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)

Innovative Strategies for the Control of Biofilm Formation in Clinical Settings

Biofilm formation in clinical settings is an increasingly important issue particularly due to the emergence of multidrug-resistant strains, as it resulted in increased mortality, which poses a considerable financial burden on healthcare systems. The bacterial biofilms are quite resistant to the routine antimicrobial-based therapies; therefore, the novel strategies are desired in addition to the conventional antibiotics for the effective control of infections caused by biofilm-forming microbes. So far, the approaches being proposed to control the biofilm formation in clinical practice settings include the use of biofilm inhibitors and the use of modified biomaterials for the development of medical devices to thwart the formation of biofilms. In this chapter, we have focused on the latest developments in the anti-biofilm strategies through the interruption of the quorum-sensing system, which is crucial for biofilm formation and have summarized the various classes of antibacterial compounds for the control of biofilm formation. This agrees with the recent approaches suggested by the National Institute of Health (NIH) that advocates the use of combinational therapies based on the conventional methods and complementary treatment to explore the potential utility and safety concerns of the natural products. The studies regarding these emerging strategies could possibly lead to the establishment of better therapeutic alternates compared to conventional treatments

Analysis of Helicobacter pylori gastritis according to Sydney classification.

Introduction: Since H. Pylori has been isolated in stomach and duodenum, there were individual methodologies to explain the grading according to colonization and density of microorganism. In 1990 Sydney system of classification was proposed at the 9th world congress of gastroenterology in Sydney Australia, based on topo-graphical, morphological and etiological findings. This classification revised in 1994 and updated by experts in Houston Texas. H. Pylori is major cause of chronic gastri-tis results in gastric and peptic ulcer. It also causes MALT lymphoma and malignan-cy. For histopathological examination four specimens, two from antrum and two from corpus are recommended.Objective: To evaluate the Sydney system of classification and grading for H. Pylori in local population.Methodology: 287 cases of biopsies received at the department of pathology Mu-hammad Medical College, Mirpurkhas Sindh Pakistan, during the period of January 2017 to December 2018 were revised. Sections stained with Hematoxylin and Eosin; Alcian blue and periodic acid Schiff to define H. Pylori and associated pathological changes. The microscopical findings classified according to upgraded Sydney pattern.Results: Out of 287 cases of gastric biopsies 23 (8.0%) were positive for H. Pylori. chronic inflammation present in 168 (58.5%). Neutrophilic activity found in 58 (18.1%). Atrophy without metaplasia observed in 31 (10.8%). Intestinal metaplasia present in 1 (0.3%) cases.Conclusion: Sydney system of grading is best to evaluate chronic gastritis and relia-ble indicator of H. Pylori microorganism. Keywords: Chronic gastritis, Gastric carcinoma. H. Pylori

Comparison of intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation in terms of mean pain reduction using vas score

INTRODUCTION: The most common dislocation presenting to emergency department is anterior shoulder dislocation. Posterior dislocations and inferior dislocations are rare. Dislocations of the anterior shoulder mostly occur with the position of the arm is abducted and externally rotated. This results in injury of the humeral head, labrum, capsuloligamentous structures and glenoid. Such patients experience severe pain, therefore prompt reduction is necessary to ameliorate the pain. Intravenous analgesia combined with sedation or intra-articular lidocaine injection can be used for closed reduction of anterior shoulder dislocation. Due to its side effects, Intra-articular lidocaine (IAL) is recommended for use as a probable alternative to intravenous sedation-analgesia especially for patients with contraindication to intravenous sedation-analgesia. OBJECTIVE: To compare intra-articular lidocaine versus intravenous sedative and analgesic for management of anterior shoulder dislocation in terms of mean pain using VAS during reduction of shoulder joint. STUDT DESIGN:   Randomized controlled trial (RCT). SETTING: Removed for blind review DURATION: 6 months (November 22nd, 2017 to May 21st, 2018) SAMPLE SIZE: 60 patients (30 in each group) RESULTS: We included sixty patients in my study. 19 (31.7%) were females and 41 (68.3%) were male patients. Out of all the patients 38 (63.3%) had right sided shoulder dislocation, while the rest 22 (36.7%) patients had left sided shoulder dislocation. Patients mean age was 33.27±10.535 years and mean pain score of all the patients was 4.966±1.930. The mean pain score in Group A was 4.200±1.648, while the mean pain score in Group B was 5.733±1.910 (p value = 0.002. Stratification was done according to gender and age group of the patients, and post-stratification t-test was applied. CONCLUSION:   Intra-articular lidocaine is better option in pain control during reduction of anterior shoulder dislocation. KEY WORDS: Intra venous analgesia, Intra-articular lidocaine, shoulder dislocation

FREQUENCY OF OCULAR SYMPTOMS IN COVID-19 PATIENTS

Objective: To determine the frequency of ocular symptoms in COVID 19 patients and its association with systemic symptoms in active COVID 19 patients.   Methods: This is a cross sectional observational study of laboratory confirmed COVID-19 patients who were admitted in isolation wards for a period from Dec 16, 2020 to Jan 15, 2021. A structured form was used to extract the data from electronic medical records. Data collected included sociodemographic characteristics, presenting symptoms, systemic signs and symptoms, ocular symptoms, past medical history, RT-PCR and chest radiographic findings.  Results: A total of 44 patients (30 (68.2%) males and 14 (31.82%) females) were admitted to the isolation wards during the study period. The mean age (+ SD) age was 55.75 + 14.53 with median range 57.50 (14-92). Age <30 years i.e. 4.5%, 30-50 i.e. 27.3% and >50 i.e. 68.2%.Ocular symptoms were present in 17 patients (38.6%).   Conclusion:  We conclude from our study that Ocular symptoms were present in 17 patients (38.6%) out of 44 (Total number of patients) However, these symptoms were mild, had no fixed pattern of occurrence, neither associated with the severity of the systemic disease nor associated with any serious ocular outcome

Impact of COVID-19 on Ophthalmologists

Objectives: To determine the effects of COVID 19 pandemic on the professional lives of ophthalmologists Methods: This cross sectional survey was conducted for 6 months in late 2020 and used google forms for data collection. Results: Total 68 respondents gave their likert response for each of the 20 statements. No. %, median, mode and interquartile range, of all respondents likert sentiment for each statement, were calculated. Survey results showed general, ‘consent and consensus’. Conclusion: Covid-19 has influenced professional lives of ophthalmologists

Carbapenem Resistance: Mechanisms and Drivers of Global Menace

The emergence of carbapenem-resistant bacterial pathogens is a significant and mounting health concern across the globe. At present, carbapenem resistance (CR) is considered as one of the most concerning resistance mechanisms and mainly found in gram-negative bacteria of the Enterobacteriaceae family. Although carbapenem resistance has been recognized in Enterobacteriaceae from last 20 years or so, recently it emerged as a global health issue as CR clonal dissemination of various Enterobacteriaceae members especially E. coli, and Klebsiella pneumoniae are reported from across the globe at an alarming rate. Phenotypically, carbapenems resistance is in due to the two key mechanisms, like structural mutation coupled with β-lactamase production and the ability of the pathogen to produce carbapenemases which ultimately hydrolyze the carbapenem. Additionally, penicillin-binding protein modification and efflux pumps are also responsible for the development of carbapenem resistance. Carbapenemases are classified into different classes which include Ambler classes A, B, and D. Several mobile genetic elements (MGEs) have their potential role in carbapenem resistance like Tn4401, Class I integrons, IncFIIK2, IncF1A, and IncI2. Taking together, resistance against carbapenems is continuously evolving and posing a significant health threat to the community. Variable mechanisms that are associated with carbapenem resistance, different MGEs, and supplementary mechanisms of antibiotic resistance in association with virulence factors are expanding day by day. Timely demonstration of this global health concern by using molecular tools, epidemiological investigations, and screening may permit the suitable measures to control this public health menace

Stability and safety analysis of statin-loaded nano-films for the treatment of diabetic wound

Diabetes mellitus (DM) is a metabolic disease that delays the regular stages of the wound’s healing process due to delayed inflammatory stages. Due to foot pressure points, chronic foot wounds are ultimately considered the primary cause of lower leg amputation. Diabetic patients have vascular dysfunction and neuropathy, leading to inadequate oxygen supply to the wound area. Statins have a crucial role in the regulation of angiogenesis that could increase vascular endothelial growth factor (VEGF) synthesis. By offering a localized treatment approach while minimizing systemic side effects associated with oral medication, this study aimed to develop statin-loaded nanofilms to determine their stability and safety among healthy individuals as a potential procedure for diabetic wound healing. Simvastatin (SIM) loaded nanofilms formulations (F1-F10) were prepared using the solvent casting method. The formulation was optimized based on tests such as physical appearance, tensile strength, microscopic photographs, morphology, and drug content uniformity. ICH guidelines were followed to determine various parameters (physical appearances, tensile strength, microscopic photographs, morphology, and drug content uniformity) for six-month stability study at three different storage conditions. Safety analysis of the nanofilms was performed on healthy human skin using the Draize skin irritation test. Results showed F7 formulation was considered an optimized formulation as well as stable through the storage period at 4 ± 2°C, 25 ± 2°C, and 40 ± 2 °C. Furthermore, Primary Irritation Index results (PII was 0 showed no irritation in case and control groups) indicate its safety and biocompatibility to skin. Thus, the optimized statin-loaded nanofilm is stable, safe, and non-toxic, which may be used as a potential diabetic wound healing agent