Isolated Pancreatic Tuberculosis Mimicking Malignancy in an Immunocompetent Host

Despite the high prevalence of tuberculosis (TB) worldwide, pancreatic TB is rare. When present, pancreatic TB is frequently associated with miliary TB, often in immunocompromised hosts. Pancreatic TB may present as a pancreatic abscess, acute or chronic pancreatitis, and cystic or solid pancreatic masses. We present a case of an immunocompetent patient who presented with two discrete pancreatic masses and was subsequently diagnosed with isolated pancreatic TB. This case suggests that clinicians should have a heightened suspicion of pancreatic TB when faced with discrete pancreatic lesions, especially in patients from areas where the infection is endemic. Such recognition may lead to appropriate diagnostic testing, and possible resolution of pancreatic lesions with antituberculin therapy

Distributed Computing and its Scope in Defence Applications

Distributed computing is one of the paradigms in the world of information technology. Middleware is the essential tool for implementing distributed computing for overtaking theheterogeneity of platform and language. DRDO’s intranet, DRONA, has the potential of hosting distributed applications across the network. This paper deals with the essentials of distributed computing, architecture of DRONA network, and the scope of distributed computing in Defence applications. It also suggests a few possible applications of distributed computing

Serum nitric oxide and homocysteine as biomarkers of ectopic pregnancy

Background: Aim of current study was to evaluate the role of serum homocysteine and nitric oxide in the diagnosis of ectopic pregnancy.Methods: The study included 32 patients with ruptured ectopic, 29 miscarriage patients and 30 normal pregnant women as controls. Fasting plasma homocysteine, serum folate, vitamin B12 levels and nitric oxide levels were estimated at the time of admission.Results: Plasma homocysteine levels were significantly lower in patients with ectopic pregnancy than normal pregnancy. Nitric oxide levels were significantly lower in patients with abortion.Conclusions: Patients with abortion have decreased circulating nitric oxide levels in serum while those with ectopic pregnancies have decreased homocysteine levels.

Direct Liver Invasion from a Gastric Adenocarcinoma as an Initial Presentation of Extranodal Tumor Spread

Gastric cancer often carries a poor prognosis, with an estimated 740,000 deaths from the malignancy occurring yearly worldwide (Dicken et al., 2005). The mortality of disease is largely dependent on the extent of tumor spread, as gastric cancer has a predilection to metastasize to other visceral secondaries via hematogenous and lymphatic dissemination. Direct invasion of a gastric adenocarcinoma to adjacent organs secondary to gastric wall perforation does occur; however, it is often present in the setting of advanced disease. Rarely does direct tumor invasion to adjacent organs from a gastric adenocarcinoma present as the initial manifestation of extranodal tumor spread. We present a case of a 40-year-old male with direct tumor extension to the liver as an initial presentation of extranodal tumor spread from a gastric adenocarcinoma. Clinicians should be aware of such an occurrence, as treatment modalities in direct liver extension from a gastric adenocarcinoma vary and may be directed towards palliation rather than curative intent

Lower Extremity Cutaneous Lesions as the Initial Presentation of Metastatic Adenocarcinoma of the Colon

Cutaneous metastases from colorectal cancers are rare and are usually present on the abdominal wall or previous surgical incision sites. Remote cutaneous lesions have been reported, however, often occur in the setting of widespread metastatic disease including other visceral secondaries. We present a case of lower extremity cutaneous metastases as the first sign of metastatic disease in a patient with adenocarcinoma of the colon. This case illustrates that new skin lesions may be the initial presentation of metastatic disease in a patient with a history of cancer

Ovarian cancer stem cells and macrophages reciprocally interact through the WNT pathway to promote pro-tumoral and malignant phenotypes in 3D engineered microenvironments

Abstract Background Innate immune cells such as macrophages are abundantly present within malignant ascites, where they share the microenvironment with ovarian cancer stem cells (CSC). Methods To mimic this malignant ascites microenvironment, we created a hanging-drop hetero-spheroid model to bring CSCs and macrophages in close association. Within these hetero-spheroids, CD68+ macrophages (derived from U937 or peripheral blood monocytes) make up ~ 20% of the population, while the rest are ovarian cancer cells and ovarian cancer stem cells (derived from the high grade serous ovarian cancer cell line, OVCAR3). Results Our results indicate that CSCs drive the upregulation of M2 macrophage marker CD206 within hetero-spheroids, compared to bulk ovarian cancer cells, implying an inherently more immuno-suppressive program. Moreover, an increased maintenance of elevated aldehyde dehydrogenase (ALDH) activity is noted within hetero-spheroids that include pre-polarized CD206+ M2 macrophages, implying a reciprocal interaction that drives pro-tumoral activation as well as CSC self-renewal. Consistent with enriched CSCs, we also observe increased levels of pro-tumoral IL-10 and IL-6 cytokines in the CSC/M2-macrophage hetero-spheroids. CSC/M2-macrophage hetero-spheroids are also less sensitive to the chemotherapeutic agent carboplatin and are subsequently more invasive in transwell assays. Using inhibitors of WNT secretion in both CSCs and macrophages, we found that CSC-derived WNT ligands drove CD206+ M2 macrophage activation, and that, conversely, macrophage-derived WNT ligands enriched ALDH+ cells within the CSC compartment of hetero-spheroids. Upon examination of specific WNT ligand expression within the monocyte-derived macrophage system, we observed a significant elevation in gene expression for WNT5B. In CSCs co-cultured with macrophages within hetero-spheroids, increases in several WNT ligands were observed, and this increase was significantly inhibited when WNT5B was knocked down in macrophages. Conclusions Our data implies that macrophage- initiated WNT signaling could play a significant role in the maintenance of stemness, and the resulting phenotypes of chemoresistance and invasiveness. Our results indicate paracrine WNT activation during CSC/M2 macrophages interaction constitutes a positive feedback loop that likely contributes to the more aggressive phenotype, which makes the WNT pathway a potential target to reduce the CSC and M2 macrophage compartments in the tumor microenvironment.https://deepblue.lib.umich.edu/bitstream/2027.42/152174/1/40425_2019_Article_666.pd

Role of Teriparatide in Accelerating Metatarsal Stress Fracture Healing: A Case Series and Review of Literature

Bone fractures are one of the leading causes of emergency room visits worldwide, with approximately 8 million bony fractures occurring annually in the US alone. Although the majority of fractures do not cause significant long-term morbidity and mortality, approximately 10% of these fractures result in impaired fracture healing, drastically affecting quality of life in affected patients. By increasing bone formation, teriparatide, an anabolic agent used in the treatment of postmenopausal osteoporosis, has shown promise in accelerating the rate of fracture healing. We present two patients with impaired healing of metatarsal fractures who were subsequently treated with teriparatide. Both patients experienced successful bony union of the fracture after the use of teriparatide. These findings suggest that teriparatide may be useful in the clinical setting for the acceleration of fracture healing, especially in patients who are at risk for impaired fracture healing

Nutritional and Anti Oxidant Potential of Commonly Growing Plant Foods from Southern India

Certain varieties of plants are abundantly available with rich in nutrients, but the complete sets of nutritional composition studies have not been carried out. Among them, the matured leaves of Murrya keonigii; seeds and leaves of Moringa oleifera, and fruit pulp of Aegle marmelos were chosen. The proximate analysed for above samples showed that the moisture varies from 2.4% -8.2%, crude proteins from 18.75%- 34.57 %, fat content from 5.6% -19.6%, ash content from 3.87%-15.6% and carbohydrate from 28.65% - 41.23%, respectively. Estimation of mineral contents revealed that the leaves and seeds of moringa had higher concentrations than others. Determination of total antioxidant (total flavonoid) was higher (63.550 μg (RU)/ml of samples) in matured curry leaves than others. Determination of in vitro antioxidant activity with FRAP revealed highest activity in curry leaves (174.5μg) to a least activity with seeds of moringa (45.725 μg), whereas the DPPH revealed highest activity for fruit pulp of bael (1680.6μg ascorbic acid) to the least in leaves of moringa (263.15 μg ascorbic acid equivalent/mg). The ABTS showed IC50 value of 210.52 ±0.5774 for curry leaf, 487.8 ±0.3347 and 205.36 moringa seeds and leaves and 513.24 IC50 μg for pulp of bael fruit. Quantitative analysis of water soluble vitamins such as thiamine (B1) varied from 2.172 -5.558 mg; riboflavin (B2) from 2.201 -11.354 mg; pyridoxine (B6) from 4.608 -194.001 mg; biotin (B7) from 36.864 -153.027 mg, respectively. Further, the vitamin C (ascorbic acid) varied from 6.733 -23.142 mg /100g of oven dried samples, respectively. Therefore, the above foods are well intended to be included in routine diet regime and may also be willing to utilise for food supplementation with other suitable diets to manage the conditions such as malnutrition and nutrient deficiencies

Multiple Intestinal Intussusceptions as a Complication of Severe Hyperglycemia in a Patient with Diabetic Ketoacidosis

Intussusception in adults is a rare phenomenon, occurring in approximately 1 in 30,000 hospital admissions annually. When it does occur, the majority of cases involve an organic lesion serving as a lead point for intussusception, such as tumors or postoperative adhesions. In a small percentage of cases, a lead point is not found, and intussusception is thought to be idiopathic or secondary to a disease process contributing to dysrhythmic peristalsis of the gastrointestinal tract. A few cases of functional intussusception have been reported as being secondary to severe hyperglycemia and metabolic derangements, including metabolic acidosis and hyperkalemia, by causing impaired gastrointestinal motility. We present a case of a 23-year-old Caucasian male who presented with severe hyperglycemia and diabetic ketoacidosis. Imaging of the abdomen revealed three intussusceptions involving the small intestine, which were easily reduced manually during exploratory laparotomy

Additional role for the ccd operon of F-plasmid as a transmissible persistence factor

Toxin-antitoxin (TA) systems are found on both bacterial plasmids and chromosomes, but in most cases their functional role is unclear. Gene knockouts often yield limited insights into functions of individual TA systems because of their redundancy. The well-characterized F-plasmid-based CcdAB TA system is important for F-plasmid maintenance. We have isolated several point mutants of the toxin CcdB that fail to bind to its cellular target, DNA gyrase, but retain binding to the antitoxin, CcdA. Expression of such mutants is shown to result in release of the WT toxin from a functional preexisting TA complex as well as derepression of the TA operon. One such inactive, active-site mutant of CcdB was used to demonstrate the contribution of CcdB to antibiotic persistence. Transient activation of WT CcdB either by coexpression of the mutant or by antibiotic/heat stress was shown to enhance the generation of drug-tolerant persisters in a process dependent on Lon protease and RecA. An F-plasmid containing a ccd locus can, therefore, function as a transmissible persistence factor