Endovascular management of residual intracranial aneurysm after neurosurgical clipping: a case report

Introduction and importance

Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping in aneurysmal subarachnoid haemorrhage. Aneurysmal subarachnoid haemorrhage is a rare subtype of stroke which can be life-threatening.

Case presentation

The authors herein report a case of successful management by endovascular coiling of residual intracranial aneurysm post-surgical clipping in a 60-year-old male who was previously diagnosed as diffuse subarachnoid haemorrhage (SAH) Fisher grade 4. On examination, he had a Glasgow Coma Scale 14/15 with verbal confusion present and was hypertensive.

Clinical discussion

Aneurysmal subarachnoid haemorrhage is a rare and serious type of stroke and may result in dependency. Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping. It further helps in decreasing dependency and mortality.

Conclusion

Endovascular coiling is a good treatment option for patients who have undergone neurosurgical clipping as their prior surgical attempt in aneurysmal subarachnoid haemorrhage. An endovascular approach may further lead to a better prognosis.

Recurrent Tolosa-Hunt syndrome: a case report

Introduction and importance

Tolosa-Hunt syndrome is a rare condition with unknown aetiology that manifests clinically as unilateral orbital pain and ophthalmoplegia. It is a diagnosis of exclusion that resolves spontaneously but can recur and respond dramatically to systemic steroids.

Case presentation

The authors herein report a case of a 38-year-old male who presented with horizontal diplopia, limited outward movement of the right eye, and blurry vision for two days which was managed with oral Prednisolone. The patient visited 3 months later with progressive ptosis and vertical diplopia with periorbital pain over the right eye. It was eventually diagnosed via magnetic imaging resonance studies and successfully treated for Tolosa-Hunt syndrome with IV methylprednisolone followed by oral prednisolone.

Clinical discussion

Hence, the typical clinical presentation of the case with significant response to steroids, exclusion of other conditions from investigation and imaging, and subsequent recurrence of similar symptoms were crucial for making the diagnosis of Tolosa-Hunt syndrome.

Conclusion

Tolosa-Hunt syndrome is a syndrome of painful ophthalmoplegia which responds well to steroid therapy but has a tendency to recur. Hence, patients must be adequately informed about the reoccurrence and kept under follow-up.

Paraganglioma at the cerebellopontine angle: A case report and review of literature

Paragangliomas (PGLs) are rare neuroendocrine tumors. Sometimes, these tumors secrete excessive catecholamines, which results in the manifestations of various signs and symptoms, usually with a triad of hypertension, tachycardia, and headache. We report the case of a 42-year-old woman presenting with uncontrolled hypertension, right facial palsy, vomiting, and disturbed gait. Diagnosis for PGL was confirmed on postoperative histological examination of the excised mass and correlated with preoperative clinical and radiological findings. Tumor excision was done via a suboccipital craniotomy approach. Our case presents the typically severe features of a jugulotympanic PGL, but most importantly, it highlights the necessity of biochemical diagnosing, thorough probing of the causes of hypertension, and a multi-disciplinary approach in dealing with these tumors. Moreover, the case emphasizes necessitating the use of preoperative embolization in vascular tumors of the head and neck to avoid a hemorrhagic crisis during surgery. Unfortunately, due to a lack of adequate hospital funds, the surgeon had to proceed without preoperative embolization. Despite such a risk, the excision was a success.

Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) are regional anesthesia techniques that have shown favorable results in pain management following thoracic surgeries; however, their relative superiority is unclear. This review (PROSPERO: CRD42023443018) aims to compare the analgesic efficacy of ESPB and SAPB in patients undergoing thoracic surgeries through the pooled analysis of co-primary outcomes: postoperative oral-morphine-equivalent (mg) consumption in 24 h and pain scores (static) at 24 h.

METHODS

A literature search was conducted across PubMed, Cochrane Library, and Google Scholar to identify randomized controlled trials (RCTs) from inception to May 2023, comparing ESPB and SAPB in thoracic surgeries. Statistical pooling was done using Review Manager 5.4.1. Bias assessment employed the Cochrane Collaboration Risk-of-Bias 2.0 tool. The strength of evidence was assessed using the guidelines from the GRADE working group.

RESULTS

Nine RCTs (485 patients) were included in the study. Postoperative pain scores (static) at 24 h (mean difference (MD) =  - 0.31 [- 0.57, 0.05], p = 0.02) and postoperative oral-morphine-equivalent (mg) consumption in 24 h (MD =  - 19.73 [- 25.65, - 13.80], p < 0.00001) were significantly lower in the ESBP group. However, the MDs did not exceed the set threshold for clinical importance. No significant differences were observed in the opioid-related adverse effects and block-related complications.

CONCLUSION

Our statistically significant results imply that ESPB has superior analgesic efficacy compared to SAPB; however, this difference is clinically unimportant. The safety profile of the two blocks is comparable; hence, current evidence cannot define the relative superiority of one block over the other. Our findings warrant further research with standardized methodologies and a longer duration of analgesic efficacy assessment to yield robust evidence for better clinical applications.

Longitudinally extensive transverse myelitis, a disabling disorder with a good prognosis: a case series from Nepal

Introduction

Longitudinally extensive transverse myelitis (LETM) is a rare spinal cord disorder with variable etiologies and presentations. It can present solely or as an association with other neurological disorders.

Methodology

It was a series of cases of LETM in a tertiary care hospital.

Clinical presentation and outcomes

The initial three cases presented with bilateral lower extremity weakness and were diagnosed as transverse myelitis while, the fourth case, already diagnosed as LETM presented with seizure followed by loss of consciousness. All four cases had a good prognosis to date with continued physiotherapy.

Conclusion

The early diagnosis of the disease helps to guide the optimal management and decide the potential need for physiotherapy.

Prevalence of pre-operative anxiety and associated risk factors among patients awaiting elective surgery in a tertiary care hospital

Background

Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60-92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country.

Methods

This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability convenience sampling was adopted and a total of 205 cases were included. The researchers themselves collected the data on the day before surgery using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately.

Results

The prevalence of pre-operative anxiety was 25.85%. The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272-4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107-5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety compared to those from a joint family and those having past history of surgery respectively. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265-0.985, p = 0.045).

Conclusions

One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.

Oxygen Requirement and Associated Risk Factors in Post-COVID-19 Patients Admitted to a Tertiary Care Center: A Cross-Sectional Study

Background

COVID-19 commonly affects the lungs and may lead to mild to severe hypoxemia. The supplemental oxygen requirement gradually reduces with the improvement in lung pathology. However, a few patients may have exertional desaturation, and ongoing oxygen needs at the time of hospital discharge. The objective of this research was to study the requirement of oxygen therapy in the immediate post-COVID-19 period and its associated risk factors.

Materials and Methods

An analytical cross-sectional study was conducted on the admitted post-COVID-19 patients who had recently tested real-time polymerase chain reaction (RT-PCR) negative in a tertiary care center from August 2021 to mid of October 2021. Nonprobability consecutive sampling was used, and the sample size was 108. The data were analyzed using the Statistical Package for the Social Sciences (IBM-SPSS), version 23. The mode of oxygen therapy (nasal cannula, face mask, reservoir mask, or mechanical ventilation) in the first two weeks of the study was presented appropriately in a table. The nonparametric statistical tests were applied to determine the association between the duration of post-COVID-19 oxygen therapy and several other risk factors such as age, gender, comorbidities, smoking status, exposure to firewood, COVID-19 vaccination, and severity of COVID-19.

Results

95 (87.96%) cases required oxygen therapy in their immediate post-COVID-19 period. The overall median duration of oxygen therapy was 6.00 (4.00-10.00) days. The nasal cannula was the most commonly used mode of oxygen supplement. The duration of oxygen therapy was significantly higher in patients aged more than 60 years (6.00 [5.00-11.00], p = 0.013), chronic obstructive pulmonary disease (10.00 [6.00-12.75], p = 0.006), history of chronic smoking (9.00 [5.50-13.00], p = 0.044), and severe COVID-19 infection (7.00 [5.00-10.50], p = 0.042).

Conclusions

The proportion of patients requiring oxygen therapy in the immediate post-COVID-19 period was higher than that reported in other studies. In addition, old age (>60 years), chronic obstructive pulmonary disease, chronic smoking, and severe COVID-19 infection significantly increased the duration of oxygen therapy. So, these factors should be assessed while discharging patients from COVID-19 facilities, and oxygen supplementation should be planned for needy patients.

Direct oral anticoagulants (DOAC) versus vitamin K antagonist in left ventricular thrombus: An updated meta-analysis

Background and Aims

Current clinical guidelines for treating left ventricular thrombus (LVT) are limited by inadequate evidence to inform the comparative efficacy of oral anticoagulants. In this meta-analysis, we aimed to compare the efficacy and safety of direct oral anticoagulants (DOAC) to vitamin K antagonists (VKA) in patients with LVT.

Methods

Four standard databases were searched for relevant literature comparing the efficacy and safety between DOAC and VKA for LVT treatment, published before August 19, 2023. Both the randomized controlled trials and observational studies were included in the analysis. The outcomes of interest were the resolution of LVT, all-cause mortality, stroke, systemic embolism, and bleeding. Data from the selected studies were extracted and analyzed using RevMan 5.4 using odds ratio.

Results

Among 3959 studies from the database search and bibliography review, 33 were included in the analysis. LVT resolution was observed in 72.59% in the DOAC group versus 67.49% in the VKA group (odds ratio [OR]: 1.28, confidence interval [CI]: 1.07-1.53). Mortality was lower in the DOAC group (11.71% vs. 18.56%) (OR: 0.60, CI: 0.36-1.00; borderline statistical significance). Likewise, bleeding events (9.60% vs. 13.19%) (OR: 0.65, CI: 0.52-0.81) and stroke (7.54% vs. 11.04%) (OR: 0.71, CI: 0.53-0.96) were also significantly lower in the DOAC group.

Conclusion

DOAC use for LVT showed better thrombus resolution and reduced risk of bleeding and stroke compared to VKA. Likewise, DOAC use was associated with lower mortality with borderline statistical significance.

Child abuse and neglect and mental health outcomes in adulthood by ethnicity: Findings from a 40-year longitudinal study in New Zealand/Aotearoa

BACKGROUND

Longitudinal studies consistently report adverse long-term outcomes of childhood maltreatment. Little is known about the impact of childhood maltreatment on mental health among a marginalized population (New Zealand Māori); therefore, we cannot assume the effects of maltreatment are the same across the population.

OBJECTIVE

Associations were examined between childhood sexual abuse (CSA), childhood physical punishment (CPP) and childhood neglect (CN) (<16 years) and mental health outcomes 18-40 years, by ethnicity (Māori/non-Māori).

PARTICIPANTS AND SETTING

Data from the Christchurch Health and Development Study, a study of a birth cohort of 1265 children born in Christchurch in 1977. By age 40, 17.8 % (n = 191) reported New Zealand Māori ethnic identity; 82.2 % (n = 883) were non-Māori.

METHODS

CSA, CPP (<16 years) were measured at 18, 21 years; CN was measured at 40 years. Major depression, anxiety disorder, suicidal ideation, alcohol abuse/dependence and cannabis abuse/dependence were measured at ages 21, 25, 30, 35 and 40 years. Childhood confounding variables controlled. Analyses were extended to include Māori ethnicity.

RESULTS

After statistical adjustment, experience of severe childhood maltreatment increased odds of mental health problems 1.8-2.6×, compared to no maltreatment; the effects of maltreatment were similar for males and females. For Māori, some higher rates of mental health problems were seen among those maltreated, no statistically significant associations were detected after Bonferroni correction (among severe maltreatment vs. no maltreatment). Limitations should be considered when interpreting results.

CONCLUSIONS

Exposure to childhood maltreatment has long-term effects into middle-age. Further research employing culturally-sensitive approaches may help clarify Māori childhood maltreatment outcomes.

Progressive multifocal leukoencephalopathy in the background of chlorambucil treated chronic lymphocytic leukemia: a case report from Nepal

Introduction

Progressive multifocal leukoencephalopathy is a rare manifestation in itself. Although many immunosuppressive states are associated with the disease, its occurrence in the setting of chronic lymphocytic leukaemia treated with chemotherapy is seldom reported to date.

Case presentation

A 67-year-old woman with known chronic lymphocytic leukaemia who was previously receiving chlorambucil treatment was identified as having progressive multifocal leukoencephalopathy; her prognosis is currently good.

Clinical discussion

Although a rare disease in an immunocompromised setting, progressive multifocal leukoencephalopathy often leads to a grave outcome. However, the authors describe a case with a good prognosis to date.

Conclusion

Progressive multifocal leukoencephalopathy should be in differentials in immunocompromised patients with dementia. Given that the later prognosis of the disease is unpredictable, an earlier diagnosis would be better for immunological reconstitution.

Outcome of In-Hospital Cardiac Arrest among Patients with COVID-19: A Systematic Review and Meta-Analysis

BACKGROUND

Outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19 have been reported by several small single-institutional studies; however, there are no large studies contrasting COVID-19 IHCA with non-COVID-19 IHCA. The objective of this study was to compare the outcomes following IHCA between COVID-19 and non-COVID-19 patients.

METHODS

We searched databases using predefined search terms and appropriate Boolean operators. All the relevant articles published till August 2022 were included in the analyses. The systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An odds ratio with a 95% confidence interval (CI) was used to measure effects.

RESULTS

Among 855 studies screened, 6 studies with 27,453 IHCA patients (63.84% male) with COVID-19 and 20,766 (59.7% male) without COVID-19 were included in the analysis. IHCA among patients with COVID-19 has lower odds of achieving return of spontaneous circulation (ROSC) (OR: 0.66, 95% CI: 0.62-0.70). Similarly, patients with COVID-19 have higher odds of 30-day mortality following IHCA (OR: 2.26, 95% CI: 2.08-2.45) and have 45% lower odds of cardiac arrest because of a shockable rhythm (OR: 0.55, 95% CI: 0.50-0.60) (9.59% vs. 16.39%). COVID-19 patients less commonly underwent targeted temperature management (TTM) or coronary angiography; however, they were more commonly intubated and on vasopressor therapy as compared to patients who did not have a COVID-19 infection.

CONCLUSIONS

This meta-analysis showed that IHCA with COVID-19 has a higher mortality and lower rates of ROSC compared with non-COVID-19 IHCA. COVID-19 is an independent risk factor for poor outcomes in IHCA patients.

Neuro-cryptococcosis in an immunocompetent individual with radiologically atypical findings: a case report and review of literature

We present a case of a 29-year-old immunocompetent female without any known comorbidities with intermittent headache and vomiting who was ultimately diagnosed with cryptococcal meningitis (CM). Though her neuroimaging findings were atypical to those commonly found in CM, she was diagnosed with CM with a cryptococcal antigen test. However, in contrast to the good prognosis as stated in the literature, she died during her course stay at the hospital. Therefore, cryptococcosis should be taken as differentials, even in an immunocompetent individual presenting with features suggestive of meningitis, to prevent the worst clinical outcome.

Upper Gastrointestinal Bleeding Induced by Gastric Ulcer Secondary to Strongyloidiasis: A Case Report

Strongyloidiasis, a parasitic infestation by Strongyloides stercoralis, involves the gastrointestinal tract with a spectrum from duodenitis to enterocolitis. However, gastric involvement with the manifestation of upper gastrointestinal bleeding is an extremely rare condition due to Strongyloides stercoralis. Due to irregular excretion of larvae, unclear symptoms, paucity of effective diagnostic tools and low parasitic load, makes clinicians difficult to reach the diagnosis of strongyloidiasis. Here, we present a case of upper gastrointestinal bleeding due to a large gastric ulcer whose aetiology was identified to be Strongyloides stercoralis infection of the gastric region by the diagnosis of exclusion.

Ciprofloxacin induced toxic epidermal necrolysis with cholestatic hepatitis: A case report with literature review and revisit to the Naranjo adverse drug reaction probability scale

Ciprofloxacin, among the many Fluoroquinolones, has been widely used as a broad-spectrum antibiotic due to its wide range of action and relatively safe adverse effect profile. However, among the cutaneous adverse drug reactions due to Ciprofloxacin, toxic epidermal necrolysis occurring along with cholestatic hepatitis is a rare one. Here, we present a case of a 22-year-old male patient who was diagnosed with toxic epidermal necrolysis with cholestatic hepatitis secondary to Ciprofloxacin. Naranjo adverse drug reaction probability scale was used for the causal association.

Prevalence and clinical characteristics of headache among medical students of Nepal: A cross-sectional study

BACKGROUND

Headache is a common neurological disorder, with a global prevalence of around 50%. It may affect people of any age, gender, education, socioeconomic status and occupation. Tension headache, migraine headache and cluster headache are commonly encountered headache types. The prevalence of headache problems is higher among medical students. This could potentially affect their academic performance and quality of life. The objective of this study is to find out the prevalence of headaches and their clinical characteristics among students of a medical college.

MATERIALS AND METHODS

An online, single-centre, cross-sectional study was conducted among undergraduate medical students in Nepal. Stratified sampling followed by a simple random sampling technique was adopted depending upon the academic years of students. For data collection, pre-tested semi-structured questionnaire was used. The data entry and analysis were done by using Statistical Package for the Social Sciences (IBM-SPSS), version-23. The prevalence of headache and its subtypes were calculated. All the clinical characteristics associated with headaches were also studied.

RESULTS

The prevalence of headache disorder was 65 (26.86%), with tension headache (69.23%) being the commonest one. It was highest among fourth-year students (37.84%) followed by first-year students (33.33%). Anxiety/stress (75.40%) was the most common precipitating factor. This problem stopped most of the students (63.09%) from doing daily activities. More than half of them (53.85%) practised self-medication in case of non-resolution of pain, and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently used.

CONCLUSION

Headache was fairly prevalent among medical students. Anxiety/stress in medical life has led to headaches in the majority of students. The headache disturbed their daily activities and promoted self-medication practice. So, this problem should be properly looked into and addressed in time by the concerned authority.

Liver metastases - An unusual cause of portal hypertension: A case report

Introduction

Portal hypertension is a rare complication of liver metastases. The study highlights that clinician should be aware of conditions mimicking cirrhosis with similar clinical presentation and imaging findings.

Case presentation

We present the case of a 29-year-old non-alcoholic lady who presented to our hospital with a history of two months of progressive, painless abdominal distension and progressively increasing yellowish discoloration of the eyes. Physical examination, laboratory investigations, and imaging tests led to a diagnosis of multiple metastases from breast carcinoma to the liver leading to portal hypertension after exclusion of other causes of portal hypertension. However, after three weeks of presentation to the hospital, the patient died before any therapeutic measures were initiated to address breast carcinoma.

Clinical discussion

Liver metastasis from primary breast carcinoma rarely presents with clinical symptoms of portal hypertension. Although portal hypertension secondary to pseudocirrhosis, predominantly linked to ongoing chemotherapy for known cancers, has been previously described in case studies, our case had an unusual presentation leading to diagnostic uncertainty.

Conclusion

Our case highlights the rare cause of liver metastasis secondary to breast carcinoma, which presented as portal hypertension.

Bulbar onset amyotrophic lateral sclerosis: A case report

Introduction

Amyotrophic lateral sclerosis is a rare progressive neurodegenerative disease that affects the brain and spinal cord nerve cells. The study highlights the role of early diagnosis and prognosis of bulbar onset ALS.

Case presentation

We present a case of 60 years old female who presented with slurring of speech with a deviation of tongue and progressive dysphagia. With the role of Magnetic Resonance Imaging (MRI), Electromyography (EMG) and Nerve Conduction Study (NCS), a diagnosis of ALS was made.

Clinical discussion

ALS is a progressive neurodegenerative disorder, and the presence of genioglossus muscle involvement at diagnosis implies a shorter survival. It mandates multidisciplinary aspects requiring a professional opinion from neurologists, speech therapists, otolaryngologists, and electrophysiologists for effective treatment. Edaravone has antioxidant properties which counteract oxidative stress leading to neuronal injury in patients with ALS.

Conclusion

ALS with bulbar onset can have a grave prognosis and hence requires a multidisciplinary approach toward effective treatment.

A novel TFG variant of uncertain significance in amyotrophic lateral sclerosis: A case report and review of literature

Introduction

Amyotrophic lateral sclerosis is a neurodegenerative disease with wide variation of genetics associated with it. Among the different genes described, mutation in TFG is a rare finding in amyotrophic lateral sclerosis.

Case presentation

A 35 years old right-handed male presenting with ipsilateral weakness was diagnosed with amyotrophic lateral sclerosis. He was found to have missense variant of TFG with uncertain significance on exome sequencing.

Clinical discussion

The genetics involved in amyotrophic lateral sclerosis is ever-evolving. The identification of new TFG variant in this disease adds another evidence to the role of TFG in neurodegenerative disease.

Conclusions

The finding of TFG variant of uncertain significance is a rare finding in amyotrophic lateral sclerosis. And with the identification of new TFG variant, it leads to further understanding of spectrum of TFG and its pathophysiology in amyotrophic lateral sclerosis.

Psychotic symptoms in a patient with Systemic Lupus Erythematosus: A diagnostic dilemma between lupus psychosis and steroid induced psychosis

Introduction

Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disorder with the involvement of multiple organ systems. It is more common in females.

Case presentation

Here, we present a case of 12-year-old female, known case of SLE with lupus nephritis, presenting with neuropsychiatric symptoms. She was under steroids as well for a few weeks due to flare-up of symptoms prior to that. Due to this, there was a diagnostic dilemma between lupus psychosis and steroid induced psychosis.

Clinical discussion

Approximately one third to half of the patients may have neurological involvement in Systemic Lupus Erythematosus. However, neuropsychiatric symptoms in them could be due to corticosteroids, which are frequently used in treatment. There are no definitive and easily available laboratory markers to distinguish these two aetiologies.

Conclusions

Systemic Lupus Erythematosus patients, who are on steroids, with neuropsychiatric features should be assessed adequately. As there are no specific guideline and biomarkers to distinguish between these two, meticulous evaluation is necessary for appropriate management.

Protein S Deficiency with Recurrent Deep Vein Thrombosis and Post Thrombotic Syndrome: A Case Report

Protein S is a vitamin K-dependent protein that acts as a break in secondary hemostasis by inactivating activated factor V and activated factor VIII. We report a case of a 40 years old male who had the first episode of deep vein thrombosis of the left lower limb 10 years back, which despite treatment, reoccurred 3 months later in the bilateral lower limb. Thrombophilic screening showed severe protein S deficiency. The patient then developed deep vein thrombosis of both upper limbs. The patient was advised to place an inferior vena cava filter, which he denied. The patient is now presenting with multiple episodes of post-thrombotic syndrome. Such attacks are treated with elastic compression stockings, rivaroxaban, and morphine. However, despite medication, the pain has not yet subsided. Hence, even though protein S deficiency is the rare cause of deep vein thrombosis when recurrent should be considered despite its rare occurrence.

Keywords

deep vein thrombosis; protein S deficiency; rivaroxaban.

Euglycemic diabetic ketoacidosis in a patient with acute stroke taking sodium glucose co-transporter 2 inhibitor

Introduction

Diabetic Ketoacidosis is characterized by a triad of metabolic acidosis, hyperglycemia, and ketonemia. It is a medical emergency that needs urgent and aggressive management. In some cases, the blood glucose level may be relatively normal. Such a condition is known as Euglycemic Diabetic Ketoacidosis.

Case presentation

We present a case of Euglycemic Diabetic Ketoacidosis, who was initially brought to the emergency room with the features of acute stroke. There was a diagnostic dilemma among the treating physicians due to his relatively normal blood glucose levels while he developed ketoacidosis.

Discussion

Presentation of the patients includes similar to DKA such as nausea, vomiting, malaise, fatigue, and Kussmaul's respiration. The diabetic patients under sodium glucose co-transporter-2 inhibitor therapy may develop it under the setting of different precipitating factors like infection, trauma/surgery, strenuous physical exercise, fasting, alcohol intake and acute vascular events.

Conclusion

Euglycemic DKA is a rare condition and its diagnosis is a challenging task. So, we should always consider it as a differential whenever any diabetic patient shows with increased anion gap metabolic acidosis with or without typical symptoms and signs. Also, we need to be aware to discontinue of SGLT-2 medication during the time of infection, surgery, severe trauma, acute illness and dehydration in the diabetic patients.

•

Diabetic Ketoacidosis is a medical emergency with a triad of metabolic acidosis, hyperglycemia and ketonemia.

•

The precipitating factors includes infection, surgery, fasting, alcohol intake, acute vascular events, trauma and prolonged physical exercise.

•

Patient presents with complaints similar to DKA such as nausea, vomiting, malaise, fatigue, and Kussmaul's respiration.

•

Management includes fluid resuscitation, insulin infusion, dextrose and potassium supplementation.

Aplastic anemia induced by human parvovirus B19 infection in an immunocompetent adult male without prior hematological disorders: A case report

Introduction and importance

Parvovirus B19 (B19V) is a human pathogenic virus of clinical relevance. Human parvovirus B19 infection can be asymptomatic or frequently associated with erythema infectiosum, or joint symptoms in healthy adults. Aplastic anemia as a complication of human parvovirus infection is rare in healthy adults without prior hematological disorders.

Case presentation

We report a case of severe aplastic anemia in a 22-years-old immunocompetent adult male without any hematological dysfunction who presented with periumbilical pain, loose watery stools, and fever with chills and rigor. General examination, laboratory investigation, and peripheral blood smear revealed anemia with leucopenia and relative lymphocytosis, thrombocytopenia, and severe neutropenia. Bone marrow biopsy revealed hypocellular bone marrow with maturation arrest at the proerythroblast stage with intranuclear inclusions and no blast and hematopoietic cells replaced by mature adipocytes in marrow spaces. Parvovirus B19 infection was confirmed by viral serology and polymerase chain reaction.

Clinical discussion

Asymptomatic or mild infection occurs most often when B19 affects immunocompetent adults. However, this is the fourth case reporting severe aplastic anemia in immunocompetent adults and the first case reported in immunocompetent adult males. The patient was admitted for close monitoring and supportive management, which effectively improved the patient's clinical condition, and discharged with a strict follow-up schedule in an outpatient setting.

Conclusion

Thus, acute infection with this virus must be considered a cause of acquired aplastic anemia even in individuals without underlying disease.

•

Erythema infectiosum, often known as the fifth disease is the most common manifestation in children, whereas, in healthy adults, most cases of infection are asymptomatic or associated with arthritis and myalgia.

•The virus causes infections worldwide that vary in severity depending on the age as well as the immunologic and hematologic status of the host.

•Parvovirus infection should be considered as one of the causes of sudden and severe aplastic anemia even in previously hematologically normal individuals with intact immunity.

•Patients should be treated symptomatically until their hematopoiesis restores, and regular follow-up is critical for detecting chronic anemia or recurrence and treating it promptly.

Acute reversible monoparesis in multiple neurocysticercosis: A case report and review of literature

Focal neurological deficit like monoparesis due to cortical lesions is a rare entity. In spite of the common presentations like seizures and headaches in neurocysticercosis, occurrence of reversible monoparesis is an atypical phenomenon. Even in the absence of infarct or hemorrhages, manifestation of neural deficit due to compressive effect only is an interesting finding. And on top of that, reversible nature of the deficit in space occupying lesion is a rare occurrence in the existing literature. Here, we describe a known case of neurocysticercosis with reversible acute monoparesis secondary to multiple neurocysticercosis. The variations with which neurocysticercosis can present broaden our understanding in its pathophysiology and management protocol.

Antibiotics Use among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Acute exacerbation of chronic obstructive pulmonary disease is a life-threatening condition triggered by infections or non-infectious agents. Antibiotics use in such cases prevents severe deterioration and treatment failure. Past studies have shown inappropriate use of antibiotics in different health care settings. The objective of this study was to find out the prevalence of antibiotics use in patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Internal Medicine of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among patients with acute exacerbation of Chronic Obstructive Pulmonary Disease admitted to Department of Internal Medicine of a tertiary care centre from 12th February, 2022 to 15th April, 2022 after taking ethical clearance from Institutional Review Committee (Reference number: 417). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 23.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data along with median and interquartile range for continuous data.

Results

The prevalence of antibiotics use among study participants was 106 (98.15%) (95.61-100 at a 95% Confidence Interval). Penicillin 82 (75.93%) was the most commonly used antibiotics group.

Conclusions

The use of antibiotics in acute exacerbation of chronic obstructive pulmonary disease was higher as compared to other similar studies.

Keywords

anti-bacterial agents; chronic obstructive pulmonary disease; guideline adherence.

Transudative or masked exudative polyserositis in disseminated tuberculosis? A case report

Introduction

Polyserositis in disseminated tuberculosis (TB) is an uncommon presentation. The exudative nature of effusion in disseminated TB can be masked by presence of malnutrition due TB.

Case presentation

A 24-year-old female, diagnosed with disseminated TB, developed polyserositis with transudative nature of fluid. She was treated with anti-tubercular therapy (ATT).

Clinical discussion

Polyserositis, though an uncommon presentation in disseminated TB, was the clinical manifestation in our case. But transudative nature of the fluid was an unexpected finding. Hypoalbuminemia as a result of malnutrition due to TB was the cause for masking exudative effusion in TB.

Conclusions

Hypoalbuminemia as a result of malnutrition due to TB can be the reason for transudative nature of effusion in polyserositis.

•

Polyserositis is an uncommon presentation in disseminated TB.

•

The exudative nature of fluid is a common finding in polyserositis due to disseminated TB.

•

The transudative nature of the fluid can also be the finding in polyserositis due to disseminated TB.

•

Hypoalbuminemia as a result of malnutrition due to TB can lead to transudative polyserositis in disseminated TB.

Late onset Wilson Disease with normal neuro-psychiatric status: A case report

Introduction

Case presentation

Clinical discussion

Conclusions

•

Wilson disease (WD) has been one of the causes for chronic liver disease (CLD) but late onset WD is one of the rare forms in WD.

•

Neurological manifestations are common in late onset WD which is absent in our case.

•

There is common diagnostic delay of WD in later ages with chronic liver disease because of variability in presentations of WD.

•

The treatment for WD has been updated but based on the availability d-penicillamine or zinc has been a common choice.

Incidence and Diagnosis of Ampullary Carcinoma in Dhulikhel Hospital, Kathmandu University Hospital

Background Endoscopy from a suspected ampulla of vator may establish an early preoperative diagnosis of ampullary carcinoma. However, information regarding the diagnostic accuracy of this procedure is limited and variable. Objective To study the preoperative diagnostic accuracy of Endoscopic/ERCP appearance of ampullary tumors with that of endoscopic biopsy. Method Among patients who were performed endoscopy during a one year period; a suspicious ampulla of vator was seen in 44 cases. Endoscopic biopsy specimens were classified into four groups based on the degree of epithelial atypia: group 1 (no evidence of malignancy), group 2 (presence of dysplasia), group 3 (suspicious of malignancy) and group 4 (positive for malignancy). In each case comparison was made between the pre-endoscopic biopsy clinical diagnosis and endoscopic appearance. Result Endoscopic biopsy diagnosis of malignancy (group 4) were seen in 22 cases, Suspicious of malignancy (group 3) in 3 cases, dysplasia (group 2) in 9 cases and no evidence of malignancy (group 1) in 10 cases. Pre-endoscopic diagnostic accuracy of endoscopy/ ERCP was 50% compared to the diagnosis by biopsy. Conclusion Diagnostic accuracy of endoscopy/ERCP was 50% compared to the diagnosis by biopsy. A diagnosis of non malignancy in the forceps biopsy material does not rule out the presence of cancerous foci in ampullary neoplasms.

A Rare Case of Subacute Sclerosing Panencephalitis Presenting As Generalized Seizure

Subacute sclerosing panencephalitis (SSPE) is a late complication of childhood measles. It is characterized by a progressive decline in cognitive and motor functions, seizures, and eventually death. Although a combination of intrathecal interferon alpha (IFN-α) and daily oral isoprinosine has been reported to have a good outcome, there is no cure for this condition.  We present a case of a 16-year-old male with SSPE who presented with progressive weakness, frequent loss of postural control, multiple episodes of generalized tonic-clonic seizures, and urinary incontinence. On exploration of his history, he had measles at the age of two months. Investigation showed increased serum measles antibody titer, high amplitude spikes in electroencephalogram (EEG), and high fluid-attenuated inversion recovery (FLAIR) signals on MRI of the brain consistent with probable SSPE. He was managed symptomatically until his condition got worse and he eventually passed away.

The Risk of COVID-19 in People Having a Particular Set of Gene

These risk factors of advancing age, male gender and co-existing health conditions like cancer, cardiovascular diseases, diabetes and obesity do not fully explain why some people have no or mild symptoms whereas others have severe symptoms. Genomewide association study (GWAS) identify a 3p21.31 gene cluster as a genetic susceptibility locus in patients with COVID-19 with respiratory failure. They also found a higher risk among persons with blood group A and protective effect for blood group O than among patients with other blood groups. The particular haplotype in a region of chromosome 3 is contributed to modern humans by neandertals. Another Neanderthal haplotype on chromosome 12 is associated with a 22% reduction in relative risk of becoming severely ill with COVID-19. The ApoE e4e4 homozygous genotype was found to increase the risk of severe COVID-19. Change in angiotensin converting enzyme (ACE) 2 gene was also found to be associated with increased risk of COVID-19, cardiovascular and pulmonary conditions.

Multiple Myeloma and Vasculitic Neuropathy: An Unusual Presentation

Multiple myeloma (MM) is a clonal proliferation of plasma cells in the bone marrow resulting in the production of paraproteins. It is more common in elderly adults and presents with nonspecific symptoms like bone pain, pathological fracture, fatigue, and signs of hypercalcemia. Peripheral neuropathy is an atypical presentation. We present a rare case of vasculitic neuropathy (VN) who was also diagnosed with MM at the same time. Nerve conduction study and biopsy showed findings suggestive of demyelinating VN. His serum protein electrophoresis and bone marrow aspirate were consistent with MM. The association between these two conditions remains understudied. So far there is no strong evidence suggesting an association between MM and VN. If VN was just coincidental or a presenting symptom of MM remains a question and warrants further studies.

Respiratory Failure in a Neonate with Pierre Robin Syndrome -A Challenging Proposition

Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies. Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions. Method This was a descriptive cross-sectional study of 125 patients who underwent imageguided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope. Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%). Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples.

Endometriosis of Groin Mimicking Neoplasm

Endometriosis is principally a disease of women in active reproductive life. Although it is rare, foci of endometrial tissue may be seen in the bowel, the umbilicus, abdominal surgical scars and in the lungs. Inguinal endometriosis is challenging to the clinicians and pathologist and often diagnosed accidentally. We present a case of inguinal endometriosis mimicking neoplasm. A 40 year old woman presented with a swelling in the right inguinal region associated with cyclical pain. In view of presence of atypical cells in fine needle aspiration cytology, metastatic carcinoma was rendered as diagnosis. Histopathological examination revealed endometrial glands and stroma which was further confirmed by immunohistochemistry. Diagnosis of inguinal endometriosis is difficult and often challenging because of unusual site. The clinician must have high index of suspicion with any patient who has cyclical symptoms. A good history and physical examination can guide clinical diagnosis of endometriosis.

Prevalence and Clinical Manifestations of Helicobacter Pylori with Reference to Histopathological Diagnosis

Background Helicobacter pylori infection is on a steep decline in most of the developed countries; however, in developing countries like Nepal such steep decline is not seen. This may be due to failure of treatment regimens and emergence of drug resistance. Our previous study done in 2004/2005 showed 38% prevalence of Helicobacter pylori. The present study has been conducted to review the prevalence and clinical diagnosis of Helicobacter pylori with reference to histo-pathological diagnosis. Method This was retrospective study done at Dhulikhel Hospital, Kathmandu University Hospital over a period of 13 years from January 2006 to December 2018. Helicobacter pylori proven cases were retrospectively analyzed with clinical features and endoscopy findings. The clinical picture were categorized into antral gastritis, gastroduodenits, erosive duodenitis, acid peptic disease, reflux esophagitis, hiatal hernia, polyp, ulcer (gastric and duodenal), acute abdomen, upper gastrointestinal bleeding and malignancy. Result A total of 1624 upper gastrointestinal endoscopy biopsies were taken during the study period. Helicobacter pylori infection was seen in 618 (38.0%) cases out of 1624 cases. Helicobacter pylori were seen in 349 male and 269 female patients with male to female ratio of 1.29:1. Clinically, gastritis 210 (41.4%), acid peptic disease74 (42.7%), gastroduodenitis 46 (37.7%), reflux esophagitis 38 (52.7%), gastric ulcer 48 (28.4%), duodenal ulcer 34 (53.1%) and acute abdomen 50 (42.3%) cases were seen respectively. Conclusion Most commonly Helicobacter pylori cause chronic gastritis in our context. There is no significant change in prevalence of Helicobacter pylori infection as compared to our previous study (2004/05). This needs proper management of Helicobacter pylori infection to prevent serious complication such as gastric cancer in our part of the world.

Clinical profile of pregnancy loss and placental histopathology at a University Hospital

Aims: To review the clinical features of abortion and intrauterine fetal demise with histopathological findings in their placenta Methods: A retrospective study conducted at Kathmandu University Dhulikhel Hospital from 2008 to 2018. Results: A total of 431 placentas were examined over one decade. One third of them (33.2%) had abortion. Mean age of the patients with abortion was 24.72±5.5 years and that of intrauterine fetal demise (IUFD) was 25.36±5.4 years (p=0.2288). Two thirds of patients with abortion presented with vaginal bleeding and/or lower abdominal pain; 73% of IUFD presented with decreased fetal movement. Gross anomaly was the most common comorbid condition in abortion group while pre/post term, antepartum hemorrhage and PIH were the commoner conditions in IUFD group. In this study, 17.4% abortion cases and 18.3% IUFD cases were with histopathologically proven infection. Conclusions: Placental examination helps in revealing unseen pathologies in cases of poor obstetric outcomes in the form of abortion or fetal demise. The service provider should collect and provide required clinical information before studying the placenta to establish a hidden diagnosis.

The Diagnostic Accuracy of Frozen Section Compared to Permanent Section: Single Center Study

Background Intra-operative consultation by frozen section is a procedure which plays a major role in the surgical management of patients with neoplastic and non neoplastic disease. Therefore it is critical to determine efficiency of frozen section performance periodically. Objective To evaluate the accuracy of frozen section tests at different anatomical sites by comparing the frozen section diagnosis with the histological diagnosis. Method We conducted a retrospective study in Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, and compared the results of 47 cases of frozen section with their final permanent section diagnosis during a period of January 2017 to December 2018. Result A total of 47 cases were studied on frozen section while no case was deferred for permanent paraffin section. The indication of frozen section was for presence/ typing of neoplasm in 38 cases (80.75%), clearance of margin in eight cases (17%) and diagnosis of Hirschsprung's disease in one case (2.1%). The overall accuracy of frozen section was 91.4% (43 cases) with 8.5% (four cases) discordant with the diagnosis, reported as false negative. None of the cases were reported as false positive. Sensitivity, specificity, positive predictive value and negative predictive value of frozen section in comparison with permanent section (as gold standard) were 85.18%, 100%, 100% and 83.33% respectively. Conclusion The accuracy of frozen section diagnosis at our institute was 91.4% which can be interpreted as comparable with most national and international studies. The overall error rate is 8.5% which is higher than previously published studies. Experience and training of the pathologist reduce the error rate.

ID: 44: LOCAL CONTROL OF OCULAR ADNEXAL LYMPHO-PROLIFERATIVE DISORDERS (OALD): SIMILAR OUTCOMES IN MALT AND NON-MALT HISTOLOGIES

Background

The outcomes of local radiation therapy (RT) in MALT vs. non-MALT OALD are not known. Herein we present outcomes of local therapy in MALT vs. non-MALT OALD treated at a specialized lymphoma program.

Abstract ID: 44 Table 1:

Baseine characteristics.

MALTNON-MALTTOTAL, N=11271 (63.3%)41 (36.6%)Age (median), years64 (22–84)66 (25–87)Sex, M25 (35.2%)16 (39%)Symptoms at presentation–Mass/Swelling–Visual changes–Other35 (49.2%)11 (15.4%)2 (2.8%)27 (66%)11(27%)1 (2.4%)Site of origin–Orbital–Conjunctival–Lacrimal gland–Eyelid–Other31 (43.6%)26 (36.6%)10 (14%)1 (1.4%)4 (5.6%)14 (34.1%)14 (34.1%)10 (24.3%)3 (7.3%)0Unilateral Involvement60 (86%)34 (83%)Stage at presentation–I–II–III–IV–Unknown60 (85%)01 (1.4%)8 (11.2%)2 (2.8%)24 (59%)4 (9.7%)2 (4.8%)7 (17%)4 (9.7%)

Methods

The analysis included 112 consecutive patients (pts) with OALD diagnosed at our institution between 1975–2014. Histology was reviewed by an expert hematopathologist. The primary objective of the study was to assess the failure free survival (FFS) in pts. with marginal zone lymphoma of mucosa associated lymphoid tissue (MALT) of ocular adnexa (OA) and non–MALT OA lymphomas treated with local radiation therapy. Complete remission was defined as absence of any disease by imaging. Local failure was defined as any failure within the OA; extra-orbital failure was either regional (within the radiation field) or distant (for cases with limited stage disease at presentation). FFS was defined as time from treatment to any failure (local, regional and distant). FFS was estimated using the Kaplan-Meier methods.

Results

Baseline characteristics are shown in table 1. Of 112, 71(57.7%) of the pts had ocular MALT, and 41(33.3%) had non-MALT (23 follicular, 8 diffuse large cell B cell lymphomas, 3 mantle cell, 6 small lymphocytic lymphoma and 1 T cell lymphoma). Unilateral eye involvement (83.9%) with mass/swelling (55.3%) was the most common presentation. Staging was performed with CT scan and bone marrow biopsy in select cases (n=63, 51%). PET scan was utilized in 33 (29.4%) pts. but was able to upstage in only 5 cases.

For ocular MALT, 62 (87.3%) received involved field radiation therapy (IFRT), 9 (12.6%) chemotherapy. For non-MALT, 34 (82.9%) had IFRT,7 (17%) chemotherapy. Among those who received IFRT, 55 (75%) in MALT and 21 (52%) in non-MALT had limited stage disease (I/II).

Among OALD pts treated with only IFRT, 91.7% in ocular MALT and 90.9% in non-MALT achieved complete remission. Resolution of symptoms occurred in 83.3% and 93.3% of ocular MALT and non-MALT respectively. Failure rates of IFRT in ocular MALT vs. non-MALT were as follows: local (7% vs. 12.1%), regional (9.8% vs. 7.3%), and distant (5.6% vs 2.4%). Median follow-up was 3 (1–22) years in each group. Median time to failure was 14 years for ocular MALT and 9 years for non-MALT. 3 year and 5 year failure-free survival was 88% and 81% for ocular MALT and 78% and 71% for non-MALT respectively (log rank p=0.26 for FFS) (figure 1).

Conclusions

Both the MALT and non-MALT OALD pts achieved excellent disease control with IFRT with no significant difference in local, regional and distant failure rates. 3 year and 5 year failure free survival were comparable between the two groups. PET scan resulted in upstaging in 5% of pts but did not alter treatment selection, indicating that PET had minimal utility in initial staging of OALD.

Assessing the performance characteristics and clinical forces in simulated shape memory bone staple surgical procedure: The significance of SMA material model

This work is focused on the detailed computer simulation of the key stages involved in a shape memory alloy (SMA) osteosynthesis bone stapling procedure. To this end, a recently developed three-dimensional constitutive SMA material model was characterized from test data of three simple uniaxial-isothermal-tension experiments for powder metallurgically processed nickel-rich NiTi (PM/NiTi-P) material. The calibrated model was subsequently used under the complex, thermomechanical loading conditions involved in the surgical procedure using the body-temperature-activated PM/NiTi-P bone staple. Our aim here is to assess the immediate and post-surgical performance characteristics of the stapling operation using the material model. From this study: (1) it was found that adequate compressive forces were developed by the PM/NiTi-P bone staple, with the tendency of this force to even increase under sustained thermal loading due to the intrinsic "inverse relaxation phenomena" in the SMA material, (2) the simulation results correlated well with those from experimental measurements, (3) the body-temperature-activated PM/NiTi-P staple was proved to be clinically viable, providing a stable clamping force needed for speedy coaptation of the fractured bones, and (4) these realistic assessments crucially depend on the use of suitable and comprehensive SMA material models.

Abstract 4672: Anti-angiogenic effects of zoledronic acid on osteotropic breast cancer cells

Emerging data suggest the bisphosphonate, zoledronic acid (ZOL), exerts both indirect and direct anti-tumor effects by decreasing tumor cell proliferation, increasing apoptosis, and inhibiting angiogenesis. Recent data indicate that anti-angiogenic factors exert cellular effects via suppression of mitochondrial oxidative phosphorylation/respiration and elevation of intracellular ROS levels. This project intended to define proteins involved in response to ZOL-treatment of an osteotropic breast cancer cell line, MDA-231BO. Results demonstrate that MDA-231BO cells are more sensitive to ZOL cytotoxicity and salutary effects are both media- and calcium-dependent. To investigate pro-apoptotic mechanisms of ZOL, total RNA, whole cell protein lysates, or mitochondrial-enriched fractions were isolated from MDA-231BO cells and using a combination of RT-PCR, 1D/2D-PAGE separation and MALDI-MS/MS, we identified several angiogenesis inhibitors that were upregulated and pro-angiogenic factors that were downregulated after ZOL treatment. Functional studies demonstrate the improved efficacy of ZOL on MDA-231BO compared to MDA-MB-231 controls. Taken together, these results further support a model that ZOL tips the ‘angiogenic switch’ in favor of anti-angiogenic factors in cancer cells with a propensity for bone metastases.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4672. doi:1538-7445.AM2012-4672

Abstract 4261: Anti-angiogenic effects of zoledronic acid on osteotropic breast cancer cells

Emerging data suggest the bisphosphonate, zoledronic acid (ZOL), exerts both indirect and direct anti-tumoral effects by decreasing tumor cell proliferation, increasing apoptosis, and inhibiting angiogenesis. Recent data indicate that anti-angiogenic factors exert cellular effects via suppression of mitochondrial oxidative phosphorylation/respiration and elevation of intracellular ROS levels. This project intended to define proteins involved in response to ZOL-treatment of an osteotropic breast cancer cell line, MDA-231BO. Results demonstrate that MDA-231BO cells are more sensitive to ZOL cytotoxicity and salutary effects are both media- and calcium-dependent. To investigate pro-apoptotic mechanisms of ZOL, total RNA, whole cell protein lysates, or mitochondrial-enriched fractions were isolated from MDA-231BO cells and using a combination of RT-PCR, 1D/2D-PAGE separation and MALDI-MS/MS, we identified several angiogenesis inhibitors that were upregulated and pro-angiogenic factors that were downregulated after ZOL treatment. Functional studies demonstrate the improved efficacy of ZOL on MDA-231BO compared to MDA-MB-231 controls. Taken together, these results further support a model that ZOL tips the ‘angiogenic switch’ in favor of anti-angiogenic factors in cancer cells with a propensity for bone metastases. Partial research support came from NIH 5P20MD002732

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4261. doi:10.1158/1538-7445.AM2011-4261