Does a routine post brush bronchial wash increase the yield in diagnosis of lung cancer?

Background: Lung cancer is the most common cause of cancer-related death in both men and women. 80% of the lung cancers are non-small cell lung cancer (NSCLC) and 20% are small cell lung cancer (SCLC). Flexible fiberoptic bronchoscopy is commonly used for diagnostic and staging purposes. Endoscopically visible abnormalities are approached with traditional biopsy forceps, brushings, and washings. Objectives were to assess the yield of bronchial washings, brush cytology and to compare the yield of pre and post brush bronchial washings.Methods: Patients with suspicion of lung cancer will be subjected to bronchoscopy using flexible fibreoptic bronchoscopy. Multiple procedures performed for the retrieval of tissue samples will include bronchial washings (pre and post brushing), bronchial brushing and endobronchial biopsy.Results: A total of 57 cases were included in the study with 40 (70.2%) males and 17 females (29.8%). The yield of pre-brush bronchial washings, post brush bronchial washings and bronchial brushings were 31.6% (18 of 57), 31.6% (18 of 57) and 61.4% (35 of 57) respectively. Biopsy was positive for malignancy in 11 of 19 (58.2%) cases. Adenocarcinoma was the commonest type seen in 32 (56.1%) patients. Of the 27 cases with endobronchial growth 11 were adenocarcinoma (40.7%).Conclusions: There was no difference between the yield of pre-brush washing and post brush washing. The yield of brush cytology was significantly more than the yield of bronchial washings. There is an increase in the yield after adding both pre and post brush bronchial wash.

Misplaced IUCD: a case report

Contraception is a national emergency, essential in a developing country like India. Intrauterine contraceptive devices (IUCDs) are amongst the most frequently used methods of contraception. The patients with misplaced IUCDs may present with pregnancies or ‘lost strings’ or they may remain asymptomatic and/ or may have recurrent pregnancy losses and may become pregnant as in our case

A large fibroma polyp of labia majora

Fibroepithelial stromal polyps are benign proliferations which are usually polypoid or pedunculated, and less than 5cm in size. They are generally single lesions but can be multiple during pregnancy. They can be polypoid or pedunculated and are usually solitary. Symptoms usually include bleeding, discharge and general discomfort with sensation of a mass. They typically have a central fibrovascular core and contain stellate and multinucleated stromal cells which are best seen beneath the surface epithelium. True myxoid stroma is absent. Although vulvovaginal fibroepithelial stromal polyps are well documented, a giant variant such as the one authors report here is rather rare. To the knowledge, present case is the largest fibroepithelial stromal polyp compared to others reported in the literature

ATP-Site Binding Inhibitor Effectively Targets mTORC1 and mTORC2 Complexes in Glioblastoma

The PI3K-AKT-mTOR signaling axis is central to the transformed phenotype of glioblastoma (GBM) cells, due to frequent loss of tumor suppressor PTEN (phosphatase and tensin homolog deleted on chromosome 10). The mechanistic target of rapamycin (mTOR) kinase is present in two cellular multi-protein complexes, mTORC1 and mTORC2, which have distinct subunit composition, substrates and mechanisms of action. Targeting the mTOR protein is a promising strategy for GBM therapy. However, neither of these complexes is fully inhibited by the allosteric inhibitor of mTOR, rapamycin or its analogs. Herein, we provide evidence that the combined inhibition of mTORC1/2, using the ATP-competitive binding inhibitor PP242, would effectively suppress GBM growth and dissemination as compared to an allosteric binding inhibitor of mTOR. GBM cells treated with PP242 demonstrated significantly decreased activation of mTORC1 and mTORC2, as shown by reduced phosphorylation of their substrate levels, p70 S6K(Thr389) and AKT(Ser473), respectively, in a dose-dependent manner. Furthermore, insulin induced activation of these kinases was abrogated by pretreatment with PP242 as compared with rapamycin. Unlike rapamycin, PP242 modestly activates extracellular regulated kinase (ERK1/2), as shown by expression of pERK(Thr202/Tyr204). Cell proliferation and S-phase entry of GBM cells was significantly suppressed by PP242, which was more pronounced compared to rapamycin treatment. Lastly, PP242 significantly suppressed the migration of GBM cells, which was associated with a change in cellular behavior rather than cytoskeleton loss. In conclusion, these results underscore the potential therapeutic use of the PP242, a novel ATP-competitive binding inhibitor of mTORC1/2 kinase, in suppression of GBM growth and dissemination

EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-AIDS PATIENTS ADMITTED TO SOUTH INDIAN TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

Objective: The objective of the study was to describe, evaluate, and analyze neurological manifestation in human immunodeficiency virus HIV positive patients admitted to a tertiary care center. Methods: The study was a prospective cross-sectional study, in which 103 HIV patients were analyzed. All patients were interviewed face to face and evaluated by the investigator with particular reference to neurological manifestations. They were classified into various stages of HIV using the World Health Organization staging system. Results: The mean age in males was 37 (standard deviation [SD] 8.0) years and in females 35 (SD 7.0) years. A greater proportion of females were diagnosed in the asymptomatic state during screening, either during pregnancy or when the spouse was found to be positive. Headache was the most common neurologic symptom and fundus abnormalities were the most common neurological sign documented in patients. The mean CD4 counts in males are 156.5/mm3 and in females are 229.57/mm3 whereas the mean absolute leukocyte count in males is 1088.30/mm3 and in females is 1473.52/mm3. The CD4 counts showed a better correlation with the occurrence of neurological manifestations than absolute leukocyte count. Conclusion: Headache was a significant predictor of the occurrence of neurological complications (p=0.01). CD4 counts were significantly lower in patients with neurological complications and most of the neurological manifestations; on the contrary, all the opportunistic infections were documented in patients with CD4 counts below 200/mm3. Neurological complications did not show any correlation with the patient being on anti-retroviral therapy

Evaluation of antimicrobial activity of Lactobacillus acidophilus and Lactobacillus rhamnosus against clinically isolated Klebsiella pneumoniae: an in vitro study

Background: Klebsiella pneumoniae are Gram-negative opportunistic pathogen, belonging to the family Enterobacteriaceae that can cause severe nosocomial infections particularly in immuno-compromised individuals. They exhibit co-resistance to multiple antibiotics which emphasize the need for non-antibiotic therapies. The goal of the presented study was to investigate the antimicrobial ability of probiotic Lactobacilli on clinical isolates of K. pneumoniae. Methods: In this cross-sectional study, antimicrobial activities of probiotic L. acidophilus and L. rhamnosus on K. pneumoniae were evaluated by Agar overlay interference technique. Clear zone around Lactobacilli were taken as positive inhibition. Antibiotic susceptibility profiles of K. pneumoniae were determined by Kirby-Bauer disk diffusion method, analyzed using interpretive standards of CLSI M100-S33 and categorized into MDR, XDR and Non MDR groups. Statistical analysis was done using descriptive statistics such as mean and standard error and inferential statistics such as ANOVA single factor. Results: K. pneumoniae exhibited positive inhibition with both the probiotic strain. On comparing the zone of inhibition of L. acidophilus and L. rhamnosus (both treated-pH adjusted and untreated), L. acidophilus had greater zone of inhibition against K. pneumoniae but concluded that statistically the values are insignificant (p>0.05). Based on antibiotic susceptibility pattern of K. pneumoniae, 63% of isolates were XDR, 3% were MDR and 34% were Non MDR Conclusions: It can be concluded that L. acidophilus and L. rhamnosus had significant inhibitory effect against K. pneumoniae in vitro and should be further studied for their human health benefit

Multiple palmar epidermoid cysts: fourth reported case

Implantation of epidermal fragments into the dermis has been pointed out as the cause of common epidermal cysts. However, some palmoplantar epidermoid cysts have been reported to be caused by human papillomavirus (HPV) infection or to be derived from eccrine ducts. A 55 year old woman presented with multiple epidermoid cysts on the palm and volar aspect of her left hand. HPV infection CEA was not detected in situ hybridization and polymerase chain reaction

Stability of Euler-Lagrange-Jensen’s (a,b)- Sextic Functional Equation in Multi-Banach Spaces

In this paper, we prove the Hyers-Ulam Stability of Euler-Lagrange-Jensen’s (a,b)-Sextic Functional Equation in Multi-Banach Spaces

Urinoma: a rare complication of ureteral calculi

Urinoma is a collection of extravasated urine either in renal subcapsular or perirenal space. It is caused by obstructive and non-obstructive pathologies. It is rare; with trauma as most common cause in adults and ureteral stones as least common. It mimics symptoms of ureteral stone. CT KUB is best modality to detect it. Here we present a case of ureteral calculi leading to urinomas formation in a 42 years old male patient present with retention of urine and pain in left flank region with nausea, vomiting and fever