Polycystic ovary syndrome and its management: In view of oxidative stress

In the past two decades, oxidative stress (OS) has drawn a lot of interest due to the revelation that individuals with many persistent disorders including diabetes, polycystic ovarian syndrome (PCOS), cardiovascular, and other disorders often have aberrant oxidation statuses. OS has a close interplay with PCOS features such as insulin resistance, hyperandrogenism, and chronic inflammation; there is a belief that OS might contribute to the development of PCOS. PCOS is currently recognized as not only one of the most prevalent endocrine disorders but also a significant contributor to female infertility, affecting a considerable proportion of women globally. Therefore, the understanding of the relationship between OS and PCOS is crucial to the development of therapeutic and preventive strategies for PCOS. Moreover, the mechanistic study of intracellular reactive oxygen species/ reactive nitrogen species formation and its possible interaction with women's reproductive health is required, which includes complex enzymatic and non-enzymatic antioxidant systems. Apart from that, our current review includes possible regulation of the pathogenesis of OS. A change in lifestyle, including physical activity, various supplements that boost antioxidant levels, particularly vitamins, and the usage of medicinal herbs, is thought to be the best way to combat this occurrence of OS and improve the pathophysiologic conditions associated with PCOS.

A General Assessment of India's Extremely Low Number of Transgender Cancer Patients

PURPOSE/OBJECTIVE(S)

Physiological transgender (TJ) is one of the most marginalized and oppressed community in the Indian subcontinent. The observable percentage of physiological transgender (TJ) cancer patients is extremely low. This concise report aims to assess the factors that contribute to the scarcity of transgender cancer patients.

MATERIALS/METHODS

The hospital database (2012-2021) of 2 centers in New Delhi (population 32 million) & 1 in Kolkata (15 million) were evaluated. In addition, 28 senior oncologists (ONC) and 17 trans women (TWs) completed a six-point questionnaire. ONC was asked how many TJ patients they had seen in their career, as well as histopathology/site. Furthermore, the data was extrapolated to account for all clinicians' cumulative years of experience. The questions for TWs were age and where they go if you have a disease or illness. And, do they know any TJ cancer patients?

RESULTS

India's last census (2011) revealed a half-million TJ population. TJ density must be at least 1 million to be comparable to the rest of the world. Hospital databases counted 10,486 patients, with no patient identified as TJ. A total of 37 TJ cancer patients were reported by 28 ONC with an average and collective years of their medical service of 23.1±4.1 and 646 years; distributed in 3 metropolis of 67 million (combined) population (Kolkata, New Delhi, and Mumbai). The average lifetime number of TJ cancer patients/oncologist was 1.3±1.1. Total 12 cases were head neck cancers, with 4 caused by human papillomavirus. The remaining 25 patients have 5 lung, 5 gynecological, 4 breast, 3 brain cancers, 2 soft tissue sarcomas, and 6 cases of unknown origin. The density of 5-year prevalent cancer cases in India is 0.2%, with an estimated 0.007% of TJ cancer patients. TW could not identify any cancer patients in their community.

CONCLUSION

Being transgender is a social taboo in this part of the world. Their legal rights and classification as the third gender are uncommon. TJs are denied access to standard education, mainstream occupations, and social respect. Although the exact number has never been determined, it is estimated that a large proportion (≈90%) of TJ people are forced to choose roadside begging and working as cheap sex workers. There is no clinical reason why TJs should have fewer cancer incidents, they should be more susceptible to cancer due to unhealthy living conditions, unprotected sex, lack of medical care, proper nutrition, and all other factors associated with their very low socioeconomic status. Nonetheless, it's difficult to find single TJ cancer patients in both public and private hospital OPD. They may be unable to access a traditional clinic due to social discrimination, financial constraints, or they may be unwilling to disclose their true sex. Even TJ's do not show up at free public clinics. The disclosure of true sex may be beneficial in obtaining better treatment, but the more prevalent reason is social unacceptability, which can be overcome through proper education and community economic growth.

CaSR expression in normal parathyroid and PHPT: new insights into pathogenesis from an autopsy-based study

PURPOSE

Calcium sensing receptor (CaSR), on the surface of normal parathyroid cells, is essential for maintaining serum calcium levels. The normal pattern of CaSR immunostaining remains undefined and is presumptively circumferential. Given the physiological variation in serum calcium, we postulated that CaSR expression could not be uniformly circumferential. Also, cytoplasmic expression has not been evaluated either in normal or pathological tissues. We studied normal parathyroid tissues derived from forensic autopsies and those rimming parathyroid adenomas for membranous and cytoplasmic CaSR immunoexpression. Results were compared with primary hyperparathyroidism (PHPT) to look for any pathogenetic implications.

MATERIALS AND METHODS

We evaluated 34 normal parathyroid tissues from 11 autopsies, 30 normal rims, 45 parathyroid adenoma, 10 hyperplasia, and 7 carcinoma cases. Membranous expression was categorized complete/incomplete and weak/moderate/strong; scored using Her2/Neu and Histo-scores; predominant pattern noted. Cytoplasmic expression was categorized negative/weak/moderate/strong; predominant intensity noted.

RESULTS

Normal autopsy-derived parathyroid tissues were Her2/Neu 3 + , but incomplete membranous staining predominated in 85%. Their immune-scores were significantly more than the cases (p <  < 0.05). The mean histo-score of normal rims was intermediate between the two (p <  < 0.05). Cytoplasmic expression was strong in all autopsy-derived tissues, weak/negative in hyperplasia (100%), moderate in 16% adenomas, and 43% carcinomas.

CONCLUSIONS

Normal autopsy-derived parathyroid tissues showed strong but predominantly incomplete membranous expression. Surface CaSR expression decreased in PHPT and is probably an early event in parathyroid adenoma, seen even in normal rims. Whether there is a defect in CaSR trafficking from the cytoplasm to the cell surface in adenoma and carcinoma needs further evaluation.

Elevated plasma ferritin in elderly individuals with high neocortical amyloid-β load

Ferritin, an iron storage and regulation protein, has been associated with Alzheimer's disease (AD); however, it has not been investigated in preclinical AD, detected by neocortical amyloid-β load (NAL), before cognitive impairment. Cross-sectional analyses were carried out for plasma and serum ferritin in participants in the Kerr Anglican Retirement Village Initiative in Aging Health cohort. Subjects were aged 65-90 years and were categorized into high and low NAL groups via positron emission tomography using a standard uptake value ratio cutoff=1.35. Ferritin was significantly elevated in participants with high NAL compared with those with low NAL, adjusted for covariates age, sex, apolipoprotein E ɛ4 carriage and levels of C-reactive protein (an inflammation marker). Ferritin was also observed to correlate positively with NAL. A receiver operating characteristic curve based on a logistic regression of the same covariates, the base model, distinguished high from low NAL (area under the curve (AUC)=0.766), but was outperformed when plasma ferritin was added to the base model (AUC=0.810), such that at 75% sensitivity, the specificity increased from 62 to 71% on adding ferritin to the base model, indicating that ferritin is a statistically significant additional predictor of NAL over and above the base model. However, ferritin's contribution alone is relatively minor compared with the base model. The current findings suggest that impaired iron mobilization is an early event in AD pathogenesis. Observations from the present study highlight ferritin's potential to contribute to a blood biomarker panel for preclinical AD.

The clinical utility of cycle of threshold value of GeneXpert MTB/RIF (CBNAAT) and its diagnostic accuracy in pulmonary and extra-pulmonary samples at a tertiary care center in India

BACKGROUND

There are knowledge gaps in the in-depth analysis of the most promising and robust diagnostic tool, GeneXpert MTB/RIF (CBNAAT). The cycle of threshold (CT) value of the CBNAAT test and its clinical implications has not been explored much.

AIMS AND OBJECTIVES

The study aimed at (a) estimating the diagnostic accuracy and incremental yield of Xpert MTB/RIF in various specimens (b) establishing the association between CT value category (high, medium, low, very low) and culture time-to-positivity (TTP).

METHODS

A total of 1000 samples, both pulmonary and extra-pulmonary were collected from presumptive TB cases in a large tertiary care hospital. Sensitivity and specificity of CBNAAT was calculated with culture as the gold standard. The association of CT value with culture TTP was also studied.

RESULTS

The overall sensitivity of CBNAAT was 88.5%, with bronchial washing specimen being the most sensitive (92.3%) and pleural fluid being the least (66.7%). In smear negative individuals, the sensitivity of CBNAAT was 80.9%. The additional yield of CBNAAT over smear microscopy was 10.9%. It was observed that as we move from high to very low CT category, culture positivity decreases significantly (p<0.001), whereas time taken for culture growth increases (p<0.001).

CONCLUSION

CBNAAT is a robust test for accurate diagnosis of tuberculosis both pulmonary and extra-pulmonary, smear negative as well, especially in resource-limited settings. The correlation between CT value and culture TTP has potential in predicting bacillary load, though further studies are required.

Association of Ambient Air Quality with Male's Pulmonary Function in Kolkata City, India

BACKGROUND

Kolkata is one of the polluted metropolitan cities in India where health effects of air pollution are raising serious concern.

OBJECTIVES

Purpose of the present study was to analyze association between levels of air pollutants and pulmonary function of adult males living in two different air pollutant zones of Kolkata.

METHODS

Air pollution data of two ambient air quality monitoring stations located at Rabindrabharati and Victoria Memorial was collected from West Bengal Pollution Control Board, Kolkata for the period from January to March 2012. Study was conducted on 200 males (17-22 yrs), subdivided into two groups from living within 3 km radius of that two monitoring stations. They were investigated for their spirometric lung functions following method and technique recommended by American Thoracic Society. Results were expressed as mean ± SD and independent samples T test was conducted to compare between groups.

RESULTS

PM10, SO2 concentrations were significantly higher in Rabindrabharati zone, whereas no significant differences were noted in NO2 and CO concentrations though values were higher at Rabindrabharati than Victoria Memorial. FVC, FEV1, FEF25-75%, MVV were significantly lower in males of Rabindrabharati zone.

CONCLUSION

Exposure to high air pollutant concentration might be associated with reduced pulmonary function in adult males.

pH-dependent size and structural transition in P123 micelle induced gold nanoparticles

The transition of the structure and size of AuNPs at a pH value around 9.5, from slowly grown, well-faceted, large (≫19 nm), less uniform and near connected to fast grown, near symmetrical, small (<19 nm), more uniform and well-separated, is observed.

Malignant Leiomyoblastoma: An Incidental Diagnosis

DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11147   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 55-56

Diagnostic dilemma in histopathology report following robot assisted laparoscopic prostatectomy: tumour 'hide and seek'

INTRODUCTION

Widespread PSA (prostate specific antigen) screening has resulted in stage migration of prostate cancer. Smaller tumor volumes are being detected in radical prostatectomy specimens. This has coincided with increasing reports about the 'vanishing cancer phenomenon.'

AIMS

To analyse the cases of robot assisted laparoscopic prostatectomy (RALP) at our institute in which the pre operative prostate biopsy was positive for adenocarcinoma but no tumor could be identified in the final histopathology, and to review the literature for possible reasons for such a phenomenon.

MATERIALS AND METHODS

Nine patients were identified out of a total of 184 cases of RALP in which the final histopathology did not correlate with the initial biopsy report. The initial biopsy slides as well as the final histopathology slides were reviewed by a second pathologist. The specimens were processed in entirety and additional sections were taken until no tissue was left.

RESULTS

Two patients had cancer diagnosed on TURP (transurethral resection of prostate) chips, while the remaining patients had undergone TRUS biopsy for elevated PSA. The final histopathological diagnosis was benign prostatic hyperplasia in two patients, chronic prostatitis in four patients, and acute florid prostatitis in one patient, granulomatous prostatitis with glandulostromal hyperplasia in one patient and TCC (transitional cell carcinoma) of prostate in one patient.

CONCLUSION

Most cases of pT0 are due to inability of routine histopathological analysis to identify minute tumor focus. Urologists need to be aware of this in view of the potential medico legal implications.

Atlantoaxial rotatory fixation in a case of tubercular lymphadenitis

Atlantoaxial fixation is a relatively rare cause of torticollis which may be easily missed in practice. Early diagnosis is important as this indicates a compromised atlantoaxial complex with the potential to cause neural damage or even death. Here, we report a case of atlantoaxial rotatory fixation in a 13 yr old male with torticollis for two years and history of defaulting treatment for tubercular lymphadenitis. In this case, the odontoid peg view revealed asymmetric distance between the odontoid and lateral mass of atlas which was confirmed with Fluoroscopy and Computed Tomography (CT) scan. Magnetic Resonance Imaging (MRI) was also done which showed hyperintensity in alar ligaments with posterior inclination of the odontoid peg along with cervical lymphadenopathy.

A Global Electricai-Optical Model of Thin Film Solar Cells on Textured Substrates

In order to simulate the performance of the present day state-of-the-art multijunction solar cells in its entirety, an integrated electrical-optical model has been developed. The one-dimensional ab initio electrical model for the analysis of the transport properties of such devices can handle a very general semiconductor device structure where the material properties vary with position and the gap state properties with position and energy. The original semi-empirical optical model used takes into account both specular interference effects, and diffused reflectances and transmittances due to interface roughness. The latter are derived from angular-resolved photometric measurements and used as input parameters to the numerical programme. Comparison of the illuminated current density-voltage (J-V) characteristics, calculated on the basis of (a) a simple exponential absorption law and (b) the optical model, reveals an increase of ˜1 mA cm−2 in the short-circuit current and ˜8% in the cell conversion efficiency for case (b). Also the long wavelength quantum efficiency (QE) shows a marked improvement, while the blue QE decreases since proper account is taken of the absorption in the transparent conducting oxide and reflection from the device. The combined model is being applied to simulate the characteristics of wideband-gap-emitter-layer solar cells deposited in a three chamber conventional glow discharge reactor onto (i) highly textured SnO2 and (ii) weakly textured indium tin oxide substrates. The cells have been characterised experimentally by J-V and QE measurements. Preliminary results indicate that the integrated model matches the experimental J-V and QE data with a more realistic set of material parameters as compared to case (a).

Gastrointestinal stromal tumours: a clinico-radiologic review from a single centre in South India

Gastrointestinal stromal tumours (GISTs) are rare tumours but are the commonest mesenchymal neoplasms in the gastrointestinal tract. To our knowledge, there is no large case series in Asian countries in which a clinico-radiological descriptive analysis of these tumours has been carried out. In this retrospective study, we analysed our experience of 70 patients with histopathologically proven GISTs, who were presurgically investigated by using CT, and describe the demography, anatomical distribution, imaging features and clinical course of the GIST. We found an unusually large predominance of males in our study, stomach and small bowel appeared to have been involved similarly and small bowel tumours had a higher rate of metastases. We also highlight some unusual CT features of these tumours that we encountered during the study, such as the presence of metastatic lymphadenopathy and satellite nodules, relapse in appendices epiploicae of the bowel, metachronous liposarcoma, adrenal and lung metastases, multiplicity of lesions and aneurysmal dilatation of the bowel. Two of our patients also had multiple neurofibromas, whose association with GIST has been seen in earlier reports. To the best of our knowledge, this article presents one of the largest series of articles on GISTs, to date, in Asian countries. We conclude with a differential diagnosis of GIST, with salient features distinguishing each entity.

Drosophila simulans Lethal hybrid rescue mutation (Lhr) rescues inviable hybrids by restoring X chromosomal dosage compensation and causes fluctuating asymmetry of development

The Drosophila simulans Lhr rescues lethal hybrids from the cross of D. melanogaster and D. simulans. We describe here, the phenotypes of Lhr dependent rescue hybrids and demonstrate the effects of Lhr on functional morphology of the salivary chromosomes in the hybrids. Our results reveal that the phenotypes of the 'Lhr dependent rescued' hybrids were largely dependent on the genetic background and the dominance in species and hybrids, and not on Lhr. Cytological examination reveal that while the salivary chromosome of 'larval lethal' male carrying melanogaster X chromosome was unusually thin and contracted, in 'rescued' hybrid males (C(mel)X(mel)Y(sim); A(mel)A(sim)) the X chromosome showed typical pale staining, enlarged diameter and incorporated higher rate of (3)H-uridine in presence of one dose Lhr in the genome. In hybrid males carrying simulans X chromosome (C(mel)X(sim)Y(mel); A(mel)A(sim)), enlarged width of the polytene X chromosome was noted in most of the nuclei, in Lhr background, and transcribed at higher rate than that of the single X chromosome of male. In hybrid females (both viable, e.g., C(mel)X(mel)X(sim); A(mel)A(sim) and rescued, e.g., C(mel)X(mel)X(mel); A(mel)A(sim)), the functional morphology of the X chromosomes were comparable to that of diploid autosomes in presence of one dose of Lhr. In hybrid metafemales (C(mel)X(mel)X(mel)X(sim); A(mel)A(sim)), two dose of melanogaster X chromosomes and one dose of simulans X chromosome were transcribed almost at 'female' rate in hybrid genetic background in presence of one dose of Lhr. In rescued hybrid males, the melanogaster-derived X chromosome appeared to complete its replication faster than autosomes. These results together have been interpreted to have suggested that Lhr suppresses the lethality of hybrids by regulating functional activities of the X chromosome(s) for dosage compensation.

Validity of 20 meter multi stage shuttle run test for prediction of maximum oxygen uptake in Indian female university students

BACKGROUND

The 20-meter multi stage shuttle run test (20-m MST) has not yet been used by Indian scientists and validity of the test has not been studied for use with any of the Indian population.

AIMS

The purpose of this study was to validate the applicability of the 20-m MST in Indian adult female.

MATERIALS AND METHODS

For application of direct method cross over design was followed. For validity of the results repeatability was used.

METHODS AND MATERIAL

32 female university students (age range 20.4 approximately 24.8 years) from three different universities of West Bengal, India were recruited for the study. Direct estimation of VO2 max comprised treadmill exercise followed by expired gas analysis by scholander micro-gas analyzer whereas VO2 max was indirectly predicted by the 20-m MST.

STATISTICAL ANALYSIS

Paired t-test, Pearson's product moment correlation, linear regression statistics and Bland and Altman approach for limit of agreement were adopted for statistical analysis of the data.

RESULTS

The difference between the mean (SD) VO2 max values of direct measurement (VO2 max = 32.84 +/- 2.92 ml/kg/min) and the 20-m MST (SPVO2 max = 32.60 +/- 3.40 ml/kg/min) was statistically insignificant (p>0.10). Limits of agreement analysis also suggest that the 20-m MST can be applied for use with the studied population.

CONCLUSIONS

The results suggest that the application of the present form of the 20-m MST be justified in the studied population. For better prediction of VO2 max a new equation has been computed based on present data for use with Indian female university students.

Double coins at the oesophageal inlet

Multiple foreign bodies lodged in the oesophagus are extremely rare. Here an unusual case of two coins accidentally lodged at the oesophageal inlet of a six-year-old girl is reported. The coins were successfully removed by oesophagoscopy. It is to be noted that apart from the straight x-ray (PA view) of the neck and chest, a lateral view is essential for proper characterisation and identification of the type and number of foreign bodies prior to surgical removal.