Non-hypertensive gestational diabetes mellitus: Placental histomorphology and its association with perinatal outcomes

INTRODUCTION

Gestational diabetes mellitus (GDM) exerts a great impact on the placenta and reflects changes on placentas both morphological and functionally. The aims of this study are to evaluate the prevalence of placental histopathological lesions in pregnancies complicated by GDM compared to gestational age-matched controls, and their association with maternal and fetal complications.

METHODS

Fifty-four singleton GDM-complicated pregnancies were recruited and compared to 33 consecutive normal pregnancies. Two pathologists, blinded to all clinical data, reviewed and evaluated all histological samples of the placentas in accordance with Amsterdam criteria. Relevant demographic, clinical data and primary birth outcomes were recorded.

RESULTS

A myriad of histomorphological abnormalities, including chronic inflammation (n = 9/54, p = 0.031), histological chorioamnionitis (n = 23/54, p < 0.001), umbilical/chorionic vasculitis (n = 9/54, p = 0.031), changes related to maternal vascular malperfusion (n = 22/54, p = 0.003), chorangiosis (n = 10/54, p = 0.046) and villous dysmaturity (n = 9/54, p = 0.012) were observed more frequently in the GDM placentas compared to the controls. Additionally, GDM significantly increased the risk of fetal complications, including macrosomia/fetal growth restriction (n = 13/54, p = 0.004).

DISCUSSION

Histoarchitectural abnormalities were observed more frequently in placentas of GDM pregnancies compared to the controls. Our findings support the hypothesis that diabetic-induced damage in the placental function may be associated with the increased in fetal growth disorders in GDM-complicated pregnancies.

An extendable optical fibre probe survey meter for naturally occurring radioactive material (NORM) and other weak emitters

We have developed a radioluminescence-based survey meter for use in industries in which there is involvement in naturally occurring radioactive material (NORM), also in support of those needing to detect other weak emitters of radiation. The functionality of the system confronts particular shortcomings of the handheld survey meters that are currently being made use of. The device couples a LYSO:Ce scintillator with a photodetector via a polymer optical fibre waveguide, allowing for "intrinsically safe" inspection within pipework, separators, valves and other such component pieces. The small-diameter optical fibre probe is electrically passive, immune to electromagnetic interference, and chemically inert. The readout circuit is entirely incorporated within a handheld casing housing a silicon photomultiplier (SiPM) detection circuit and a microprocessor circuit connected to an LCD display. A 15 m long flexible PMMA optical fibre waveguide is butt coupled to an ABS plastic probe that retains the LYSO:Ce scintillator. Initial tests have included the use of lab-based mixed gamma-ray sources, measurements being made in concert with a reference conventional GM survey-meter. Characterization, via NORM sources at a decontamination facility, has shown useful sensitivity, covering the dose-rate range 0.10- to 28 µSv h^-1 (R-squared 0.966), extending to 80 µSv/h as demonstrated in use of a Cs-137 source. The system is shown to provide an effective tool for detection of radioactivity within hard to access locations, in particular for sources emitting at low radiation levels, down to values that approach background.

Brachial artery injuries - the impact of the anatomical site of injury on postoperative outcomes

BACKGROUND

The start of the armed conflicts in Libyan society in 2011 led to a dramatic increase in the incidences of unusual types of brachial artery injuries, which were previously uncommon. In this study, the postoperative outcomes have been compared prospectively between patients who have had injuries at the proximal anatomical half of the brachial artery with those who suffered injuries at the distal anatomical half.

METHODS

A cohort study was undertaken to compare patients who had an injury at the proximal anatomical half of the brachial artery (considered as the first group) and patients who had an injury at the distal anatomical half of the brachial artery (considered as the second group). This was undertaken to analyse the influence of the anatomical site of injury on the postoperative outcomes in patients who underwent urgent surgical repair procedures at the hospital from February 2011 to December 2016.

RESULTS

Out of fifty-one patients, 31 (60.8%) patients had gunshot injuries, 12 (23.5%) had explosive injuries, four (7.8%) had stab wounds and four (7.8%) were victims of road traffic accidents. There were 13 (25.5%) patients in the first group and 38 (74.5%) patients in the second group. Three patients (5.9%) had postoperative arterial occlusion due to thrombosis, while two (3.9%) had postoperative graft occlusion due to thrombosis; the other two (3.9%) had compartment syndrome.

CONCLUSION

Based on the anatomical background, critical limb ischaemia and postoperative ischaemic complications, as well as delayed limb amputation, are more associated with the injuries to the proximal anatomical half of the brachial artery due to poor collateral circulation at this level.

To evaluate if ultrasound gel or water-based media affects ER/PR staining patterns on breast core biopsy specimens

Introduction/Objective

IHC staining for biomarkers ER, PR and HER-2 (CerB2) forms an essential component of breast cancer management and prognostication. Staining for these biomarkers is dependent on optimal fixation of the specimen in formalin. Scoring systems employed for ER and PR grade the intensity of the nuclear staining along with the percentage of the cells stained. This study aims to determine if ultrasound gel used during core biopsy as opposed to water affects immunohistochemical staining of biomarkers ER and PR in breast cancer specimens, following an observation that ultrasound gel assisted core biopsies may affect ER/PR nuclear staining scores through excess cytoplasmic staining.

Methods/Case Report

We included a total of 50 cases of invasive breast carcinoma diagnosed on core biopsy from KK Women’s and Children’s Hospital from February 2019 to July 2020. These included 25 cases with gel and 25 cases with water applied to the breast prior to the procedure. All biopsies were optimally fixed in formalin as per recommended latest ASCO/CAP guidelines. The control group included 25 resection cases of invasive breast carcinoma which had neither gel nor water and had been optimally fixed in formalin. Cytoplasmic staining for ER and PR was graded as being present or absent and was compared against the excision specimens (control group) to determine if using the gel was significant in producing cytoplasmic staining. The data was analyzed on SPSS using multiple logistic regression.

Results (if a Case Study enter NA)

Using the gel appeared to be statistically significant in producing cytoplasmic staining for ER (p=0.042) as opposed to using water (p=0.274). For PR staining, both gel-based (p=0.250) and water-based media (p=0.286) were not statistically significant in causing cytoplasmic staining.

Conclusion

The preliminary findings of this small retrospective case-control study gives an insight that gel-based media may have a role in causing cytoplasmic staining for oestrogen receptor in breast cancer biopsy specimens which may interfere with accurate scoring and impact results of external quality assurance schemes to which laboratories subscribe to. However the study is limited by the small sample size and exclusion of any other pre- analytical factors like needle bore or number of cores taken which may have had an impact on the staining.

RCL2, a potential formalin substitute for tissue fixation in routine pathological specimens

AIMS

To investigate RCL2 as a fixative for tissue fixation in routine histopathological examination and to assess tissue suitability for ancillary investigations.

METHODS AND RESULTS

  Forty-nine samples from 36 fresh specimens were cut into three equal pieces and fixed in RCL2 diluted in 100% ethanol, RCL2 in 95% ethanol, or neutral buffered formalin as control. Suitability for microtomy, quality of histomorphology, histochemistry, immunohistochemistry, fluorescent and silver in-situ hybridization analysis and extracted genomic DNA were assessed. Microtomy was straightforward in most tissue blocks, but there was difficulty in cutting in approximately a quarter of samples, which required careful handling by an experienced technician. There were no significant differences in tissue morphology between RCL2- and formalin-fixed tissues (P=0.08). Generally, the quality of histochemical staining, immunohistochemistry and in-situ hybridization were comparable to that of formalin-fixed tissues. Inconsistent immunoreactivity was noted, however, with antibodies against pan-cytokeratin and progesterone receptor. Genomic DNA concentration was higher in RCL2-fixed tissues. Using RCL2 diluted in 95% ethanol did not affect fixation quality.

CONCLUSION

RCL2 is a potential formalin substitute suitable as a fixative for use in routine histopathological examination; however, difficulty in microtomy and occasional discrepancies in immunohistochemical reactivity require further optimization of the methodology.

Efficacy of quinine for falciparum malaria according to previous chloroquine exposure

Chloroquine has been reported to antagonise the anti-parasitic action of quinine against Plasmodium falciparum in vitro. We looked for evidence of any such antagonism in vivo. In 123 Malawian children with cerebral malaria treated with parenteral quinine, the likelihood of survival and the rate of recovery were much the same in patients who had taken chloroquine and those who had not. In these circumstances we found no evidence of chloroquine/quinine antagonism.

Freshwater snail consumption and angiostrongyliasis in Malaya

A survey of the freshwater snails, Pila scutata and Bellamyia ingallsiana, as food consumed by the local population was carried out in Peninsular Malaysia. Of these two species the first is preferred; the sizes favoured are between 25--40 mm. Pila snails were found to be consumed by the three communities, viz. Malay, Chinese and Indian, in different ways. The various methods of preparing the snails for consumption are described. P. scutata is an intermediate host of the rat-lung worm, Angiostrongylus malaysiensis. As this worm presumably is the causative agent of human eosinophilic meningoencephalitis, the eating habits of the three races in consuming the snail in relation to the epidemiology of the disease was also discussed.