Rare and atypical presentations of endometriosis causing diagnostic dilemma and management challenges: an experience at a tertiary center

Endometriosis is a disease that most of the times is diagnosed by its common presenting sign and symptoms, but can have varied presentations and may come as a surprise during surgery. We here present a case series of unusual presentations of endometriosis, which created diagnostic dilemma and challenges in the management of the cases at this tertiary center and share our experience. Endometriosis must be kept as a differential diagnosis whenever patient presents with acute pelvic or abdominal pain with adnexal masses and things are not fitting into straight forward diagnosis

Successful clinical outcome in complicated monochorionic twins: case series

Monochorionic twins have some unique complications like twin-to-twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), twin reverse arterial perfusion syndrome (TRAP) and conjoined twins which are otherwise not seen in dichorionic twins. In this case series, we report 3 cases of monochorionic twins who had complications. Our first case had monochorionic twin with a pump fetus and a TRAP. The second case had TTTS stage I and after spontaneous preterm premature rupture of membranes at 32 weeks, delivered both fetuses vaginally at an interval of about 3 hours. Our third case had TTTS stage II and she underwent selective fetoscopic laser photocoagulation of intertwin anastomotic vessels at about 25 weeks and subsequently multiple episodes of amnioreduction till 31 weeks when she underwent emergency caesarean delivery. Our study highlights the need for constant vigilance in patients with monochorionic twins to look for complications like TTTS and TRAP

Thermostable Direct Hemolysin Downregulates Human Colon Carcinoma Cell Proliferation with the Involvement of E-Cadherin, and β-Catenin/Tcf-4 Signaling

BACKGROUND: Colon cancers are the frequent causes of cancer mortality worldwide. Recently bacterial toxins have received marked attention as promising approaches in the treatment of colon cancer. Thermostable direct hemolysin (TDH) secreted by Vibrio parahaemolyticus causes influx of extracellular calcium with the subsequent rise in intracellular calcium level in intestinal epithelial cells and it is known that calcium has antiproliferative activity against colon cancer. KEY RESULTS: In the present study it has been shown that TDH, a well-known traditional virulent factor inhibits proliferation of human colon carcinoma cells through the involvement of CaSR in its mechanism. TDH treatment does not induce DNA fragmentation, nor causes the release of lactate dehydrogenase. Therefore, apoptosis and cytotoxicity are not contributing to the TDH-mediated reduction of proliferation rate, and hence the reduction appears to be caused by decrease in cell proliferation. The elevation of E-cadherin, a cell adhesion molecule and suppression of β-catenin, a proto-oncogene have been observed in presence of CaSR agonists whereas reverse effect has been seen in presence of CaSR antagonist as well as si-RNA in TDH treated cells. TDH also triggers a significant reduction of Cyclin-D and cdk2, two important cell cycle regulatory proteins along with an up regulation of cell cycle inhibitory protein p27(Kip1) in presence of CaSR agonists. CONCLUSION: Therefore TDH can downregulate colonic carcinoma cell proliferation and involves CaSR in its mechanism of action. The downregulation occurs mainly through the involvement of E-cadherin-β-catenin mediated pathway and the inhibition of cell cycle regulators as well as upregulation of cell cycle inhibitors