| Clinicohematological profile of patients with peripheral blood cytopenias in clinical practice Rajneesh Thakur, Navjyot Kaur, Malhotra Arjun, Sharma Sanjeevan, Puri Pankaj, Nair Velu Iraqi Journal of Hematology 2019 8(1):1-6 BACKGROUND: In clinical practice, the cytopenias may result from relatively benign causes such as viral infections and Vitamin B12/folic acid deficiency to more sinister causes such as bone marrow failure. In this study, we looked into the clinicohematological profile and etiological factors of bicytopenia and pancytopenia. OBJECTIVES: To study the etiology and clinicohematological profile in patients of peripheral blood cytopenias. MATERIALS AND METHODS: This was a cross-sectional study conducted at a tertiary care hospital over a period of 1 year. Cytopenias were defined as pancytopenia when there was simultaneous presence of hemoglobin <10 g/dL, total leukocyte count <4000/dL, and platelets < 100000/dL or as bicytopenia when two of the three blood cell lines were depressed. All patients who presented with pancytopenia and bicytopenia were included, and their clinicohematological profile was recorded. RESULTS: A total of 204 patients (103 males and 101 females) were diagnosed to have cytopenias. Pancytopenia was observed in 69/204 and bicytopenia was seen in 135/204 cases. The various causes of cytopenias included infections (n = 126 [61.76%]), megaloblastic anemia (MA) (n = 48 [23.52%]), drugs (n = 12 [5.8%]), hypersplenism (n = 8 [3.9%]), bone marrow failure syndromes such as aplastic anemia and myelodysplastic syndrome (n = 7 [3.4%]) and leukemias (n = 3 [1.4%]). We found a significant association between MA and pancytopenia (odds ratio [OR] = 2.47, P < 0.05) and also between infections and bicytopenia (OR = 5.8, P < 0.05). CONCLUSION: The present study concluded that infections and MA are the most common cause of bicytopenia and pancytopenia, respectively. The more serious disorders affecting the bone marrow constitute only <5% of all cases of cytopenias. |
| Acute promyelocytic leukemia: Epidemiology, clinical presentation, and outcome over a 10-year period of follow-up at Nanakali Hospital of Erbil city "Single-center study" Araz Taha Ahmed, Ahmed Khudair Yassin, Nawsherwan Sadiq Mohammed, Kawa Muhamedamin Hasan Iraqi Journal of Hematology 2019 8(1):7-13 BACKGROUND: Among the subtypes of acute myeloid leukemia, acute promyelocytic leukemia (APL) is a distinctive one. There are no published data regarding APL in Kurdistan, Iraq, so the data on this disease is limited. OBJECTIVES: The aims of this study was to recognize the epidemiology, clinical presentation, and to find out the outcome among APL patients at Nanakali hospital in Erbil city. PATIENTS AND METHODS: This was a retrospective study performed at Nanakali Hospital for blood diseases and cancer, Erbil, Iraq. Patients older than 18 years diagnosed with APL from January 2007 to December 2016 were involved in the study. Chi-square test, Kaplan–Meier survival curves, and the Log-Rank (Mantel–Cox) test were used for data analysis. RESULTS: During the period of the study, APL was diagnosed in 90 patients. The mean age (± standard deviations) was 37.5 ± 15.5 years, and the median was 35.5 years, the male: female ratio was 1.3:1. Around 70% were living in urban areas. Regarding clinical presentations: 71.4% of the patients presented with generalized weakness, 64.44% with bleeding, 48.9% with fever, and 2.2% presented with thrombosis. The mean hemoglobin was 8.31 ± 2.69 g/dL, mean white blood cell count of 22.3 ± 29.4 × 109/L, and mean platelet count was 33.37 ± 27.5 × 109/L. The complete remission rate was 68.2%. Early death rate was 46.4% and the 5-year survival rate was 37.8%. CONCLUSION: The clinical and epidemiological features were compared with previously published studies. High-risk patients predominate in our study population. There was a significant association between the overall survival and risk score. |
| Clinicopathological, immunohistochemical charachtaristic and the outcome of Hodghkin lymphoma patients in Erbil city, Iraq Lilan Bahzad Mohammedzaki, Kawa Muhammedamin Hasan, Ranan Kardagh Polus, Ahmed Khudair Yassin Iraqi Journal of Hematology 2019 8(1):14-20 BACKGROUND: Hodgkin lymphoma (HL) has unique epidemiological features with diversified pathologies and exhibits considerable clinicopathological variations in different parts of the world. OBJECTIVES: We aimed in this study to assess clinic-pathological features, immunohistochemistry and outcome of HL patients treated in Erbil, northren Iraq. PATIENTS AND METHODS: This was a retrospective study conducted in Nanakaly Hospital for blood diseases and oncology in Erbil, North Iraq; a total of 125 patients diagnosed between January 2012 and December 2016 were involved; they were assessed for their clinical characteristics and histopathology and immunophenotyping findings and their outcome was evaluated as well. RESULTS: The median age was 28 years (range: 18–71 years); 55% were male and 41% had Stage II disease; common histological type is nodular sclerosis (51.2%) followed by mixed cellularity (43.2%); CD30 was positive in nearly all cases of classical HL, and CD15 was positive in 98.7% and CD20 was positive in 75% in nodular lymphocyte predominant subtype. Most of the patients received adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy, and the 5-year overall survival in our study is 70%. Advanced stage (IV), high lactate dehydrogenase level, low hemoglobin, and splenomegaly are significant predictors for poor survival. CONCLUSION: Our patient exhibited outcomes that were lower to those reported in developed countries. |
| Prevalence of gestational thrombocytopenia and its effect on maternal and fetal outcome Vijay Zutshi, Nidhi Gupta, Renu Arora, Supriya Dhanker Iraqi Journal of Hematology 2019 8(1):21-24 BACKGROUND: Gestational thrombocytopenia (GT) is considered as the most common cause of thrombocytopenia in pregnancy and accounts for about 75% of cases. OBJECTIVES: The objectives of the study are (1) to estimate the prevalence of GT among antenatal patients at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital in New Delhi, India, and (2) to study the fetomaternal outcome in mild, moderate, and severe GT. MATERIALS AND METHODS: This is a prospective observational study done in the Department of Obstetrics and Gynaecology, VMMC and Safdarjung hospital in New Delhi, India, for a period of 6 months. All antenatal women underwent complete hemogram with manual platelet count in the third trimester. Those with platelet count 150 × 109/L were included and divided into three groups on the basis of platelet count. Maternal and fetal outcome was observed. Cord blood was sent for neonatal platelet count. Follow-up was done in these cases till 6 weeks postpartum. RESULTS: The prevalence of GT was 12.82%. Fetomaternal outcome was favorable. A total of five (2.5%) patients suffered from abruption. Postpartum hemorrhage was present in about 7 cases (3.5%). Blood transfusion including platelet transfusion was needed in around 13 cases (6.5%). There was no maternal mortality. Only 6 (3%) neonates were having thrombocytopenia (platelet count < 150 × 109/L) regardless of degree of maternal thrombocytopenia. Twenty-six (13%) neonates were admitted in nursery for monitoring; among these, 11 (5.5%) neonates' ventilation was needed. There was no neonatal death. CONCLUSION: Better fetomaternal outcome is seen in GT, so a vigilant and careful monitoring can prevent any adverse event. |
| A one year anticipated blood transfusion requirements among patients with acute leukemia undergoing chemotherapy in the National Center of Hematology in Baghdad Alaa Fadhil Alwan, Nidal Kareem Alrahal, Maha Abdul-Jabbar Alnuaimi Iraqi Journal of Hematology 2019 8(1):25-28 BACKGROUND: Acute leukemia is considered one of the most diseases that required frequent blood transfusion. Despite that blood transfusion is one of the main parts in the supportive management of acute leukemia patients, still, there are few data showing the exact requirements in regard to blood components for those patients. OBJECTIVES: The aims of this study were to review the predicted amount of blood transfusions needed for a patient with acute leukemia under a regimen of chemotherapy and to verify the transfusion frequency practices, according to the types of acute leukemia, levels of treatment, prognosis, and other demographic factors. MATERIALS AND METHODS: A prospective cohort study conducted at the National Center of Hematology/Mustansiriyah University from January 2013 to January 2015. Thirty newly diagnosed patients were enrolled in this study. The inclusion criteria included newly diagnosed acute leukemia whether lymphoid or myeloid except acute promyelocytic leukemia (M3) patients who were excluded. All patients subjected to detailed history and routine hematological investigations. They were followed up and assessed during induction and consolidation phases for both disease entities. RESULTS: Thirty patients were included in this study; 20 were male and 10 were female. The mean age was 31.4 years, ranging from 15 to 66 years. There were 15 cases of AML and 15 cases for ALL. The number of transfused units was found to be higher and statistically significant in those below 40 years of age, male patients and in patients with complete remission, while it was not significant for type of disease. CONCLUSION: This study provides information to estimate the anticipated requirements for blood transfusion for those patients in regard to different factors which can be considered as guideline for these tertiary centers for accurate assessment of transfusion requirements and to direct resources for better outcome. |
| School performance of children with sickle cell disease in Basra, Iraq Falah Hassan Abid, Mea'ad Kadhum Hassan, Bahaa Abd Al Hussein Ahmed Iraqi Journal of Hematology 2019 8(1):29-37 BACKGROUND: Children with sickle cell disease (SCD) have a greater likelihood of demonstrating many medical complications that may put them at risk for a variety of difficulties, including poor school performance and cognitive impairment. OBJECTIVES: This study was designed to assess the school performance of primary school-aged patients with SCD compared to age- and gender-matched healthy students and to evaluate the factors that influence school performance in these patients. MATERIALS AND METHODS: A total of 68 patients with SCD from 48 primary schools and 68 healthy student classmates (control group), aged 7–12 years, were recruited. The average school examination scores were used as a school performance measure, while cognitive functioning was assessed by using the Draw-A-Person test. RESULTS: The average school examination scores and cognitive function scores of patients with SCD (82.46 ± 15.48 and 24.72 ± 7.48, respectively) were significantly lower than the corresponding scores of their classmate control group (93.42 ± 10.02 and 27.84 ± 7.46, respectively), P < 0.05. Students with SCD missed significantly more school days (12.37 ± 10.57) than healthy students (3.18 ± 3.62), P < 0.001, and high school absence was significantly associated with low school performance among SCD patients, P = 0.027. Among patients with SCD, Pearson correlation revealed a negative association between school performance and age and school absence days (r = −0.346 and r = −0.390, respectively, P < 0.01) and a positive association between school performance and maternal education (r = −0.388, P < 0.001). CONCLUSIONS: School performance and cognitive function were significantly lower among patients with SCD than among their classmates, and school absence and the age of patients had a negative impact on school performance. |
| Molecular detection of Toxoplasma gondii in a sample of Iraqi patients with acute leukemia and stem cell transplantation Hussein Ali Al-Toban, Huda Dhaher Al-Marsomy, Waseem F Al-Tameemi, Asmaa Baqer Al-Obaidi, Mazen Abbas Mohammed, Raghad Majid Al-Saeed, Ibrahim Khalil Al-Shemary Iraqi Journal of Hematology 2019 8(1):38-44 BACKGROUND: Acute leukemia and allogenic bone marrow transplantation BMT are immunocompromised conditions which may be susceptible for many opportunistic infections or reactivation of latent infections like Toxoplasma gondii (T.gondii). OBJECTIVES: The aims of study were to detect T.gondii in both acute leukemia patients and allogenic BMT recipients and to determine copy number of T.gondii in these groups in comparison to healthy individual as control group. METHODS: Sixty one acute leukemia patients enrolled in a prospective study from 1st December 2016 to 1st June 2017. Forty eight of them evaluated while induction chemotherapy (group I), while the other 13 within 1 year post bone marrow transplantation-BMT-(group II). In addition to 30 apparently healthy individuals as (control group), blood samples were collected from all groups. T.gondii DNA was extracted and then measured by Taqman quantitative real-time PCR. Measurement IgG and IgM antibody specific to T. gondii was investigated also in the control group by an enzyme-linked immune assay (ELISA). RESULTS: T.gondii parasitemia was detected in (8.3%) 4 out of 48 group I patient. While negative in group II and control group. The range of T.gondii load was (6.285×103-17.915×103) copy/ml, the mean of the copy numbers 11458.75± 5120.85. CONCLUSION: T.gondii should be looked for Leukemic patients at least by routine serological test for early diagnosis and early treatment if indicated. Quantitative PCR is used to monitor post BMT patients at risk for T.gondii disease and for a timely start of preemptive therapy. |
| Lenalidomide-related malar rash-like lesion in patient with 5q-syndrome Gokhan Sargin, Irfan Yavasoglu Iraqi Journal of Hematology 2019 8(1):45-47 It has become important to be careful in terms of side effects with the increased lenalidomide use. The most commonly reported adverse events with the use of lenalidomide were hematologic toxicities and less frequently peripheral edema, infections, gastrointestinal disorders, fatigue, and muscle cramps. In particular, the nonserious rash is the most common cause of permanent discontinuation of lenalidomide. Although morbilliform, urticarial, or acneiform rashes have been observed with lenalidomide, malar rash-like lesions have not been described previously. Our aim is to present here 71-year-old female myelodysplastic syndrome patient with deletion of 5q abnormality who should be discontinued lenalidomide due to recurrent skin reaction like a malar rash. |
| Extramedullary hematopoiesis in case of hemoglobin E Beta-thalassemia: An unusual cause of paraplegia Prita Pradhan, Narendra Kumar Das, Kanakalata Dash, Nageswar Sahu, Urmila Senapati Iraqi Journal of Hematology 2019 8(1):48-51 Hemoglobin E (HbE) beta-thalassemia is common in Asian countries. Extramedullary hematopoiesis (EMH) is a chronic complication of this condition, which is a rare cause of paraplegia. Here, we discuss an uncommon presentation of HbE beta-thalassemia with EMH. A 32-year-old male patient presented with spastic paraplegia at C7 level. Contrast magnetic resonance imaging showed epidural extramedullary soft-tissue clumps at D2–D7 vertebra. Histology section showed numerous pleomorphic large cells admixed with colonies of small cells having rounded contour. A relook at the history revealed a history of hemolytic anemia diagnosed at the age of 12 years, for which he was on 1–2 transfusions/year. HbE beta-thalassemia had been diagnosed 20 years before. Hence, a final diagnosis of EMH was made. Although such case reports have been documented, the amount of available data is limited. A high index of suspicion for EMH should be held in patients with hematological disease who present with neurological disorders. |
Τετάρτη 13 Φεβρουαρίου 2019
Hematology
Bronchology
| Role of bronchoscopy in diagnosis of smear-negative pulmonary tuberculosis Rajendra Prasad, Abhijeet Singh Egyptian Journal of Bronchology 2019 13(1):1-5 Tuberculosis (TB) remains an important cause of morbidity and mortality in many developing countries including India. Prompt and accurate establishment of diagnosis is one of the essential basic principles of care for persons with TB. Sputum smear microscopy and culture remain the cornerstone of diagnosis but can be negative in a substantial proportion of pulmonary TB patients (multiple smear-negative status or scanty sputum). Bronchoscopy has been proven to be a safe and effective method for those patients with varying diagnostic yields ranging from 30 to 90%. Various specimens are obtained from a fiber-optic bronchoscope such as smear and culture for mycobacteria from the bronchial aspirate or wash, bronchoalveolar lavage fluid, bronchial brushing, postbronchoscopy sputum, transbronchial needle aspiration, and transbronchial biopsy. The diagnostic yield is significantly enhanced when nucleic acid amplification testing is applied to bronchoscopic specimens. The role of bronchoscopy in TB diagnosis is likely to be limited because of availability, cost, and logistical challenges. Future studies are needed to better define the role of the newer diagnostic modalities to improve early TB diagnosis. |
| Study of cardiopulmonary rehabilitation versus cardiac rehabilitation in patients suffering from coronary artery diseases and chronic obstructive pulmonary disease Yasser M Mohamed, Hala M Salem, Hazem M Khorshid, Karim H Abdel Fattah Egyptian Journal of Bronchology 2019 13(1):6-11 Introduction Chronic obstructive pulmonary disease (COPD) and coronary artery disease are common treatable and preventable chronic diseases. Rehabilitation is now considered an important part of the long-term management in both diseases and includes exercise, education, and smoking cessation. Patients and methods This study included 40 patients with COPD and coronary artery disease referred to the cardiac rehabilitation unit at Ain Shams University hospitals. Patients were assessed by clinical assessment, ECG, ECHO, modified Bruce protocol, spirometry, and St George’s Respiratory Questionnaire (SGRQ). Then, patients were divided into two groups: a cardiac rehabilitation group and a cardiopulmonary rehabilitation group. All patients received 8–12 weeks of rehabilitation and were reassessed by spirometry, the modified Bruce protocol, and SGRQ. Results Both groups improved in terms of spirometric parameters (forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity), SGRQ, and metabolic equivalents of tasks, but there was a statistically significant in resting heart rate in the cardiopulmonary rehabilitation group. Conclusion The inclusion of upper limb exercise and inspiratory muscles training in pulmonary rehabilitation improves exercise tolerance in patients suffering from both COPD and coronary artery disease compared with cardiac rehabilitation alone. |
| Cardiac evaluation of patients with chronic obstructive pulmonary disease using echocardiography Yasser Moustfa Mohammed, Ghada Samir ElShahid, Nehad Mohammed Osman, Nehal Qadry Abd ElHameed Egyptian Journal of Bronchology 2019 13(1):12-16 Background Chronic obstructive pulmonary disease (COPD) is a significant cause of death. Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Aim We used echocardiography to evaluate cardiac function in patients with COPD and correlated echocardiographic findings with COPD severity. Patients and methods We performed a prospective cross-sectional study on 60 patients with stable COPD who presented to the Abbasia Chest Hospital during the period from November 2016 till August 2017. Spirometry was performed for all participants using American and European Thoracic Society (2005) recommendations. They were classified according to GOLD guidelines (2017) and evaluated by two-dimensional Doppler echocardiography according to American and European Association of Echocardiography ASE recommendations. Results Echocardiographic examination of left ventricular functions revealed no cases of left ventricular systolic dysfunction, but left ventricular diastolic dysfunction was found in ∼25%. Right ventricle dilatation was found in ∼18% of the patients. Tricuspid regurge was seen in ∼75%, with variable grades from mild to severe. Pulmonary hypertension (PH) was found in ∼40% of the patients. It was more prevalent in patients with severe and very severe disease. Correlation between echocardiographic findings and severity of COPD revealed significant positive correlation only with right ventricle size, tricuspid regurgitation, and PH. Conclusion Left ventricular diastolic dysfunction appears to be frequent in patients with COPD, but it is not related to the disease severity. Abnormal right heart changes could be expected. Presence of PH has a linear relationship with COPD severity. |
| Detection of chronic obstructive pulmonary disease among shisha smokers in the Fayoum Governorate Assem F El Essawy, Radwa A Elhefny, Randa I Ahmed, Samar A Fouad Egyptian Journal of Bronchology 2019 13(1):17-28 Background Shisha smoking is a common practice among the population in Arabic countries. Shisha smoking has a negative effect on lung function; it is probably one of the causes for chronic obstructive pulmonary disease (COPD). Objective Detection of COPD among Shisha Smokers in the Fayoum Governorate. Design Prospective study. Setting Fayoum University Hospital in Egypt between 2016 and 2017. Patients and methods Of the 300 participants, 200 were shisha smokers for more than 20 years or their age above 40 years and 100 of them were nonsmoker volunteers. History of smoking was taken from the patients with recording of the COPD assessment score and then general and local examination was done followed by flow volume loop and finally by a chest radiography (posteroanterior view). Statistical analysis: case–control study Coding of the data was done and then entered with SPSS (statistical package for the social sciences) version number 24. After that data was summarized using mean, SD, median, minimum and maximum in the quantitative data with using frequency (count) and relative frequency (percentage) for categorization of data. Results Out of the 300 male patients included in this study 51% has obstructive airway disease and 19% had restrictive airway disease. The mean age was 56.20±10.98 years. Number of hagars smoked by the COPD patients were 10.82±9.88 hagars per day with a duration of smoking of 24.87±12.36 years. Conclusion Shisha smoking increases the risk of COPD and this risk increases with the increase in the duration of smoking and number of hagar smoked was the conclusion of the study. |
| Forced vital capacity as a primary clinical outcome measure of bronchodilator reversibility in chronic obstructive pulmonary disease Magdy Mohamed Khalil, Eman Badawy AbdelFattah, Yasmin Yousif Mostafa Egyptian Journal of Bronchology 2019 13(1):29-34 Background Spirometry is the most reproducible and objective measurement of airflow limitation. The effectiveness of inhaled bronchodilator in individual patients with chronic obstructive pulmonary disease (COPD) is assessed by comparing measurements from pulmonary function tests made before and after administration. Generally forced expiratory volume in one second (FEV1) is the marker used with the global initiative for COPD (Global Initiative for Chronic Obstructive Lung Disease) guidelines. An increase in FEV1 that is both greater than 0.2 l and 12% above the prebronchodilator FEV1 value is considered significant. The aim of this study is to assess forced vital capacity (FVC) as a clinical outcome measure of bronchodilator reversibility in patients with COPD. Patients and methods This was a prospective study conducted on 163 patients with COPD at Suez Chest Hospital during the period from first of October 2016 till the end of March 2017. Patients were diagnosed based on clinical and spirometric criteria, and then reversibility test was done using inhaled short-acting B2-agonist. All patients were subjected to COPD Assessment Test questionnaire. Results Overall, 14.11% of patients had significant increase in FEV1, whereas 54.6% of patients had significant increase in FVC after bronchodilator inhalation. There was a highly significant positive correlation in FEV1 and FVC value before and after bronchodilator inhalation, and there was a highly significant direct correlation between ΔFEV1 and ΔFVC. There was a statistically significant relation between age and COPD Assessment Test score and ΔFVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilator as airway obstruction increases. The addition of ΔFVC to the evaluation will help physicians to better interpret airways reversibility tests, particularly in more severe patients, without adding spirometric maneuvers or measurements. Patients with COPD, even if nonresponders in terms of FEV1, may benefit from bronchodilators because they can breathe at a lower lung volume owing to reduced air-trapping, notwithstanding the fact that they are still flow limited. ΔFVC correlates better than ΔFEV1with the degree of airway obstruction and the clinical status of the patients. |
| Psychological assessment of patients with bronchial asthma: focus on some predictors of abnormalities Hend M Esmaeel, Hanan Y Aly Egyptian Journal of Bronchology 2019 13(1):35-42 Background Bronchial asthma is a common chronic respiratory illness. Psychiatric comorbidity is a neglected zone in the care and management of such important physical disorders as bronchial asthma. Objective The present study targeted a population sample of out-patient asthmatics, aiming at detailed psychocognitive evaluation. Predictors of depression, anxiety, and cognitive impairment were searched for by detailed assessment of patient sociodemographic and disease-related criteria. Patients and methods A total of 50 patients with confirmed asthma diagnosis were recruited and subjected to detailed respiratory and psychiatric evaluation using Mini-Mental State Examination, Beck Depression Inventory-II, and Taylor manifest anxiety scale tests. Results Mild, moderate, and severe depression were diagnosed in 26, 28, and 14% of patients, respectively, whereas mild, moderate, and severe anxiety were revealed in 32, 34, and 20%, respectively. Overall, 54% of the patients showed cognitive impairment. Asthmatic female patients were more common to have depression (P=0.022). The present analysis showed that predictors of cognitive impairment were older age, increasing frequency of hospital admission for asthma in the past year, improper adherence to treatment, and uncontrolled asthma. Meanwhile better education level proved to be protective from abnormal cognitive function. Conclusion There was high prevalence of depression, anxiety, and cognitive dysfunction among asthmatic patients in Sohag University. Improving patient education, patient adherence to treatment, and asthma level control may lessen the chance of cognitive abnormality. |
| Assessment of lung functions using impulse oscillometry before and after bronchoscopic lung volume reduction with histoacryl gel Adel M Khattab, Nevine Abd Elfattah, Ayman Farghaly, Alsayyed Hassan Egyptian Journal of Bronchology 2019 13(1):43-48 Background Many forms of bronchoscopic lung volume reduction were introduced as a treatment for patients with emphysema surpassing the surgical management and its fatality. Biological bronchoscopic lung volume reduction (BBLVR) proved to be a safe and competent solution inducing collapse of the emphysematous segment(s). Impulse oscillometry (IOS) constitutes an effortless but underused surrogate to spirometry in assessment of pulmonary function. Therefore, the aim of this study was to evaluate the use of IOS before and after BBLVR with histoacryl gel in comparison with spirometry among patients with emphysema. Patients and methods A prospective comparative follow-up study was performed at Kobry El-Kobba Military Hospital. A total of 30 patients with radiological evidence of heterogenous emphysema or emphysematous bullae were enrolled during the period from July 2014 to April 2015. BBLVR was accomplished by the instillation of the histoacryl gel into the affected segment(s) using standard technique. Clinical, radiological, and functional assessments were done before and 4 weeks after the procedure. Results After BBLVR, the following outcome was measured: 6-min walk test, partial pressure of O2 in arterial blood, forced expiratory volume in the first second, resistance at 5 Hz, resistance at 20 Hz, and reactance at 5 Hz. They improved with statistical significance among all the patients. There was a negative correlation between forced vital capacity and resistance at 5 Hz in the heterogenous emphysema group (ρ=0.47 and P<0.025); however, the forced expiratory volume at first second showed positive correlation with reactance at 5 Hz in emphysematous bullae group (ρ=0.82 and P<0.023). Conclusion BBLVR with histoacryl gel is associated with improvement in exercise capacity and lung functions. IOS provided comprehensive assessment of the pulmonary functions, which was in good correlation with spirometry. |
| Evaluation of lung cancer patterns and bronchoscopic presentations in patients admitted to Abbasia Chest Hospital Farrag A Muhammad, Diab S Haytham, Khalaf A Mostafa Egyptian Journal of Bronchology 2019 13(1):49-54 Background Lung cancer is the most common cause of cancer-related death worldwide, accounting for more cancer-related deaths compared with colon, breast, and prostate combined. Aim The aim of this work is to detect the predominant bronchoscopic presentations and anatomical sites for all histopathological types of lung cancer. Patients and methods This study was conducted prospectively in the bronchoscopy units in Abbasia Chest Hospital. It included 132 patients suspected clinically and radiologically to have lung cancer and admitted to the hospital during the period from July 2016 to March 2017. Of them, 81 patients were pathologically diagnosed as having primary lung cancer. Statistical analysis χ2 test was used to examine the relationship between the two qualitative variables. Student’s t test was used to assess the statistical significance of the difference between the two study group means. McNamara test was used assess the statistical significance of the difference between a qualitative variable measured twice for the same study group. Results A total of 81 patients (73 males and eight females) with primary lung cancer were included in the study; most of them were in the sixth decade of life. The main anatomical sites of bronchogenic carcinoma were main bronchi and lower lobe bronchi equally (24% each), followed by lower lobe bronchi (20%). Most common macroscopic bronchoscopic presentations of bronchogenic carcinoma were end bronchial lesion (46.91%) followed by external compression (12.35%) and then mucosal infiltration and external compression (9.88%). Conclusion Persistent pulmonary complaints like productive cough, dyspnea, chest pain, and hemoptysis should be investigated immediately. Proper screening and early diagnostic methods should be applied on a large scale to find out suspected patients who at risk to develop lung cancer. |
| The role of medical thoracoscopy in the management of empyema Ahmad G El Gazzar, Mohammad A.E El-Mahdy, Gehan F Al Mehy, Asmaa El Desoukey Mohammad Egyptian Journal of Bronchology 2019 13(1):55-62 Background Empyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality. Aim The aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema. Patients and methods This study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface. Results The present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study. Conclusion MT is a simple, safe, minimally invasive, and effective modality in the management of empyema. |
| Evaluation of safety and diagnostic yield of pleural cryobiopsies during thoracoscopy Mona M Ahmed, Samar H AlSharkawy, Amr M Shoukri, Yousra T AbouBakr Egyptian Journal of Bronchology 2019 13(1):63-66 Background Biopsies using cryoprobe are now widely used in interventional pulmonology. There are only few data available on the use of cryotechnique through rigid thoracoscopy. Aim The aim of this work was to evaluate the diagnostic yield and safety of pleural cryobiopsies using rigid thoracoscopy. Patients and methods A total of 30 patients with undiagnosed exudative pleural effusion who underwent rigid thoracoscopy were included in our study. Biopsies were obtained from suspicious areas by rigid forceps and cryoprobe. Results A total of 30 patients with undiagnosed exudative pleural effusion have been analyzed. Histopathological results of thoracoscopic pleural biopsies revealed that the most common diagnosis was malignancy (50%), followed by tuberculosis (26.7%). Cryobiopsy specimens were larger than forceps biopsy specimens, with no difference in diagnostic yield (76.7%). Cryotechnique proved to be beneficial in cases of thin highly vascular pleura, allowing easier biopsies with lesser risk of bleeding. In cases of thickened fibrous pleura, there was no difference between both the techniques. Conclusion Pleural cryobiopsies through rigid thoracoscopy is a simple and safe procedure. It has a high diagnostic yield similar to rigid forceps biopsy, and it showed better performance in thin highly vascular pleura where biopsies can be performed with minimal risk of bleeding. |
Advanced Pharmaceutical Technology & Research
| Nanomedicine in prosthetic dentistry Upendra Nagaich Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):1-1 |
| Quercetin prevent proteoglycan destruction by inhibits matrix metalloproteinase-9, matrix metalloproteinase-13, a disintegrin and metalloproteinase with thrombospondin motifs-5 expressions on osteoarthritis model rats Dian Agustina Permatasari, Deantari Karliana, Iskandarsyah Iskandarsyah, Ade Arsianti, Anton Bahtiar Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):2-8 Prior study has shown that Ageratum conyzoides L. extract that containing quercetin has been proved to prevent inflammation and proteoglycan degradation by inhibiting tumor necrosis factor-alpha and matrix metalloproteinase (MMP-9) expression. Target of osteoarthritis (OA) treatment was in the synovial joint that requiring a drug delivery system. The aim of this study was to prove the efficacy of quercetin-loaded lecithin-chitosan nanoparticles on the OA model rats by observed its effect on interleukin (IL-1) β, MMP-9, MMP-13, and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS-5) expressions. In this study, 70 white male Sprague Dawley rats were divided into 14 groups, 7 groups each for destabilization of medial meniscus (DMM) and monoiodoacetate (MIA)-induced OA. After 28 days from induction, SHAM and negative group received gel base topically; positive group received sodium diclofenac gel; three-dose group received each 0.84, 1.68, 3.36 mg/g quercetin-loaded nanoparticles gel; and A. conyzoides L. group received A. conyzoides L. extract gel. Each group gets treatment until day 70, and then, blood sample was collected for serum analysis; knee joint was isolated and subjected to histology samples treatment. Quercetin-loaded nanoparticle gel dose 1 (0.84 mg/g gel), dose 2 (1.68 mg/g gel), dose 3 (3.36 mg/g), and A. conyzoides L. extract gel could decreased the level of IL-1 β, MMP-9, MMP-13, ADAMTS-5, and increasing color intensity significantly on histopathological observations on DMM and MIA-induced OA. |
| High mannoronic acid containing alginate affects the differentiation of Wharton's jelly-derived stem cells to hepatocyte-like cell Saeed Azandeh, Darioush Bijan Nejad, Vahid Bayati, Foroug Shakoor, Negar Varaa, Bahman Cheraghian Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):9-15 For transplantation of cell into injured tissues, cells should be transferred to the damaged site through an adequate carrier. Nevertheless, the nutrient-limited and hypoxic condition in the carrier can bring about broad cell death. This study set to assess the impact of alginate concentrations on the differentiation and the proliferation of cells encapsulated in alginate hydrogels. Human Wharton's Jelly-derived Mesenchymal Stem Cells (HWJ-MSCs) were encapsulated in two concentrations of alginate hydrogel. Then, the proliferation and the hepatic differentiation were evaluated with an MTT assay and the enzyme-linked immunosorbent assay software and urea production. The results demonstrated that the proliferation of cell and urea production in 1.5% alginate concentration was higher than in 2.5% alginate concentration in the hydrogels of alginate. We deduce that the optimized alginate hydrogel concentration is necessary for achieving comparable cell activities in three-dimensional culture. |
| The effect of venous caffeine on the prevention of apnea of prematurity in the very preterm infants in the neonatal intensive care unit of Shahid Motahhari Hospital, Urmia, during a year Zahra Fakoor, Ali Aghayar Makooie, Zahra Joudi, Rasool Gharaaghaji Asl Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):16-19 Due to the importance of prevention of apnea of prematurity in the very preterm infants and the side effects of using methylxanthines in preterm infants, the present study was conducted and aimed at investigating the effects of prophylactic caffeine on the incident of apnea (short-term consequence). This is a clinical–experimental trial, in which the infants were included after receiving written consent from their parents. The infants were randomly divided into two groups, namely, Group A (receive caffeine) and Group B (did not receive caffeine). After sampling of the collected data, the two groups were analyzed using statistical tests using SPSS software 23. Among the 50 infants in the caffeine group and 50 infants in the control group, 1 (2%) and 2 (4%) infants required long-term oxygen, respectively. Three (6%) infants from the caffeine group and 2 (4%) infants from the control group had an intraventricular hemorrhage. Two (4%) infants from the caffeine group and 1 (2%) infant from the control group had a positive patent ductus arteriosus and needed treatment. Among the 50 infants in the caffeine group and 50 infants in the control group, 7 (14%) and 9 (18%) infants had apnea, respectively. According to the Fisher's exact test, there was no significant difference between the incident of apnea in the two groups (P = 0.58). Ten (20%) infants from the caffeine group and 7 (14%) infants from the control group died. The prescription of prophylactic caffeine had no effect on the incident of apnea in the infants. Hence, the use of that should be limited to the preterm infants lower than 1250 g in the prophylactic form. |
| Proniosomal gel-mediated topical delivery of fluconazole: Development, in vitro characterization, and microbiological evaluation Amal Saber Mohammed Abu El-Enin, Maha Khalifa Ahmed Khalifa, Aya Mohammed Dawaba, Hamdy Mohammed Dawaba Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):20-26 The aim of this study was to explore the potential of proniosomal gel for topical delivery of fluconazole, an antifungal drug used in fungal infections caused by pathogenic fungi. Fluconazole-loaded proniosomal gels were prepared by the coacervation phase separation method using different nonionic surfactants (spans and tweens). The prepared fluconazole proniosomal gels were evaluated for various parameters such as particle size (PS), drug entrapment efficiency percentage (EE%), and in vitro drug release. The experimental results showed that the EE% for the prepared formulae are acceptable (85.14%–97.66%) and they are nanosized (19.8–50.1 nm) and the diffusion from the gels gave the desired sustaining effect. F4, which was prepared from span 60, tween 80 (1:1), and cholesterol showed highest EE% and gave slow release (40.50% ± 1.50% after 6 h), was subjected to zeta potential (ZP) test, transmission electron microscopy as well as microbiological study. The results showed a well-defined spherical vesicle with sharp boundaries with good physical stability of fluconazole within the prepared gel. Moreover, F4 showed an excellent microbiological activity represented by a greater zone of inhibition (5.3 cm) compared to control gel (fluconazole in 2% hydroxy propyl methyl cellulose (HPMC) gel formula) (4.2 cm) and plain gel with no drug (0 cm) against Candida albicans. This study showed the suitability of the proniosomal gel in attaining the desired sustainment effect for topical delivery of fluconazole for the management of fungal infection. The physical stability study showed that there was no significant change in EE%, PS, and ZP of fluconazole proniosomal gel after storage for 6 months. |
| The potency of chitosan-Pinus merkusii extract nanoparticle as the antioxidant and anti-caspase 3 on lead acetate-induced nephrotoxicity in rat Sri Agus Sudjarwo, Koerniasari Eraiko, Giftania Wardani Sudjarwo, Koerniasari Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):27-32 The current study was carried out to evaluate the antioxidant and anti-caspase 3 activity of chitosan-Pinus merkusii nanoparticle in against lead acetate-induced nephrotoxicity in rats. chitosan-P. merkusii nanoparticle was characterized by dynamic light scattering (DLS) and scanning electron microscope (SEM). The male rats were divided into control group (rats were given with distilled water), lead acetate group (rats were injected with lead acetate 15 mg/kg BW i. p), and the treatment group (rats were given the chitosan-P. merkusii nanoparticle 150 mg, 300 mg, 600 mg/kg BW orally and were injected with lead acetate 15 mg/kg BW). The rats blood samples were measured levels of blood urea nitrogen (BUN) and creatinine. The kidney tissues were collected to evaluate the malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx). Histological to evaluate renal damage, and immunohistochemical to analyze the expression of caspase 3. The results showed that DLS showed the size of chitosan-P. merkusii nanoparticle was 165.9 ± 24.18 nm. SEM images of the chitosan-P. merkusii nanoparticles showed an irregular shape and its the rough surface. Administration of lead acetate resulted in a significant increase in levels of the BUN, creatinine, MDA level, caspase 3 expression, and a decrease in SOD and GPx were compared with the control group. Treatment with the chitosan-P. merkusii nanoparticle 600 mg/kg BW significantly decreased the elevated BUN, creatinine, MDA levels, caspase 3 expression and also increase in SOD and GPx as compared to lead acetate group. The lead acetate induced loss of the normal structure of renal cells and necrosis, whereas treated with chitosan-P. merkusii nanoparticle improved renal cell necrosis. This study indicates that chitosan-P. merkusii nanoparticles appeared to be a promising agent for protection against lead-induced nephrotoxicity through increasing antioxidant and inhibiting caspase 3 expression. |
| Effects of rosuvastatin on metabolic profile: Versatility of dose-dependent effect Hayder M Al-Kuraishy, Ali I Al-Gareeb Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):33-38 Obesity refers to an excess of body fat content causing metabolic and inflammatory disorders. Therefore, the aim of the present study was to investigate dose-dependent effect of rosuvastatin on the metabolic profile of diet-induced obesity in mice model study. A total number of 40 male Albino Swiss mice were used which divided into Group I: Control group, fed normal diet for 8 weeks (n = 10); Group II: High-fat diet (HFD) group, fed on HFD for 8 weeks (n = 10); Group III: HFD + 20 mg/kg rosuvastatin for 8 weeks (n = 10); and Group IV: HFD +40 mg/kg rosuvastatin for 8 weeks (n = 10). Anthropometric and biochemical parameters were estimated, including fasting blood glucose, lipid profile, fasting insulin, and glucose tolerance test (GTT). Mice on HFD fed showed a significant increase in the insulin resistance, body weight, deterioration of lipid profile and significant reduction in the β-cell function, and insulin sensitivity compared to the control P < 0.05. GTT and blood glucose level were significantly high in HFD fed group compared to the control group P < 0.05. Rosuvastatin in a dose of 40 mg/kg illustrated better effect than 20 mg/kg on the glucometabolic profile P < 0.05. Rosuvastatin may has a potential effect on reduction of glucometabolic changes induced by HFD with significant amelioration of pancreatic β-cell function in dose-dependent manner. |
| Assessment of the fitness of Cox and parametric regression models of survival distribution for Iranian breast cancer patients' data Maryam Mohseny, Reza Shekarriz-Foumani, Parastoo Amiri, Marjan Vejdani, Pezhman Farshidmehr, Hossein Zabihi Mahmoudabadi, Farzaneh Amanpour, Pegah Mohaghegh, Farzad Tajdini, Azadeh Sayarifard, Esmat Davoudi-Monfared Journal of Advanced Pharmaceutical Technology & Research 2019 10(1):39-44 Factors affecting the time of survival after breast cancer (BC) diagnosis remain unknown. However, some of the prognostic factors have been identified. The aim of this study was to investigate the effects of biologic and socioeconomic factors on long-term survival of BC patients. This was a descriptive chart review and survey of all women with a confirmed diagnosis of BC registered in Shohada-e-Tajrish Cancer Research Center database from March 2004 to March 2015. The checklist of study consisted of biologic, demographic, reproductive, genetic, medical, and therapeutic information of patients. The minimum time of follow-up was 3 years and the maximum was 10 years. We then evaluated possible associations of these variables with BC survival using Cox and parametric regression models of survival analysis. The study population was 1276 BC patients. Their mean survival was 23 (range 1–120) months. Between the parametric models, Weibull regression model demonstrated the lowest Akaike information criterion and thus the best fit, and tumor size, number of lymph nodes, BC stage, educational level, and high-fat diet were significant in this model. Based on our findings, educational level, consumption of fat, and characteristics of tumor at the time of diagnosis (disease stage, tumor size, number of involved lymph nodes) are the most important prognostic factors affecting long-term survival of BC patients. We suggest that future studies assess the efficacy of possible interventions for these factors. |
Pharmacy And Bioallied Sciences
| Date palm (Phoenix dactylifera L.) fruit as potential antioxidant and antimicrobial agents Hussah A Al-Shwyeh Journal of Pharmacy And Bioallied Sciences 2019 11(1):1-11 Date palm (Phoenix dactylifera L.) is the most popular fruit in the Middle East and North Africa. It is consumed widely and has been used for traditional medicine purposes for a long time. The fruits are nutrient rich, containing dietary fibers, sugar, protein, vitamins, minerals, flavonoid, and phenolic compounds. Due to the presence of the phenolic compounds, date palm fruits are antioxidant rich with potent bioactivities against several bacterial pathogens. Therefore, on the basis of the available evidence as reviewed in this paper, it was found that date fruits are a good source of natural antioxidants, which can be used for the management of oxidative stress–related and infectious diseases. |
| Biosimilars in India; current status and future perspectives Bikash R Meher, Sakthi Balan, Rashmi R Mohanty, Monalisa Jena, Smita Das Journal of Pharmacy And Bioallied Sciences 2019 11(1):12-15 Many key biologics are scheduled to lose their patent by the year 2020, which will provide the opportunity to other biopharmaceutical companies to develop the similar biologics. Biosimilar or similar biologic used has increased in the recent year following the approval of the first biosimilar in early 2000. India is one of the leading manufacturers of similar biologics. India has developed a new guideline in 2012 for the pre- and post-marketing approval of similar biologics. |
| High-performance liquid chromatographic analysis explores the potential antioxidative agents of Argyreia argentea ARN. EX CHOISY extract Md. Nazim Uddin, Md. Atiar Rahman, Hemayet Hossain, Tanzir Ahmed Khan, Rehana Akter Journal of Pharmacy And Bioallied Sciences 2019 11(1):16-22 Background: Antioxidative properties of medicinal plants play the key role in plant defense mechanism. Argyreia argentea is an evergreen shrub which is used in the treatment of boils, gastric ulcers, tumor, marasmus, paralysis and spermatorrhea, rheumatoid arthritis, cold, painful sensation, and fever. Aims: This research investigates the phytochemical contents and antioxidative effects of optimized crude methanol extract of A. argentea. Materials and Methods: Crude methanol extract of A. argentea prepared in an optimized procedure has been analyzed by high-performance liquid chromatography to quantitatively determine the phytochemical contents. Tannin content of the extract was determined by established method. The extract was also analyzed for in vitro antioxidative actions by spectrophotometric analysis using 2,2’-azino-bis(3-ethylbenzo-thiazoline-6-sulfonic acid) diammonium salt (ABTS) method, N, N-dimethyl-1,4-diaminobenzene (DMPD) free radical scavenging method, superoxide radical scavenging method, and nitric oxide scavenging method. Results: The experimental results showed a high amount of catechin hydrate (348.62mg/100g of dry extract) and moderate amount of gallic acid, p-coumaric acid, and rutin hydrate in the methanol extract of A. argentea. Tannin content was found to be 29.66mg/g tannic acid equivalent. Scavenging effects expressed as inhibition concentrations (IC50) for ABTS assay, DMPD assay, superoxide assay, and NO assay were 1148.3 µg/mL ± 7.32 µmol ascorbic acid/g, 1017.68 µg/mL, 1116.89 µg/mL, 1835.23 µg/mL, respectively. All the values were compared with their respective standards. No β-carotene was detected in the extract. Conclusions: Use of A. argentea extract as a source of functional food as well as an antioxidative agent could be considered with further confirmation. |
| Cysteine supplementation mitigates the toxicity associated with antitumor therapy of Ehrlich's ascites fluid adsorbed over protein a containing Staphylococcus aureus cowan I† Ashish S Verma, Anchal Singh, Priyadarshini Mallick, Premendra D Dwivedi Journal of Pharmacy And Bioallied Sciences 2019 11(1):23-32 Introduction: Previously, we have reported the amelioration of ad-AF induced hepatotoxicity with the exogenous supplementation of glutathione (GSH) without compromising the anti-tumor effect of ad-AF in ascites tumor model of mice with transplantable Ehrlich’s Ascites Tumor cells. Cellular uptake of glutathione (GSH) has its own limitations, therefore exogenous supplementation of L-cysteine (Cys) was tried to reduce the toxicity of ad-AF by providing –SH contents without compromising the anti-tumor property of adsorbed ascites fluid (ad-AF). Results: A significant increase in mean survival time (MST) of tumor bearing mice from 18.1 days to 32.9 days with exogenous supplementation of Cys was observed. Cys supplementation did not alter decline in body-weight gain, tumor cell counts as well as decrease in the viability of tumor cells in ascites tumor bearing animals. Similarly, Cys has been helpful to restore the hepatic –SH contents upto the levels of –SH content in tumor control group. The exogenous supplementation of Cys along with ad-AF has been helpful to restore the decline in the activities of phase-I and enhanced levels of glutathione-S-transferase (GST). The changes in the activities of different enzymes of phase-I and phase-II indicate the reduction in toxic insult induced by the therapeutic material (ad-AF). However, ad-AF treatment could not prevent tumor bearers from natural death due to tumor progression but significantly reduced the rate of tumor progression. Conclusions: Our study suggests that exogenous supplementation of Cys alongwith ad-AF could have a potential to be developed as a modality for the treatment of ascites tumor at least at experimental level. |
| Effect of Azadirachta indica crude bark extracts concentrations against gram-positive and gram-negative bacterial pathogens Shreelakshmidevi Singaravelu, Jaikumar Sankarapillai, Abilash Sasidharn Chandrakumari, Pammy Sinha Journal of Pharmacy And Bioallied Sciences 2019 11(1):33-37 Background: Today’s pharmaceutical markets are crowded with antibacterial agents, yet their toxicities and resistance are always contentious. Azadirachta indica is used in India as an age-old treatment for diverse medical conditions. This study was put forth to analyze the antibacterial action of A. indica bark extract on different bacterial pathogens. Materials and Methods: A. indica bark extract was prepared using Soxhlet extraction method. The bark extract of A. indica was screened for antibacterial activity by agar well diffusion assay technique against Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, and Proteus mirabilis. Ciprofloxacin (5 µg per disc) was used as positive control. All assays were carried out under strict aseptic precautions. All the concentrations included were duplicated, and the results obtained were the average of two independent experiments. Broth microdilution method was used to study the minimum inhibitory concentration of the bark extract of A. indica. Results: A. indica bark extract has shown antibacterial activity against all concentrations of bark extract, whereas antibacterial activity against S. aureus was observed at higher concentration of >500 µg/mL. The bark extract of A. indica showed zone of clearance against E. faecalis, P. aeruginosa, and P. mirabilis at all concentrations. Zone of inhibition was observed in higher concentrations against S. aureus. Conclusion: This study has shown that A. indica bark extract has a potent antibacterial property against S. aureus, E. faecalis, P. aeruginosa, and P. mirabilis. Further isolation of bioactive compounds may lead to a new scope in the treatment of bacterial infections. |
| Apoptosis-mediated cytotoxic effect of Caralluma adscendens var. attenuata on colon (HT29) and Hepatic (HepG2) cancer cell lines Mallela Vijaya Jyothi, Eranti Bhargav, Chilamakuru Naresh Babu, Kanala Somasekhar Reddy, Bhupalam Pradeep Kumar, Ravi Prasad Rao Journal of Pharmacy And Bioallied Sciences 2019 11(1):38-42 Introduction: Caralluma adscendens var. attenuata (Wight) Grav. and Mayur., a member of Apocynaceae, is a perennial stem succulent plant with wide distribution in tropics and subtropics of the world. This plant is reported for the presence of steroids, flavonoids, saponins, triterpenes, and pregnane glycosides, and is known to have antidiabetic and antiulcerogenic properties. Materials and Methods: In this study, an attempt was made to identify antioxidant capacity and cytotoxic potential of n-hexane and aqueous methanolic extracts of total stem part of C. adscendens var. attenuata. Antioxidant activity was evaluated by total phenolic content assay, total flavonoid content assay, free radical scavenging activity, and reducing ability methods. Cytotoxic activity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide (MTT) assay and nuclear staining methods for colorectal cancer cell lines HT29 and liver cancer cell lines HepG2. Results: MTT assay method has proven that the IC50 value was 10 μg/mL for both extracts, whereas for cisplatin standard, it was 2 μg/mL. By nuclear staining, the apoptotic cells were identified as oval masses with dark cytoplasm and dense green nuclear chromatin fragments indicating the programmed cell death for both n-hexane and aqueous methanolic extracts at the same concentration (10μg/mL). Conclusion: However, aqueous methanolic extract showed prominent cytotoxic potential against both cancer cell lines. |
| Comparison and evaluation of different seed extracts of Trachyspermum ammi for immunomodulatory effect on cell-mediated immunity through delayed-type hypersensitivity assay skin thickness method Mohammad Jamshed Siddiqui, Adeel Aslam, Tanveer Khan Journal of Pharmacy And Bioallied Sciences 2019 11(1):43-48 Objective: The aim and objective of this study was to find the immunostimulant and immunomodulatory effect of T. ammi seed extracts. Methods: Seeds of T. ammi were extracted using three different solvents n-hexane, chloroform, and methanol by using soxhlet apparatus. To assess the immunomodulatory effect, delayed-type hypersensitivity (DTH) assay method was used and by the DTH assay, the effect of T. ammi on the skin thickness of rats was estimated. To find the exact dose for administration, acute toxicity test was performed using crude methanolic extract at a dose of 400, 800, 1600, and 3200mg/kg. After acute toxicity test, 500mg/kg dose was determined as safe for therapeutic effect and immunomodulatory effect was evaluated at this dose. Dose of 500mg/kg was administered to Wistar rats daily for 14 days and skin thickness of rats was measured at 24, 48, and 72h. Results: Results were obtained from six groups of rats, which were positive control group, negative control group, and the groups receiving the test drugs. Standard drug was the combination of sodium selenite, vitamin E, and sodium chloride and it showed more positive results as compared to that of test drug. Furthermore, among the three extracts, methanol extract showed more effectiveness on skin thickness. Conclusion: There was a meaningful difference was observed between the skin thickness of rats which shows that T. ammi have good immunomodulatory as well as immunostimulant activity. |
| Development and validation of liquid chromatography method for determination of glimepiride in presence of (Vimto®) soft drinks in rats: application to pharmacokinetics studies Mohammed Hamad, Areej Rahhal, Wael Abu Dayyih, Eyad Mallah, Alice Abu Dayyih, Zainab Zakaria, Tawfiq Arafat Journal of Pharmacy And Bioallied Sciences 2019 11(1):49-59 Context: Diet and beverages are thought to have notable effects on drugs. Recently, this relationship has received significant consideration. Aims: To develop and validate a simple, rapid, and sensitive method for the determination of glimepiride in rat serum. This will be performed using high-performance liquid chromatography–mass spectrometry (HPLC-MS/MS). Potential pharmacokinetic interactions between glimepiride and the soft drink, Vimto, will also be investigated in the serum of experimental rats. Materials and Methods: HPLC-MS/MS was constructed and clarithromycin was used as an internal standard. Results: The method was validated in terms of linearity, precision, accuracy, stability, and system suitability parameters. The method was found to be satisfactory and suitable for the determination of glimepiride. The precision of glimepiride was high (coefficient of variation, CV% <15%), the accuracy over all 3 days of validation was within the accepted criteria. Glimepiride peak serum concentration (Cmax) was 126.01ng/mL and was reached within 1h (Tmax) of administration. Mean area under curve (AUC) was 964.70ng/mL and was reached within 24h of administration. The Vimto soft drink significantly (P < 0.050) reduced glimepiride peak serum concentration to 57.87ng/mL and was reached within 2h of administration. AUC was significantly reduced to 335.04 ng*h/mL (P < 0.050). Conclusion: Glimepiride pharmacokinetic parameters such as Cmax and AUC were significantly affected by the Vimto soft drink. Therefore, this study developed a simple, rapid, and sensitive method for validation and determination of the effects of soft drinks on drugs using the LC-MS/MS method. |
| Antioxidant potential of Solanum nigrum aqueous leaves extract in modulating restraint stress-induced changes in rat's liver Syed K Zaidi, Shakeel A Ansari, Shams Tabrez, Muhammad I Naseer, Moyad J Shahwan, Naheed Banu, Muhammad H Al-Qahtani Journal of Pharmacy And Bioallied Sciences 2019 11(1):60-68 Introduction: This study was carried out to evaluate the antioxidant potential of crude extract of Solanum nigrum leaves and its active constituents as treatment against restraint stress in rat’s liver. Methods: For this purpose, male albino Wistar rats were treated with crude extract of leaves and its alkaloid and flavonoid fractions both before and after 6 h of acute restraint stress. Prooxidant status of rat liver was assessed by determining the levels of thiobarbituric acid reactive substances, reduced glutathione, alkaline phosphatase, alanine transaminase, aspartate aminotransferase, and the activities of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione S-transferase (GST). Results: Six hours of restraint stress generated oxidative stress in rat’s liver resulted in a significant rise in the level of the aforementioned liver enzymes. On the other hand, SOD, CAT, and GST enzymatic activities showed a significant decline in their level. The administration of crude leaves extract, both before and after stress exposure, significantly prevented the rise in the level of liver enzymes and reverted the activities of studied biochemical parameters toward their normal control values. However, the reversion was found to be more prominent in after-stress group. Conclusion: The aforementioned results highlight the significant antioxidant potential of S. nigrum extracts. On the basis of our study, we suggest the possible use of S. nigrum leaves extract as a nutritional supplement for combating oxidative stress induced damage. |
| Impact of pharmacist-directed counseling and message reminder services on medication adherence and clinical outcomes in type 2 diabetes mellitus Narayana Goruntla, Vijayajyothi Mallela, Devanna Nayakanti Journal of Pharmacy And Bioallied Sciences 2019 11(1):69-76 Introduction: Medication nonadherence is the most common issue observed in the management of diabetes because of complex and lifelong therapy. The study aimed to assess the effect of pharmacist-directed counseling and daily text message reminder on medication adherence and clinical profile of patients with type II diabetes. Materials and Methods: This prospective, open-labeled, randomized control trial was carried out in outpatient medical department of a secondary care referral hospital. A total of 330 patients who met study criteria were enrolled and randomized into an intervention group (n = 165), received counseling and daily messages about medication intake and control group (n = 165), and usual care by physician. Medication adherence and clinical outcomes such as glycosylated hemoglobin (HbA1C), systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, triglyceride (TG) levels, and body mass index (BMI) were recorded at baseline and follow-up visits. Two-sample Wilcoxon rank sum test was used to compare the mean difference of medication adherence and paired t-test was used to compare clinical outcomes. Results and Discussion: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53 years, respectively. The mean difference of medication adherence from baseline to second follow-up visit was significantly more in intervention group (12.2±7.1%) compared to that in control group (0.75±10.2%) with a P < 0.001. From baseline to second follow-up visit, HbA1C (7.79±0.67 to 6.91±0.83%), SBP (136.75±20.09 to 126.23±18.22mm Hg), and LDL cholesterol (104.14±26.23 to 98.29±20.87mg/dL) levels were significantly reduced in intervention group compared to that in control group with a P < 0.01. No significant improvement was observed in TG (169±33.71 to 168 65±33.90mg/dL) and BMI (27.9±4.21 to 27.1±3.12Kg/m2) levels from baseline to second follow-up visit. Conclusion: Pharmacist-directed patient counseling combined with message reminder showed a greater effect on the improvement of medication adherence and control of glycemia, blood pressure, and lipid profile in diabetes. |
Hepatotoxicity induced by immune checkpoint inhibitors, Drug–drug interactions of a two-drug regimen of dolutegravir and lamivudine for HIV treatment,Enhancement of lung levels of antibiotics by ambroxol and bromhexine,Pharmacokinetic considerations for anti-epileptic drugs in children
New for Expert Opinion on Drug Metabolism & Toxicology and online now
on Taylor & Francis Online
Pharmacokinetic considerations for anti-epileptic drugs in children
Alberto Verrotti, Giulia Iapadre, Giulia Di Donato, Ludovica Di
Francesco, Luca Zagaroli, Sara Matricardi, Vincenzo Belcastro & Maria
Laura Iezzi
Pages: 1-13
DOI: 10.1080/17425255.2019.1575361
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Enhancement of lung levels of antibiotics by ambroxol and bromhexine
Vojo Deretic & Graham S. Timmins
Pages: 1-6
DOI: 10.1080/17425255.2019.1578748
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Drug–drug interactions of a two-drug regimen of dolutegravir and
lamivudine for HIV treatment
Dario Cattaneo, Amedeo Capetti & Giuliano Rizzardini
Pages: 1-8
DOI: 10.1080/17425255.2019.1577821
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Hepatotoxicity induced by immune checkpoint inhibitors: a
comprehensive review including current and alternative management
strategies
Joseph J. Jennings, Rohan Mandaliya, Ahmad Nakshabandi & James H.
Lewis
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DOI: 10.1080/17425255.2019.1574744
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Pharmacokinetic considerations for anti-epileptic drugs in children
Alberto Verrotti, Giulia Iapadre, Giulia Di Donato, Ludovica Di
Francesco, Luca Zagaroli, Sara Matricardi, Vincenzo Belcastro & Maria
Laura Iezzi
Pages: 1-13
DOI: 10.1080/17425255.2019.1575361
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Enhancement of lung levels of antibiotics by ambroxol and bromhexine
Vojo Deretic & Graham S. Timmins
Pages: 1-6
DOI: 10.1080/17425255.2019.1578748
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Drug–drug interactions of a two-drug regimen of dolutegravir and
lamivudine for HIV treatment
Dario Cattaneo, Amedeo Capetti & Giuliano Rizzardini
Pages: 1-8
DOI: 10.1080/17425255.2019.1577821
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Hepatotoxicity induced by immune checkpoint inhibitors: a
comprehensive review including current and alternative management
strategies
Joseph J. Jennings, Rohan Mandaliya, Ahmad Nakshabandi & James H.
Lewis
Pages: 1-14
DOI: 10.1080/17425255.2019.1574744
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Outcomes of carotid‐sparing IMRT for T1 glottic cancer: Comparison with conventional radiation
Objectives
We aim to report oncologic outcomes after conventional radiotherapy (ConRT) using opposed lateral beams and intensity‐modulated radiation therapy (IMRT) for tumor (T)1 nodal (N)0 T1 N0 glottic squamous cell carcinoma.
Study Design
Retrospective case‐control study.
Methods
We retrospectively reviewed demographic, disease, and treatment characteristics for patients treated at our institution during 2000 to 2013.
Results
One hundred fifty‐three patients (71%) were treated using ConRT and 62 (29%) using IMRT. The median follow‐up for all patients was 68 months. There was no statistically significant difference in 5‐year local control between patients with T1a versus T1b disease (94% vs. 89%, respectively, P = 0.5). Three‐year locoregional control for patients treated with ConRT was 94% compared to 97% with IMRT (P = 0.4). Three‐year overall survival (OS) for patients treated with ConRT was 92.5% compared with 100% with IMRT (P = 0.1). Twelve of 14 patients with local recurrence underwent salvage surgery with 5‐year ultimate locoregional control of 98.5% and 97.1% in the ConRT and IMRT cohorts, respectively (P = 0.7). Multivariate analysis showed age < 60 years (P < 0.0001) and pretreatment Eastern Cooperative Oncology Group performance status <2 (P = 0.0022) to be independent correlates of improved OS. Postradiation cerebrovascular events were in four patients in the ConRT cohort (3%), whereas no patients in the IMRT cohort suffered any events.
Conclusion
Because the oncologic outcomes for patients treated with IMRT were excellent and IMRT allows for carotid sparing, we have transitioned to IMRT as our standard for most patients with T1 glottic cancer.
Level of Evidence
3b. Laryngoscope, 2019
http://bit.ly/2GlSBsF
Selective reinnervation using phrenic nerve and hypoglossal nerve for bilateral vocal fold paralysis
Objective
To evaluate the extent of airway improvement and voice quality in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery.
Methods
Seven patients with BVFP caused by thyroid surgeries were enrolled. They underwent selective laryngeal reinnervation surgery. Videostroboscopy data, voice perceptual data (grade [G]), acoustic data, laryngeal electromyography data, and pulmonary function test data were obtained preoperatively and postoperatively.
Results
Videostroboscopic videos showed that six patients could achieve moderate‐to‐maximal abduction in the bilateral vocal folds during inspiration, whereas all patients achieved adduction in the bilateral vocal folds during phonation at 4 to 7 months postoperatively. G score was decreased significantly versus preoperative values (P < 0.05), and vocal functional parameters were improved significantly at 12 months postoperatively (P < 0.05). The aerodynamic parameter of maximum phonation time was significantly longer than the preoperative value (P < 0.05). Most parameters in pulmonary function test recovered to normal reference levels as early as 3 months postoperatively, whereas maximal inspiratory pressure (PImax) values were still slightly lower than normal levels 12 months after surgery. All of these parameters improved significantly versus preoperative values. Electromyographic data at 12 months postoperatively showed full interference potentials in bilateral posterior cricoarytenoid muscles during inspiration and full interference potentials in bilateral thyroarytenoid muscles during phonation in all patients. Moderate electric potentials were seen in left interarytenoid muscle in one failed patient.
Conclusion
This new selective laryngeal reinnervation procedure can achieve physiological movements of the bilateral vocal folds in selected patients with BVFP.
Level of Evidence
4. Laryngoscope, 2019
http://bit.ly/2IaBeN6
Safety of office‐based percutaneous injection laryngoplasty with calcium hydroxylapatite
Objective
To evaluate the safety of office‐based calcium hydroxylapatite (CaHA) injection laryngoplasty via the cricothyroid approach through an analysis of all procedures performed over a period of 10 years at a single institution.
Methods
In total, 962 office‐based CaHA injection laryngoplasty via the cricothyroid approach procedures were performed by a single physician at our institution between 2007 and 2016. From these, 955 procedures performed in 617 patients were included in our analysis. The medical records of all 617 patients were retrospectively reviewed. We classified all procedure‐related complications according to the time of onset. Complications that occurred during the procedure were considered intraprocedural complications, whereas complications that developed within 1 week after injection and those that developed after 1 week and were recorded more than twice in the medical records were considered acute and delayed complications, respectively. Failed cases were categorized separately as failure.
Results
Five cases were failed (0.5%). Intraprocedural complications included superficial injection in eight cases (0.8%). Acute and delayed onset of dyspnea was observed in three (0.3%) and two (0.2%) cases, respectively. The incidence of failures and major complications requiring active intervention was 1.6%.
Conclusion
Our findings suggest that office‐based CaHA injection laryngoplasty via the cricothyroid approach is as safe as conventional transoral injection laryngoplasty.
Level of Evidence
4. Laryngoscope, 2019
http://bit.ly/2GmGiMx
The effect of foxp3 on tumor stage, treatment response, recurrence and survivalability in nasopharynx cancer patients
Abstract
Objectives
To investigate the relationship between the cell percentage of T regulator (Treg) cells of patients' specimens and disease severity, survivability, recurrence and metastasis in patients who were diagnosed with nasopharyngeal carcinoma (NPC). Design: Sixty patients who were diagnosed as NPC and treated by the same protocol were enrolled to the study. Patient files were reviewed retrospectively and their clinical and pathological results were recorded. Deparaffinized samples of patients were stained immunohistochemically with anti‐FoxP3 monoclonal antibody. All patients's Anti‐FoxP3 stained slides were evaluated by the same pathologist. Stained Treg lymphocytes around the tumoral foci were investigated. Patients were divided into two groups according to the total anti‐FoxP3‐stained Treg cell counts of the specimens; that is, less than 20% of the total or more than 20% of the total. These groups were compared statistically.
Results
The study group consisted of 42 male patients (70%) and 18 female patients (30%). The mean age was 47 ± 14.9. NPC subtypes among the patients were undifferentiated non‐keratinized type in 54 patients (90%), differentiated non‐keratinized type in 4 patients (6.66%) and keratinized type squamous cell carcinoma (SCC) in 2 patients (3.33%).. When the two groups were compared in terms of pathological subtype, there was no significant variation between the two groups. There was also no significant variation between the two groups when compared on the basis of tumor stage (p = 0.36 for T phase, p = 0.122 for N phase), early stage, late phase (p = 0.15), survival rate (p = 0.69 for general survival), recurrence (p = 0.2 for local recurrence, P = 0.37 for regional recurrence) and distant metastasis (p = 0.3).
Conclusion
There was no significant relationship between the concentration of these cells in the stained specimens and the disease stage, survival rate, recurrence and distant metastasis discovered. Key‐words: Nasopharynx, carcinoma, radiotherapy, staining, immunity, Herpesvirus 4, human.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Dx6UXm
Utility and Practicality of Multi-level Sectioning and Upfront Unstained Slide Cutting in Head and Neck Biopsies: A Critical Analysis
Abstract
Upfront interval sectioning (cutting unstained slides between H&E levels) is used at our institution for biopsies at all sites except the gastrointestinal tract. Very limited data exists in the literature for the need for interval sectioning, and we are aware of no data at all for the head and neck. Biopsies from the larynx, oral cavity, pharynx, and sinonasal tract at our institution have had 5 levels cut. Levels 1, 3, and 5 or levels 2 and 5 had been stained with hematoxylin and eosin (H&E), depending on the subsite, and the remaining slides saved for possible later use. We retrospectively evaluated the use of unstained slides at these sites for clinical utility and efficiency by analyzing 3 years of cases from 1/1/2014 to 12/30/2016. A cutoff of 10% utilization was considered justification for continued upfront unstained slide cutting. We collected 706 larynx, 572 oral cavity, 184 pharynx, and 85 sinonasal tract biopsies over 3 years. The overall rate of unstained slide usage was 18.2%. Usage rates were significantly different by site: 7.8% (55/706) for larynx, 21.9% (125/572) for oral cavity, 30.6% (26/85) for sinonasal tract and 40.8% (75/184) for pharynx (p < 0.0001). The most common stain ordered in the pharynx was p16 immunohistochemistry (59.7%), but it was Grocott methenamine silver staining in the larynx (74.5%), oral cavity (70.4%), and sinonasal tract (35.1%). Usage of unstained slides was lowest for the larynx, and review of the biopsies with unstained slides utilized showed that the lesion was present on the 3rd H&E level in all cases. Removing this practice would have translated to saving 1,378 unstained slides. Upfront interval sectioning makes practical sense for biopsies from most sites in the head and neck, especially the pharynx, but our data suggests it can reasonably be forgone at least for biopsies of the larynx.
http://bit.ly/2BzYLRF
Thyroid Gland Solitary Fibrous Tumor: Report of 3 Cases and a Comprehensive Review of the Literature
Abstract
Solitary fibrous tumors of the thyroid gland are exceptionally rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, three cases of thyroid gland solitary fibrous tumor were analyzed in conjunction with 35 cases compiled from the English literature. Thyroid gland solitary fibrous tumors showed an equal sex distribution with a mean age at presentation of 54.4 years (range, 28–88 years). The patients typically presented with an asymptomatic, slow growing neck mass. Microscopically, the tumors were characterized by cytologically bland spindle cells with patternless growth, hypocellular and hypercellular areas, variable amounts of collagen, and ectatic, branching blood vessels. Two previous reported tumors were considered to be histologically malignant on the basis of increased mitotic activity, profound pleomorphism and tumor necrosis. Immunohistochemically, the tumor cells are variably positive with CD34, bcl-2, and CD99. STAT6 immunohistochemistry, performed on the current cases, demonstrated a strong, diffuse nuclear expression in all tumors. Among 26 patients with available follow up data (mean 47.3 months), one developed local recurrence and distant metastasis. Solitary fibrous tumors occurring in the thyroid gland are uncommon, but can be reliably diagnosed based on the presence of characteristic morphologic features as well as immunohistochemical expression of STAT6 and CD34. The majority of thyroid gland solitary fibrous tumors have exhibited an indolent clinical course, however experience is limited. The rare potential for aggressive clinical behavior requires clinical surveillance.
http://bit.ly/2TNNx34
Utility and Practicality of Multi-level Sectioning and Upfront Unstained Slide Cutting in Head and Neck Biopsies: A Critical Analysis
Abstract
Upfront interval sectioning (cutting unstained slides between H&E levels) is used at our institution for biopsies at all sites except the gastrointestinal tract. Very limited data exists in the literature for the need for interval sectioning, and we are aware of no data at all for the head and neck. Biopsies from the larynx, oral cavity, pharynx, and sinonasal tract at our institution have had 5 levels cut. Levels 1, 3, and 5 or levels 2 and 5 had been stained with hematoxylin and eosin (H&E), depending on the subsite, and the remaining slides saved for possible later use. We retrospectively evaluated the use of unstained slides at these sites for clinical utility and efficiency by analyzing 3 years of cases from 1/1/2014 to 12/30/2016. A cutoff of 10% utilization was considered justification for continued upfront unstained slide cutting. We collected 706 larynx, 572 oral cavity, 184 pharynx, and 85 sinonasal tract biopsies over 3 years. The overall rate of unstained slide usage was 18.2%. Usage rates were significantly different by site: 7.8% (55/706) for larynx, 21.9% (125/572) for oral cavity, 30.6% (26/85) for sinonasal tract and 40.8% (75/184) for pharynx (p < 0.0001). The most common stain ordered in the pharynx was p16 immunohistochemistry (59.7%), but it was Grocott methenamine silver staining in the larynx (74.5%), oral cavity (70.4%), and sinonasal tract (35.1%). Usage of unstained slides was lowest for the larynx, and review of the biopsies with unstained slides utilized showed that the lesion was present on the 3rd H&E level in all cases. Removing this practice would have translated to saving 1,378 unstained slides. Upfront interval sectioning makes practical sense for biopsies from most sites in the head and neck, especially the pharynx, but our data suggests it can reasonably be forgone at least for biopsies of the larynx.
http://bit.ly/2BzYLRF
Thyroid Gland Solitary Fibrous Tumor: Report of 3 Cases and a Comprehensive Review of the Literature
Abstract
Solitary fibrous tumors of the thyroid gland are exceptionally rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, three cases of thyroid gland solitary fibrous tumor were analyzed in conjunction with 35 cases compiled from the English literature. Thyroid gland solitary fibrous tumors showed an equal sex distribution with a mean age at presentation of 54.4 years (range, 28–88 years). The patients typically presented with an asymptomatic, slow growing neck mass. Microscopically, the tumors were characterized by cytologically bland spindle cells with patternless growth, hypocellular and hypercellular areas, variable amounts of collagen, and ectatic, branching blood vessels. Two previous reported tumors were considered to be histologically malignant on the basis of increased mitotic activity, profound pleomorphism and tumor necrosis. Immunohistochemically, the tumor cells are variably positive with CD34, bcl-2, and CD99. STAT6 immunohistochemistry, performed on the current cases, demonstrated a strong, diffuse nuclear expression in all tumors. Among 26 patients with available follow up data (mean 47.3 months), one developed local recurrence and distant metastasis. Solitary fibrous tumors occurring in the thyroid gland are uncommon, but can be reliably diagnosed based on the presence of characteristic morphologic features as well as immunohistochemical expression of STAT6 and CD34. The majority of thyroid gland solitary fibrous tumors have exhibited an indolent clinical course, however experience is limited. The rare potential for aggressive clinical behavior requires clinical surveillance.
http://bit.ly/2TNNx34
Primary Tonsillar Epithelioid Follicular Dendritic Cell Sarcoma: Report of a Rare Case Mimicking Undifferentiated Carcinoma and a Brief Review of the Literature
Abstract
We present a 52 years old male with a left tonsillar follicular dendritic cell sarcoma with prominent epithelioid features that on light microscopical examination bore a striking resemblance to a lymphoepithelial or undifferentiated carcinoma. The tumor was immunohistochemically positive for CD21 and CD35 and negative for cytokeratins. Two distinct histopathological features (both present in our case) that may serve as clues to the correct diagnosis on light microscopical examination were formation of ectatic pseudovascular spaces lined by malignant cells and the presence of non-neoplastic multinucleated giant cells. Familiarity with the above-mentioned morphological clues, and awareness that this tumour may occur in anatomical sites outside the lymph node, are essential for accurate diagnosis.
http://bit.ly/2N1Pjeo
Τρίτη 12 Φεβρουαρίου 2019
Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17 Year Female: Case Report
Abstract
Primary osteosarcoma of sphenoid and ethmoid sinus present as a challenge in head neck cancer. A 17 year female presented with left sided hemifacial pain, headache with nasal discharge. Clinico-radiological finding showed mass in sphenoethmoid recess spreading to adjacent structures. Endoscopic resection was done. Histopathological diagnosis was osteosarcoma of sphenoid and ethmoid sinus. Adjuvant chemotherapy administered. Osteosarcomas of sphenoid and ethmoid sinus are aggressive tumors with variable clinical features warranting high clinical suspicion.
http://bit.ly/2ByXs5E
Primary Tonsillar Epithelioid Follicular Dendritic Cell Sarcoma: Report of a Rare Case Mimicking Undifferentiated Carcinoma and a Brief Review of the Literature
Abstract
We present a 52 years old male with a left tonsillar follicular dendritic cell sarcoma with prominent epithelioid features that on light microscopical examination bore a striking resemblance to a lymphoepithelial or undifferentiated carcinoma. The tumor was immunohistochemically positive for CD21 and CD35 and negative for cytokeratins. Two distinct histopathological features (both present in our case) that may serve as clues to the correct diagnosis on light microscopical examination were formation of ectatic pseudovascular spaces lined by malignant cells and the presence of non-neoplastic multinucleated giant cells. Familiarity with the above-mentioned morphological clues, and awareness that this tumour may occur in anatomical sites outside the lymph node, are essential for accurate diagnosis.
http://bit.ly/2N1Pjeo
Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17 Year Female: Case Report
Abstract
Primary osteosarcoma of sphenoid and ethmoid sinus present as a challenge in head neck cancer. A 17 year female presented with left sided hemifacial pain, headache with nasal discharge. Clinico-radiological finding showed mass in sphenoethmoid recess spreading to adjacent structures. Endoscopic resection was done. Histopathological diagnosis was osteosarcoma of sphenoid and ethmoid sinus. Adjuvant chemotherapy administered. Osteosarcomas of sphenoid and ethmoid sinus are aggressive tumors with variable clinical features warranting high clinical suspicion.
http://bit.ly/2ByXs5E
Contribution of Nitric oxide synthase 3 genetic variants to nasopharyngeal carcinoma risk and progression in a Tunisian population
Abstract
Purpose
We conduct this study to evaluate the clinical and functional impact of Nitric Oxide Synthase 3 (NOS3) T-786C and G894T genetic variants on nasopharyngeal carcinoma (NPC) risk and progression in a Tunisian population.
Methods
259 NPC patients and 169 healthy controls were enrolled into our case–control study. Blood samples were genotyped by the RFLP-PCR analysis. The levels of Nitric oxide (NO) were measured by a colorimetric assay kit in the plasma of NPC patients, healthy controls and according to NOS3 genotypes. The correlation between the NOS3 variants and the clinicopathological parameters was examined.
Results
We found no linkage disequilibrium between NOS3 T-786C and G894T variants. These results showed that NOS3 variants were genetically independent. In contrast to NOS3 T-786C, a significant association was found between NOS3 G894T polymorphism and NPC risk. The 894T allele decreased significantly in NPC patients and appeared as protective factor (OR = 0.65, CI 95%= 0.48–0.88, p = 0.006). NPC patients had significantly higher levels of plasma NO as compared to healthy controls (p = 0.0011). The T-786C mutation reduced the levels of plasma NO and decreased risk of lymph node metastasis in NPC patients (OR = 0.64, 95% CI = 0.43–0.96; p = 0.03). In contrast, NOS3 G894T polymorphism had no effects neither on NO plasma levels nor clinical parameters.
Conclusions
This is the first study to associate NPC with significantly higher levels of plasma NO. NOS3-derived NO could play key roles in NPC pathogenesis. NOS3 variants differently contribute to NPC risk and progression in a Tunisian population. NOS3 G894T was associated with NPC risk. NOS3 T-786C decreased the levels of plasma NO and reduced the development of regional lymph node metastasis.
http://bit.ly/2GnioAv
β-Catenin nuclear expression discriminates deep penetrating nevi from other cutaneous melanocytic tumors
Abstract
Recent advances in genomics have improved the molecular classification of cutaneous melanocytic tumors. Among them, deep penetrating nevi (DPN) and plexiform nevi have been linked to joint activation of the MAP kinase and dysregulation of the β-catenin pathways. Immunohistochemical studies have confirmed cytoplasmic and nuclear expression of β-catenin and its downstream effector cyclin D1 in these tumors. We assessed nuclear β-catenin immunohistochemical expression in a large group of DPN as well as in the four most frequent differential diagnoses of DPN: "blue" melanocytic tumors, Spitz tumors, nevoid and SSM melanomas, and pigmented epithelioid melanocytomas (PEM). Nuclear β-catenin expression was positive in 98/100 DPN and 2/16 of melanomas (one SSM and one nevoid melanoma with a plexiform clone) and was negative in all 30 Spitz, 26 blue, and 6 PEM lesions. In 41% DPN, β-catenin expression was positive in more than 30% nuclei. No differences were observed in cytoplasmic and nuclear cyclin D1 expression between these tumor groups, suggesting alternate, β-catenin-independent, activation pathways. We have subsequently studied nuclear β-catenin expression in a set of 13 tumors with an ambiguous diagnosis, for which DPN was part of the differential diagnosis. The three out of four patients showing canonical DPN mutation profiles were the only β-catenin-positive cases. We conclude that nuclear β-catenin expression, independently from CCND1 expression, in a dermal melanocytic tumor is an argument for its classification as DPN. In ambiguous cases and in early combined DPN lesions, this antibody can be helpful as a screening tool. β-Catenin is also potentially expressed in a subset of malignant melanomas with CTNNB1 mutations.
http://bit.ly/2N0SP8M
Recent success and limitations of immune checkpoint inhibitors for cancer: a lesson from melanoma
Abstract
Several researches have been carried over the last few decades to understand of how cancer evades the immune system and thus to identify therapies that could directly act on patient's immune system in the way of restore or induce a response to cancer. As a consequence, "cancer immunotherapy" is conquering predominantly the modern scenario of the fight against cancer. The recent clinical success of immune checkpoint inhibitors (ICIs) has created an entire new class of anti-cancer drugs and restored interest in the field of immuno-oncology, leading to regulatory approvals of several agents for the treatment of a variety of malignancies. The first to be approved in 2011 was the anti-CTLA-4 antibody ipilimumab for the treatment of unresectable or metastatic melanoma. Subsequently, the anti-PD-1s, nivolumab and pembrolizumab, received regulatory approvals for the treatment of melanoma and several other cancers. More recently, three anti-PD-L1 antibodies have received approval: atezolizumab and durvalumab for locally advanced or metastatic urothelial carcinoma and metastatic non-small cell lung cancer (NSCLC) and avelumab for the treatment of locally advanced or metastatic urothelial carcinoma and metastatic Merkel cell carcinoma. This review, starting from the results of melanoma trials, highlights in turn different ICIs and data for different indications in several malignancies are included under each drug class.
http://bit.ly/2SKodO7
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
