-Selectin and VCAM-1 as well as their expression in the primary tumors of patients with benign thyroid diseases and papillary thyroid carcinoma (PTC) have been determined in this study. The serum levels of TNF-α, L-Selectin, and VCAM-1 were significantly higher in patients with both benign thyroid diseases and PTC as compared to the healthy individuals. However, the levels of only TNF-α and L-Selectin, and not VCAM-1, were significantly higher in patients with PTC in comparison to those observed in patients with benign thyroid diseases. Further the expression of TNF-α and L-Selectin was also significantly higher in the primary tumors of PTC patients, relative to the benign thyroid diseases. The expression of L-Selectin and VCAM-1 significantly correlated with aggressive tumor behavior. In PTC patients, the circulating TNF-α levels significantly positively correlated with the levels of L-Selectin, while TNF-α immunoreactivity was significantly associated with VCAM-1 expression. Serum TNF-α was found to be a significant prognosticator for OS in PTC patients. Overall the results signify that the interaction between TNF-α and the adhesion molecules may have a role in thyroid carcinogenesis and understanding this complexity may offer potential therapeutic targets for better management of thyroid cancer

A study of the perception of medical teachers regarding education in ophthalmology in Western India

Background: Frequent unpleasant incidences, conflicts, and litigations between patients and doctors point to the fact that medical graduates perhaps primarily lack professionalism and competence. Instances of unethical practice are on the rise. Respect for the profession has dwindled, with the field of ophthalmology being no exception. This study aims to identify the current problems of medical education in ophthalmology in Western India along with the possible solutions for improvement. Materials and Methods: Cross-sectional data were collected through an online validated questionnaire from ophthalmology teachers of medical colleges of Western India. The questionnaire included 62 questions with information on their demography, faculty development program details, teaching schedule details, satisfaction regarding the undergraduate (UG) and postgraduate (PG) ophthalmology training, and suggestions regarding improvisation. It was analyzed to identify caveats and find possible solutions. Results: Forty-two responses were obtained. Thirty-one (73.8%) teachers suggested a change in the current teaching methodologies, 30 (71.4%) suggested changes in assessment strategies, 12 (28.6%) suggested curricular reforms, and 6 (14.3%) suggested change in the duration of the courses, both in UG and PG ophthalmology education. Need for interactive, integrated, and problem-based teaching and more skill-based assessments was expressed. Conclusions: Improvement in the current scenario needs an integrated approach of the government, accreditation system, institutional heads, faculties, and medical students to build a strong foundation for a better future

Cross-Sectional Study on Exam Anxiety among Medical Students of a Tertiary Care Teaching Hospital of Western India

"Background: Students with test anxiety feel tense, fearful and worried in evaluative situations. This study was carried out with the objective to find out the levels of exam anxiety and factors contributing to it. Methodology: It was a cross-sectional study conducted among 150 randomly selected medical students with the help of a tool used for measuring exam anxiety, Test Anxiety Inventory (TAI). Results: The mean score of TAI-worry was 16.95 (+ 3.39), TAI-emotionality was 17.04 (+ 2.901) and that of TAI-total was 41.99 (+5.336). The TAI-emotionality subscale and TAI-total scores was higher in female medical students. Those students who were living in hostel had higher mean TAI-emotionality scores. No significant difference between TAI-worry, TAI-emotionality and TAI-total with respect to regular/repeater batch, parental pressure, extent of course of study and duration of exams. No association was found TAI-total with year of study in MBBS and medium of study in higher secondary education. Conclusion: The total anxiety scores were significantly higher among female medical students. The emotional effect of exam anxiety was significantly higher among the female medical students than the males and among the students living at hostel than those living with their families. [Natl J Community Med 2016; 7(5.000): 449-454

IL-2 and IL-12 in thyroid cancer: Clinical implication

Purpose: The roles of IL-2 and IL-12, in different malignancies have been looked for since years. But very few studies have elucidated their role in thyroid tumorigenesis. Hence, present study sought to explore their utility in thyroid cancer, mainly the papillary thyroid cancer (PTC).Methods: A total of 67 patients with benign thyroid diseases, 106 with thyroid cancer and 67 healthy individuals were included in the study. Circulating levels of IL-2 and IL-12 were estimated by ELISA from all patients and controls. Protein expression of both interleukins was determined using immunohistochemistry. The results were statistically analysed using SPSS software.Results: Serum IL-12 exhibited good discriminatory efficacy between patients with benign thyroid diseases and healthy individuals. IL-2 and IL-12 levels could efficiently differentiate PTC and anaplastic thyroid cancer (ATC) patients from healthy individuals. Additionally, IL-12 showed good discriminating efficacy between PTC and benign thyroid disease patients and IL-2 well discriminated ATC patients from benign thyroid diseases. IL-2 was significantly higher in patients having unilateral tumors (P=0.006) while, IL-12 was significantly higher in patients with smaller tumor size (P=0.036) and early stage disease (P=0.008). The cytokine protein expressions in benign thyroid tissues and carcinoma did not differ significantly. IL-12 expression was significantly higher in male patients (P=0.042) and unilateral tumors (P=0.031).Kaplan-Meier survival analysis revealed that nuclear IL-2 expression was able to predict disease free survival and overall survival (OS) in subgroup of PTC patients having multifocal tumors and only OS in patients having bilateral tumors. Moreover, higher IL-12 immunoreactivity was a significant predictor of shorter OS in PTC patients treated with surgery alone.Conclusion: Serologic determination of IL-2 and IL-12 may help in validating indeterminate FNAC results and disclose diagnostic difference between benign and malignant thyroid diseases. However, a large cohort study is mandatory to establish a defined cut off for such discrimination

A case report of Ophthalmic Myiasis in an urban setting.

Myiasis is the infestation of the tissues and organs of animals or man by fly larvae. Oestrosis is a regional myiasis caused by larvae of the fly Oestrus ovis which belongs to class Insecta, order Diptera and family Oestridae. In this study, we present the clinical manifestations of external ophthalmomyiasis caused by the larvae of the sheep nasal botfly, Oestrus ovis, in a 46 year old male patient, who did not work in close contact with sheep or goats. He presented with pain and foreign body sensation in left eye. On detailed examination, the larvae were observed on the bulbar conjunctiva and in fornices. Following their removal, the symptoms of eye inflammation improved in a few hours

Comparative evaluation of DFDBA versus PRF with DFDBA in treatment of grade-II furcation defects – A clinical trial

Background: In order to determine whether a method is more successful for treating a grade-II furcation deficiency, this randomized trial will compare demineralized freeze-dried bone allograft (DFDBA) to platelet-rich fibrin with DFDBA. Materials and Methods: Twenty systematically healthy patients between the ages of 30 and 60 with a grade-II furcation were evaluated pre and postoperatively for changes in the modified plaque index, probing depth, relative vertical and horizontal clinical attachment level, gingival marginal level, and radiographic bone defect. Results: The test group significantly outperformed the control group on all clinical and radiological measures. Conclusion: The experimental group improved at both clinical attachment levels and had a higher decrease in probing depth than the control group did

Influence of thymidylate synthase expression on survival in patients with colorectal cancer

Background: Thymidylate synthase (TS) plays a critical role in nucleotide metabolism and is an important target for 5-fluorouracil (5-FU), the standard chemotherapeutic drug for treatment of colorectal cancer (CRC). Aims and Methods: The present study aimed to evaluate TS variable number tandem repeat sequences (VNTR) polymorphism by polymerase chain reaction and TS protein expression by immunohistochemistry and its association with clinicopathological parameters in untreated CRC patients (n = 100). Further, the prognostic and predictive role of TS has been evaluated. Results: For TS VNTR polymorphism, the observed frequencies of 2R/2R, 2R/3R, and 3R/3R genotypes were 22%, 51%, and 27%, respectively. When immunohistochemical localization was studied, cytoplasmic staining for TS was observed in 70% of patients. A significant inverse correlation was noted between TS protein expression and tumor, node, metastasis staging (P = 0.027), Dukes' staging (P = 0.039), and lymph node status (P = 0.012) of CRC patients. However, there was no significant correlation between TS VNTR polymorphism and TS protein expression. On survival analysis, a significantly shorter overall survival (OS) was seen in CRC patients with negative protein expression (P = 0.031). Moreover, the subgroup of CRC patients treated only with surgery also showed a trend of poor OS in patients with negative TS protein expression (P = 0.058). However, neither TS polymorphism nor its protein expression was able to predict relapse-free survival. Conclusion: Negative TS protein expression may be related to unfavorable clinical outcome in CRC patients. However, further studies in a larger set of patients are necessary to better assess TS as a prognostic and predictive marker for 5-FU response in CRC patients

ERCC1 expression in patients with colorectal cancer: a pilot study

Aim: Excision repair cross complementation group 1 (ERCC1) has a key role in enhanced DNA damage repair caused by oxaliplatin-based therapy and may lead to resistance of these platinum drugs in colorectal cancer (CRC) patients. Hence, the present preliminary study aimed to explore the role of ERCC1 C/T polymorphism at codon 118 as well as its immunoreactivity in patients with primary CRC. Methods: ERCC1 polymorphism was studied using PCR-RFLP and ERCC1 protein expression was examined by immunohistochemistry in 50 CRC patients. Results: ERCC1 codon 118 C/T polymorphism analysis reported the predominance of C/T (52%) genotype as compared to C/C (38%) and T/T (10%) genotypes. Furthermore, 72% of patients showed positive ERCC1 protein expression. Significant correlation was not observed between clinicopathological parameters and ERCC1 polymorphism, while ERCC1 protein expression significantly correlated only with tumor site (colon vs. rectum) (P = 0.046). Further, the present study failed to demonstrate the role of ERCC1 C118T polymorphism or protein expression as useful prognostic markers in CRC patients. Conclusion: ERCC1-positive protein expression may be a useful marker for rectal cancer patients. However, further evaluation in a larger set of CRC patients is required to better understand the role of ERCC1

Significance of TNF-α and the Adhesion Molecules: L-Selectin and VCAM-1 in Papillary Thyroid Carcinoma

Circulating levels of TNF-α and the adhesion molecules L-Selectin and VCAM-1 as well as their expression in the primary tumors of patients with benign thyroid diseases and papillary thyroid carcinoma (PTC) have been determined in this study. The serum levels of TNF-α, L-Selectin, and VCAM-1 were significantly higher in patients with both benign thyroid diseases and PTC as compared to the healthy individuals. However, the levels of only TNF-α and L-Selectin, and not VCAM-1, were significantly higher in patients with PTC in comparison to those observed in patients with benign thyroid diseases. Further the expression of TNF-α and L-Selectin was also significantly higher in the primary tumors of PTC patients, relative to the benign thyroid diseases. The expression of L-Selectin and VCAM-1 significantly correlated with aggressive tumor behavior. In PTC patients, the circulating TNF-α levels significantly positively correlated with the levels of L-Selectin, while TNF-α immunoreactivity was significantly associated with VCAM-1 expression. Serum TNF-α was found to be a significant prognosticator for OS in PTC patients. Overall the results signify that the interaction between TNF-α and the adhesion molecules may have a role in thyroid carcinogenesis and understanding this complexity may offer potential therapeutic targets for better management of thyroid cancer