International Journal of Research in Medical Sciences
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Clinicopathological association of CD44 and PD-L1 expression in epithelial ovarian carcinoma: a hospital-based cross-sectional study from AIIMS Patna
Get PDFBackground: Epithelial ovarian carcinoma (EOC) is the most lethal gynecological malignancy, often presenting at advanced stages. Molecular markers such as CD44, a stem cell-associated adhesion molecule, and PD-L1, an immune checkpoint regulator, have been implicated in tumor progression, chemoresistance, and immune evasion. Understanding their expression patterns and correlation with clinicopathological features may aid prognostic stratification and therapeutic decision-making. Aim was to assess CD44 and PD-L1 expression in EOC and analyze their association with clinicopathological parameters.
Methods: A hospital-based cross-sectional study was conducted over 5 years (2018-2023) in the department of pathology, AIIMS Patna. A total of 132 histologically confirmed cases of EOC were included. Immunohistochemistry (IHC) for CD44 and PD-L1 was performed, and expression was scored semi-quantitatively. Associations with age, histological subtype, tumor grade, stage, and lymph node involvement were evaluated. Statistical analysis was performed using chi-square and logistic regression.
Results: CD44 positivity was observed in 79/132 cases (59.8%), while PD-L1 was expressed in 62/132 cases (47.0%). Co-expression of both markers was found in 38 cases (28.8%). High CD44 expression was significantly associated with high-grade serous carcinoma (p=0.01), advanced FIGO stage (p=0.03), and lymph node metastasis (p=0.04). PD-L1 positivity correlated with advanced stage (p=0.02) and presence of ascites (p=0.03). Co-expression was linked to poor differentiation and advanced disease. Multivariate analysis showed CD44+/PD-L1+ tumors had 2.6-fold higher odds of lymph node metastasis.
Conclusions: CD44 and PD-L1 are frequently expressed in EOC and show significant association with adverse pathological features. Their combined expression may serve as a prognostic biomarker and highlight potential candidates for targeted and immune checkpoint therapies in ovarian carcinoma
Uterine smooth muscle tumours and the role of Ki67 expression in determining their biological behaviour
Get PDFBackground: Uterine smooth muscle tumours include leiomyoma, intravenous leiomyoma, metastasizing leiomyoma, smooth muscle tumour of uncertain malignant potential (STUMP) and leiomyosarcoma (LMS). Diagnosis primarily relies on histopathological features. In cases with overlapping morphological findings, immunohistochemical markers can help in differentiating benign and malignant lesions. This study evaluates the role of Ki67 immunohistochemical expression in determining the biological behaviour of uterine smooth muscle tumours.
Methods: In this study a total of 58 cases of uterine smooth muscle tumours were analysed. Gross findings were observed. The microscopic evaluation was done on formalin fixed paraffin embedded sections and haematoxylin and eosin-stained slides. This was followed by Ki67 staining by immunohistochemistry and was graded depending on percentage of nuclear expression. Association of Ki67 grade with gross and microscopic findings were determined.
Results: Among 58 tumours, 52 (90%) were leiomyomas, 3 (5%) STUMPs, and 3 (5%) LMS. Most patients were between 41 and 50 years of age, with menorrhagia being the most common presenting complaint. Ki67 expression was low (86.2%) in all leiomyomas, consistently high in LMS and showed variable levels in STUMP. Ki67 levels demonstrated a significant association with mitotic activity, necrosis and cytologic atypia (p<0.05), but did not correlate with tumour size and secondary changes.
Conclusions: Combining histopathology with Ki67 immunostaining improves diagnostic efficacy in uterine smooth muscle tumours and thus contributes to a more effective clinical management
Comparison of fasting and non-fasting lipid profile in Nigerian adults
Get PDFBackground: Lipid profiles are a vital cardiovascular risk factor. Traditionally fasting lipid profiles are used to minimise postprandial variability, the necessity of fasting for accurate lipid assessment has been questioned, and its utility among Nigerian adults remains uncertain. We compared fasting and non-fasting plasma lipid levels in Nigerian adults to assess the practicality of a non-fasting lipid profile.
Methods: We conducted this self-control comparative study at University College Hospital in Ibadan, Nigeria. We recruited 90 consenting adults aged 18 and older from various outpatient units. We collected plasma samples after an overnight fast and two hours post-prandial. We analysed the lipid levels using standard laboratory methods. We used paired t-tests and bland Altman graphs to compare mean values and determine agreement.
Results: The fasting total cholesterol (TC) (5.25±2.05 mmol/l) and LDL cholesterol (3.84±2.08 mmol/l) levels were significantly higher than their non-fasting counterparts (3.95±1.79 mmol/l and 2.34±1.74 mmol/l, respectively; p<0.001). Conversely, triglyceride (TG) levels were significantly higher in the non-fasting state (1.68±0.88 mmol/l) compared to the fasting state (1.35±0.73 mmol/l; p<0.001). HDL cholesterol levels showed minimal differences between fasting and non-fasting conditions (p=0.136). Bland-Altman analysis indicated that the variations between fasting and non-fasting lipid profiles fell within clinically acceptable limits.
Conclusions: Within the acceptable limits of agreement, non-fasting lipid profiles offer a practical alternative to fasting profiles for cardiovascular risk assessment in Nigerian adults
Cyto-diagnosis of unilateral adrenal histoplasmosis mimicking a primary adrenal neoplasm in an immunocompetent patient
Get PDFHistoplasmosis mostly shows bilateral adrenal gland involvement in immunocompromised patients. Our case is of a 43 years old immunocompetent male patient having pain in the left flank for one month. CECT abdomen revealed a well-defined hypodense mass measuring 64×61×56 mm with necrotic areas in right adrenal region. A possibility of primary adrenal neoplasm was suggested. Left side adrenal gland was normal. Microscopic examination of imprint smears from adrenal mass revealed cellular smears revealing histiocytes, plasma cells, lymphocytes and numerous intra-cytoplasmic and extra-cytoplasmic yeast forms with basophilic crescent shaped nucleus with pericellular halo. Background showed RBC’s, acellular debris and multinucleate giant cells. Diagnosis of histoplasmosis was suggested which was confirmed on histopathology and culture. Patient recovered with anti-fungal treatment. If Fine needle aspiration (FNA) of the adrenal mass would have been done, adrenalectomy could be prevented. This case highlights the importance of FNA in diagnosing abdominal lumps and avoiding unnecessary surgery
Geriatic lower limb amputations in a tertiary health centre in Southwestern Nigeria: a 5-year retrospective cohort study
Get PDFBackground: Amputation in the geriatric population is a significant health concern with overmastering implications for individual well-being, healthcare systems, and societal resources. The aim was to review all geriatric patients who had lower limb amputation over a 5-year period.
Methods: Retrospective cohort study which examined 54 elderly patients aged 65 years and older who underwent lower limb amputation in a 5year period. Data on demographics, clinical characteristics, and surgical details were extracted from medical records.
Results: The mean age of patients was 73.9 years, with 61.1% between 65-74 years old. There was an equal distribution of males and females. The left lower limb was more commonly affected (53.7%) than the right (44.4%). Diabetic foot was the leading cause of amputation (66.7%), followed by peripheral arterial disease (31.5%).
Conclusions: This study highlights the significant impact of diabetes and peripheral arterial disease on lower limb amputations in the elderly population. The findings underscore the need for targeted interventions in diabetes management and vascular health to reduce amputation risk. Further research is warranted to investigate the slight predominance of left lower limb amputations and to develop strategies for improving outcomes in this vulnerable population
Comparing diagnostic PET versus response PET at the 16th week induction and it’s correlation with MFC MRD: a deeper look into myeloma genomics
Get PDFBackground: Multiple Myeloma is a heterogenous disease. A homogenous approach to a heterogeneous disease is discouraged as more and more data evolves. Diagnostic PET is recorded for measuring the disease burden along with metabolic uptake of the burden. Minimal residual disease (MRD) measurement at the end of induction, consolidation and pre-maintenance have been looked into by multiple authors. Also, follow-up PET is done at multiple time points by multiple authors and has been correlated with molecular response. In this study, we shall correlate PET response post 16 weeks of induction and MRD assay.
Methods: We have a retrospective analysis of the newly diagnosed multiple Myeloma (NDMM) with all the baseline data available at our centre and received the standard induction regimen for 16 weeks and the follow-up data was analyzed.
Results: At the end of the 16th week of induction, 41 patients were in complete resolution in PET. Of them, 26 had MRD detected and 15 had no MRD detected. Ten patients had stable disease, with all of them positive for MRD. One patient with positive MRD was having a partial response. Four patients with detectable MRD had progressive disease on PET, with (p=0.058).
Conclusions: MRD should be correlated with follow-up FDG PET/CT for a comprehensive evaluation of treatment response. We firmly believe that the genome of the disease drives the disease and definitely, MRD-PET correlation should be attributed to genomics
Attachment styles and depression among nursing officers of tertiary care centre in India
Get PDFBackground: The concept of attachment plays a relevant role in mental health. Attachment style refers to how a person perceives and experiences interpersonal relationships. There are various attachment styles or patterns through which an individual attaches or form relationships with others. Attachment has a persistent and long-term impact on depression. The main aim of the study is to assess the attachment styles and depression among nursing officers of tertiary care centre in India.
Methods: Descriptive research design was used. The study was conducted at all India institute of medical sciences (AIIMS), Jodhpur among 250 nursing officers selected by convenient sampling technique. Self-structured attachment style questionnaire was used to assess the attachment style and structured questionnaire centre for epidemiologic studies depression scale was used to assess the depression among nursing officers. Data analysis was done by using statistical package for social sciences-version 25 (SPSS-25). Frequency, percentage, mean, standard deviation, chi square test, Fisher exact test and Pearson correlation were used.
Results: Result revealed that out of 250, majority 213 (85.2%) nursing officers had secure attachment style. Majority 183 (73.2%) nursing officers were normal, showed no depression. Moderate negative correlation was there between secure attachment style and depression scores. Strong positive correlation was found between anxious attachment style and depression scores. There was moderate positive correlation between avoidant, fearful attachments and depression scores respectively.
Conclusions: The study indicates that majority of nursing officers were having secure attachment style and were normal, showed no depression. The study established a relationship between attachment style and depression
The microbiota-gut-brain axis in irritable bowel syndrome: expert guidance on diagnosis and management
Get PDFIrritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder marked by chronic abdominal pain, discomfort, and altered bowel habits, significantly affecting quality of life and healthcare costs. This review explores the role of the microbiota-gut-brain axis in IBS pathogenesis and discusses current and emerging management strategies. Dysbiosis, characterized by gut microbiota imbalance, contributes to inflammation, increased intestinal permeability, and disrupted gut-brain communication, exacerbating symptoms. Stress further impacts the gut microbiome, underscoring the psychological and gastrointestinal link in IBS. Diagnosis remains complex due to overlapping symptoms with other functional gastrointestinal disorders. The Rome IV criteria are standard for diagnosis, but Rome III may be more sensitive in India. Treatment is personalized, integrating dietary and lifestyle modifications with pharmacological options. Antispasmodics (e.g., mebeverine) provide pain relief, while rifaximin targets gut bacteria, and antidepressants address psychological factors and visceral hypersensitivity. Probiotics, especially Bifidobacterium and Lactobacillus strains, show promise in modulating gut microbiota and enhancing gut-brain signaling. Future IBS management aims to develop non-invasive biomarkers for improved diagnosis and identify novel therapeutic targets. Enhancing treatment accessibility and affordability, particularly in developing regions, remains critical. This review highlights the importance of understanding the microbiota-gut-brain axis to advance effective, individualized IBS treatments
Morphological spectrum of soft tissue tumours: experience of a cancer institute
Get PDFBackground: Soft tissue tumours are defined as mesenchymal proliferations that occur in the extra skeletal nonepithelial tissues of the body, excluding viscera, brain coverings and lymphoreticular system. This study was undertaken to study the spectrum of soft tissue tumours in State Cancer Institute, Assam.
Methods: This is a cross-sectional study undertaken in the Department of Oncopathology, State Cancer Institute, Guwahati from January, 2021 to June, 2024. All cases of soft tissue tumours, biopsy, excised specimen and review cases were included in the study. Inadequate biopsy, non-mesenchymal and bone tumours were excluded.
Results: The overall prevalence of soft tissue tumours was 1.1% (104/9575). 46.15% cases were males while 53.85% cases were females with the male to female ratio of 1:1.17. 20.19% cases were benign, 16.35% intermediate and 63.46% malignant. Adipocytic tumours consisted of 14.42% cases, fibroblastic tumours 26.92%, vascular tumours 2.88%, perivascular tumours 0.96%, smooth muscle tumours 3.85 %, skeletal tumours 5.77%, nerve sheath tumours 18.27% and tumours of uncertain differentiation 26.92%.
Conclusions: Soft tissue tumours are rare and it is important for pathologists to identify them based on morphology, immunohistochemistry and molecular analysis for prognosis and proper management of patients
Effect of preoperative anxiety on recovery time in general anesthesia
Get PDFBackground: Preoperative anxiety, common in patients undergoing surgery under general anesthesia, can negatively affect recovery by increasing stress responses and postoperative complications. This study investigates the impact of preoperative anxiety on recovery times and evaluates the effectiveness of non-pharmacological interventions, like relaxation techniques and patient education, in reducing anxiety and improving surgical outcomes. The aim was to assess the impact of preoperative anxiety on recovery time and evaluate anxiety management strategies in surgical patients.
Methods: This prospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from June 2022 to May 2023, with 142 patients aged 20-60 years undergoing elective surgery under general anesthesia. Data collection included demographics, preoperative anxiety using the state-trait anxiety inventory (STAI), physiological stress indicators, and recovery times. Patients with psychiatric conditions or on anxiety medications were excluded. Statistical analysis was performed using statistical package for the social sciences (SPSS) (version 27.0.1) to assess anxiety and recovery outcomes.
Results: The largest group of patients was aged 40-49 (29.58%) with more males (54.93%). Moderate preoperative anxiety was most common (38.73%). Surgery typically lasted 2-3 hours (38.73%), and most patients recovered within 3-4 hours (36.62%). Mild anxiety patients had faster recovery times, while severe anxiety prolonged recovery. Pain was the most frequent postoperative complication (38.73%), followed by nausea/vomiting (31.69%) and drowsiness (21.13%).
Conclusions: Preoperative anxiety prolongs recovery time. Effective management through pharmacological and non-pharmacological methods enhances postoperative recovery and outcomes