Effect of Tobacco Use on Semen in Infertile Male

Background/Objective/Methods

Infertility is one of the major global public health issues. In a social setup like India, there is a strong emphasis on childbearing, which leads to economic and psychological stress and trauma. Various studies have shown that worldwide, there is a decline in the quality of semen. Many environmental, nutritional, and lifestyle factors are responsible for the reduced semen quality. The methods of this study are the source of data, the method of collection of data, and statistical analysis.

Results

Semen analysis is an important diagnostic test in the assessment of infertility in male partners. Ninety-eight semen samples were analyzed from the patients who presented with the complaint of infertility over a period of 2 years (June 2018-May 2020).

Conclusion

Based on our analysis, it can be inferred that an escalation in the intensity of tobacco consumption is directly associated with a proportional decline in sperm count and motility and a notable increase in liquefaction time.

Assessment of Intratumoural and Stromal Infiltrating Lymphocytes In The Various Subtypes of Breast Carcinoma Patients who have Received Neoadjuvant Chemotherapy

BACKGROUND

Breast cancer comprises a highly heterogeneous subset of tumours that respond well to Neoadjuvant Chemotherapy (NAC). Tumour Infiltrating Lymphocytes (TIL) act as a means to an end by shedding light on the treatment response as well as predictive factors to the clinicopathological features for the same. Therefore, this article attempts to shift the attention to the relevance of TIL in the aforementioned aspects by bringing to notice the contrasting traits displayed by them in the different immunohistochemical subtypes of breast carcinoma.

MATERIALS AND METHODS

75 triple-negative breast cancer (TNBC) patients, 25 human epidermal growth factor receptor (HER2BC) positive patients and 77 hormone receptor (HRBC) positive breast cancer patients were included in this study who received NAC before surgical excision of the tumour which was then stained using routine Haematoxylin and Eosin techniques. Standardised guidelines were used to evaluate TIL in the stroma and the tumour.

RESULTS

In TNBC, a significant association between Intratumoural (IT) TIL (p=0.0288) and Intrastromal (IS) TIL (p=0.0250) with pathological complete response (pCR). IS TIL and age at operation (p=0.0494) showed significant values but no correlation was found with IT TIL. In HER2BC, IS TIL revealed a significant association with the tumour response(p=0.0229). A strong association was found between IT TIL and the age of menopause(p=0.0441). In HRBC, no significant associations were found between IT and IS TIL scores and the clinicopathological features.

CONCLUSION

The predictive factors of TIL and complete response post-neoadjuvant chemotherapy can be a strong indicative factor for immunohistochemical markers. It also helps throw light on further studies which can be carried out to determine the clinicopathological features and TIL correlation in the various subtypes of breast carcinoma.

Expression of p53 as Potential Biomarker in Oral Submucous Fibrosis: An Immunohistochemical Study

Background

Oral submucous fibrosis (OSMF) is potentially malignant disorder known to transform into oral cancer. The malignant transformation is often associated with changes at the genetic level that in turn is reflected by the altered expression of proteins related to cell cycle, proliferation, and apoptosis. Expression of p53 tumor suppressor gene is one of the common findings in human cancers including the oral cancer. Therefore, the early detection of potentially malignant OSMF has been crucial in the inhibition of oral cancer.

Aim and Objectives

To determine the main pathological logical factors and expression of aberrant p53 in OSMF, oral squamous cell carcinomas (OSCC) and in normal patients, to study correlation between p53 expression with clinical staging and histological grading of OSMF.

Materials and Methods

An immunohistochemical (IHC) study was performed for p53 expression on 35 cases of OSMF, 10 cases of OSCC with history of habits and 10 normal patients without any habits.

Results

The expression of p53 showed a significant difference between normal oral mucosa, OSMF and OSCC samples.

Conclusion

The study demonstrated a high incidence of p53 over expression in OSMF and OSCC. The results indicate that p53 over expression may play a role in pathogenesis of OSMF and in the development of Oral squamous cell carcinoma. With early detection of the high-risk patients with OSMF, we can expect to develop more intensive treatment modalities, leading to the reduction in cancer transformation rate from OSMF.

Comparative Study of Immunohistochemical Expression of Moesin and FLOT 1 in OSCC and Their Correlation with Histopathological Prognostic Factors

AIM

To study immunohistochemical (IHC) expression patterns of Moesin and FLOT 1 in oral squamous cell carcinoma (OSCC) and to correlate it with histopathological prognostic factors.

MATERIALS AND METHODS

A cross-sectional study design was conducted on histopathologically diagnosed cases of OSCC. The inclusion criteria were carcinoma of buccal mucosa, tongue, alveolar mucosa, palate, gingiva, the floor of the mouth, retromolar area, and soft palate. The exclusion criteria included cases of squamous cell carcinoma from sites other than the oral cavity, potentially malignant disorders (PMDs), and any pseudomalignancies of the head and neck. Tissue sections were subjected to IHC staining for Moesin and FLOT 1 and the results were subjected to statistical analysis.

RESULTS

Moesin showed strong positivity and was significantly associated with the histopathological variables such as lymph nodes and the worst pattern of invasion, whereas FLOT 1 was not associated with any clinical, histopathological, or demographical variable in this study.

CONCLUSION

Cytoplasmic detection of Moesin (35.19%) was higher than FLOT 1 (15.74%). There was no statistically significant relationship between the grade of the lesion and Moesin and FLOT 1.

CLINICAL SIGNIFICANCE

New emerging prognostic biomarkers can aid to assess the rate of malignant transformation (epigenetic and molecular changes), thereby resulting in early prophylactic conciliation of the disease progression in OSCC. There is an urgent need for introducing these as an interventional therapy for effectively addressing OSCC at an early stage, thus preventing it from further proceeding to the advanced severe stage.

To evaluate an association between prognostic significance of Moesin with histopathological grading of oral squamous cell carcinoma: A systematic review

Purpose

The aim of the present Aetiology/Risk type and Prognostic type of systematic review is to evaluate the value of Moesin as a biomarker of invasiveness in Oral Squamous Cell Carcinoma patients and to review/assess the available evidence regarding the prospective prognostic association between Moesin and histopathological grading of OSCC to enhance the quality of life and survival rate of oral cancer patients.

Method

A systematic wide-range literature search was performed by authors (BS, KS, and DK) till October 2022 using both, electronic search media and manual search by hand, searching appropriate journals as per the focussed guiding question and inclusion/exclusion criteria. Major databases such as Scopus, EMBASE, Web of Science, Cochrane central register for controlled trials, PubMed & Google Scholar were conducted by two calibrated reviewers independently to gauge the association between the prognostic significance of Moesin with histopathological grading of oral squamous cell carcinoma. As this study is based on tissue samples of oral squamous cell carcinoma patients, all the selected studies were mostly, cross-sectional studies, and retrospective in nature. The studies were integrated with this review to gauge the association between the prognostic significance of Moesin with histopathological grading of oral squamous cell carcinoma (OSCC). The review included a total of 7 studies with tissue samples of 645 cases. The prime outcome was to assess the immunoexpression of Moesin among the different histopathological grades i.e well-differentiated SCC, moderately differentiated SCC, and poorly differentiated SCC and the subordinate outcome was to consider the extent of strong immunoexpression characteristics (cytoplasmic, membranous and mixed type) in different grades of OSCC as well as to correlate with morbidity, mortality, and/or 5 years or 10 years survival rate.

Results

The results were analyzed and presented narratively using the Critical Appraisal Tools developed by the University Of Oxford; Risk of Bias - Cochrane Risk of Bias tool - RoB 2.0, and GRADE-pro (Grading of Recommendations, Assessment, Development, and Evaluations) which rates the features of the evidence as high, moderate, low and very low. The risk of mortality expressed in terms of Hazard ratio has been elicited as a 1.37 times higher rate of mortality in the advanced histopathological stages of the OSCC cases. As the sample size of this review was insignificant, therefore, the authors have incorporated hazard ratios of some other studies of carcinomas in diverse sites in the body to give a flavor of prognostic outcomes of Moesin. It was observed that Moesin expression in Breast cancer and UADT carcinomas have a higher mortality rate as compared to OSCC and lung carcinoma cases and this decree strengthens our conviction that Moesin expression in the cytoplasm of advanced histopathological stages of cancer can be assumed as a sign of poor prognosis in all carcinomas including OSCC patients.

Conclusion

A sample of seven studies is inadequate as definite evidence for claiming that Moesin is a strong biomarker of invasiveness in OSCC cases and more clinical trials need to be conducted on the prognostic efficacy of Moesin expression in the various histopathological grades of OSCC cases.

Evaluation and comparison of intratumoural and intrastromal infiltrating lymphocytes with clinicopathological features in breast carcinoma patients who have received neoadjuvant chemotherapy - A cross-sectional study

Background

The microenvironment of breast cancer plays a significant role in determining the prognosis of the disease. With the shifting paradigm on the predictive factors post-Neoadjuvant Chemotherapy (NAC), it was sought out that Tumour infiltrating lymphocytes (TILs) are of valuable use for the same. Yet, the delineation of the two types - Intrastromal and Intratumoural has seldom been facilitated. This study, therefore, aimed to evaluate, analyse and compare the two - to gauge the importance of the treatment outcome and clinicopathological features.

Materials and methods

180 breast cancer patients were included in this study who underwent NAC, and their post-surgically resected tumour specimens were sectioned and stained using routine Haematoxylin and Eosin techniques. The evaluation of TILs in the stroma and tumour was done based on the standardised guidelines.

Results

Out of the 180 patients, 55 (i.e. 30.56%) displayed pathological complete resolution (pCR). Furthermore, Intratumoural TILs had a slight association with the pCR (p = 0.0335) whereas Intrastromal TILs had a significantly large association with pCR (p < 0.0001) dependent on the lymphocytic response. Backward regression revealed that - the age at operation, pCR, lymph node involvement and menopause highly contributed to predicting 68.2% of the total cases correctly with a sensitivity of 93.0% and specificity of 24.6% for Intratumoral TILs. Age at operation, pCR, lymph node involvement and tumour emboli highly contributed to predicting 71.5% of the total cases correctly with sensitivity of 71.6% and specificity of 71.4% for Intrastromal TILs.

Conclusion

TILs and the prediction of NAC and pCR should be made standardised and reproducible so that they can be universally available to all patients with breast cancer. Through this study, further avenues of research have opened up for their relations with clinicopathological features mainly age at operation and menopausal status.

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IT & IS TILs play a varied role in the prediction of NAC and pCR.

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Post-NAC 55 patients (i.e. 30.56%) out of 180 displayed pCR.

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Age at operation, pCR, lymph node involvement and menopause highly contributed to predict IT TILs.

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Age at operation, pCR, lymph node involvement and tumour emboli highly contributed to predict IS TILs.

•

Analysis of TILs can be a reliable method in the treatment response and immunogenicity of breast tumours.

Expression of Ki67 as potential biomarker in oral submucous fibrosis: An immunohistochemical study

Background

Oral submucous fibrosis (OSMF) is a potentially malignant disorder (PMD) known to transform into oral cancer. One of the important hallmarks of malignant transformation is the uncontrolled growth rate, commonly reflected as increased cell proliferation which can be significantly detected by proliferative markers such as a high Ki-67 index.

Aim

The aim of this study is to evaluate the degree and pattern of expression of Ki67 in OSMF, oral squamous cell carcinoma (OSCC) and in normal mucosal (NOM) patients and to correlate the Ki67 expression with clinical and histological grading of OSMF and OSCC patient.

Materials and Methods

A prospective cross-sectional study was conducted over a duration of two years. An immunohistochemical study was performed for Ki76 expression on 35 cases of OSMF, 10 cases of OSCC and 10 normal mucosal patients.

Statistical Analysis

Data were analysed using SPSS version 21. Chi-squared test was used to analyse the differences between the intensity levels in OSMF, OSCC and NOM.

Results

Expression of Ki67 was significantly higher in OSMF than that of NOM samples but less than that of OSCC samples. Expression of Ki67 increased with increasing grade of clinical and histological stages.

Conclusion

The study demonstrated a high incidence of Ki67 overexpression in OSMF and OSCC and showed a correlation between clinical and histological grading of OSMF and OSCC. Identification of high-risk oral PMDs and intervention at premalignant stages could constitute one of the key steps in reducing the mortality, morbidity and cost of treatment associated with malignant transformation of these diseases.

Expression of Ki67 Biomarker in Oral Submucous Fibrosis with Clinico-Pathological Correlations: A Prospective Study

Objectives:

Oral Submucous Fibrosis (OSMF) is potentially malignant disorder known to transform into oral cancer. The aim of this study is to determine the degree and pattern of expression of aberrant Ki67 in OSMF, oral squamous cell carcinoma (OSCC) and in normal oral mucosa patients (NOM). The objective is to correlate between Ki67 expression and degree of dysplasia in OSMF patents and also Ki67 expression with clinical and histological grading of OSMF and OSCC patient.

Materials and Methods:

A prospective cross-sectional study was conducted with purposive sampling technique from Jan 2017 to April 2020.The study groups consist of 35 OSMF cases, 10 cases of each OSCC and NOM. The samples were immunohistochemically analyzed for expression Ki67 antigen using chi-square test (P < 0.05).

Results:

The expression of Ki67 was significantly higher in OSMF than that of NOM samples, but less than that of OSCC samples. Present study showed correlation between expression of Ki67 with clinical staging and histological grading both in OSMF and OSCC patients.

Conclusion:

The study demonstrated a high incidence of Ki67 over expression in, OSMF and OSCC. Hence, Ki-67 can be widely used as a proliferation marker to measure growth fraction of cells in OSMF and also for determining the severity of epithelial dysplasia.

Membrane-organizing extension spike protein and its role as an emerging biomarker in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most malignant tumor worldwide with a relatively poor prognosis. This can be due to lack of using new specific biomarkers as a mode of pristine interventional therapy for detecting the lesions at an early stage, thereby not allowing it to proceed to a severe advanced stage. Biomarkers, being the products of malignant cells, can prove to be promising prognostic factors in understanding the molecular pathogenesis of oral cancer. One such biomarker is membrane-organizing extension spike protein (MOESIN). Belonging to the family of ezrin/radixin/MOESIN proteins, MOESIN acts as a structural linker between plasma membrane and actin filament of the cell moiety and is involved in regulating many fundamental cellular processes such as cell morphology, adhesion and motility. This narrative review is a systematic compilation on MOESIN and its role as an emerging biomarker in OSCC.

Sinonasal inverted schneiderian papilloma presenting as a large intraoral lesion

Sinonasal inverted schneiderian papilloma (ISP) is a rare tumour, which almost exclusively arises from the mucosa lining, the nasal cavity and the paranasal sinuses. The tumour in its early stages presents as an asymptomatic mass, which may be discovered during routine examination. Large lesions usually measure a few millimetres to centimetres in size and show symptoms such as nasal blockade, recurrent sinusitis, postnasal drip, anosmia, epistaxis, facial pain and headache. Lesion presenting as a large oral mass is extremely rare and may cause diagnostic dilemma, resulting in misdiagnosis. This report describes a rare case of ISP presenting as large intraoral lesion, with wide area of facial skeletal involvement. Diagnosis and management of the pathology has also been highlighted.

Multicentric study on prevalence and risk factors for hypertension and diabetes in tribal communities in Western and Northern Maharashtra

BACKGROUND AND OBJECTIVES

Although a number of studies have been conducted on the prevalence of hypertension (HTN) and diabetes on tribal populations in different parts of India, comparative tribe-specific information is very meager. The main objective of this study is to generate tribe-specific information on the noncommunicable disorders (NCDs) and associated risk factors in scheduled tribes (STs) in Coastal and Western Maharashtra.

METHODS

The study was conducted on 1864 (females 960) adults (≥18 years) of both sexes in four dominant tribes in the region, namely, Bhils (748), Katkaris (560), Kokana (352), and Thakars (204), using the protocols approved by the Institutional Review Board. The study areas were geographically separated by large distances (250-500 km apart). Prevalence of overweight, diabetes, HTN, and hypercholesterolemia was measured using standard field-based techniques described in our earlier publication.

RESULTS

All STs in this study are grossly underweight; the Katkaris are worst affected. The prevalence of obesity (body mass index ≥30 kg/m2), HTN (blood pressure ≥140 mmHg), diabetes (capillary blood glucose >126 mg/dl), and hypercholesterolemia (cholesterol ≥200 mg/dl) was 0.9%, 11.7%, 6.7%, and 0.6% respectively. There are no statistically significant inter-tribal differences in the prevalence of these parameters. Age and obesity appeared to be the most dominant risk factors for HTN. However, there is no clear-cut picture about the influence of risk factors on diabetes or hypercholesterolemia.

INTERPRETATION AND CONCLUSION

The prevalence of NCDs is still very low in STs, probably due to near absence of the risk factors such as obesity, sedentary lifestyle, and hyperlipidemia. STs are highly endogamous, and the study areas are separated by large distances ruling out intermingling of tribes. Yet, there is no consistent inter-tribal prevalence pattern for NCDs. Although the sample size is small, the results support the view that environmental factors are likely to be more important than host genetics in the causation of NCDs.

Prevalence and risk factors of hypertension and diabetes in the Katkari tribe of coastal Maharashtra

Background and Objectives:

Urban and rural India are both going through health epidemiological transition and will soon face huge burden of noncommunicable diseases (NCDs). Information on the status of NCDs in tribals is limited. Although the prevalence of hypertension in scheduled tribes (STs) has been studied in several states by the National Nutrition Monitoring Bureau, tribe-specific data are very scanty. The objective of this study was to generate data on the status of hypertension and diabetes, the two objectively measurable NCDs in Katkaris, the dominant ST in the Raigad district of coastal Maharashtra.

Methods:

The study was conducted in 410 adult Katkaris (women 219) of both sexes of ≥18 years of age in three adjoining tehsils of the district. Using the Institution Review Board approved protocol; information was obtained on sociodemographic parameters, educational level, dietary pattern, and substance abuse. Prevalence of overweight, hypertension, and diabetes was measured using standard field-based procedures and techniques.

Results:

Katkaris, who are mostly landless manual laborers, subsist on a protein-poor, imbalanced diet. About half of women and one-third of men have body mass index (BMI) <18.5 kg/m², an indication of undernutrition. On the other hand, about 2% of participants were obese (BMI ≥30 kg/m²). The overall prevalence of hypertension and diabetes was 16.8% and 7.3%, respectively. Hypercholesterolemia was recorded in about 3% of the participants.

Interpretation and Conclusions:

Prevalence of diabetes and hypertension in Katkaris is still lower than that of urban and rural populations, closer to the latter. This may be due to the absence of known risk factors such as obesity, sedentary lifestyle, and hyperlipidemia in this community. Fast acculturation of the STs suggests that NCDs will soon become a major health issue in them too. It is time to launch a multicentric national study to gather baseline information on the status of NCDs in STs.

Recurrent dermatofibrosarcoma protuberans over anterior abdominal wall

A 45-year-old female complained of a painless swelling, which had developed in the epigastric region, and was slowly growing in size over the last one year. The patient had undergone excision of a similar swelling at the same site seven years ago and was now facing recurrence. Histopathology and immunohistochemical (IHC) examination confirmed the diagnosis of Dermatofibrosarcoma Protuberans.

Mixed malignant tumor of the submandibular gland

A 70-year-old woman presented with chief complaints of swelling in the right side of her neck for 20 years, mainly in the submandibular region, with an increase in size 2 months prior, discharge of foul-smelling pus, ulceration of the overlying skin, and pain in the swelling for 15 days. Immunohistochemical studies reported the tumor to be a mixed malignant tumor arising from the submandibular gland. Wide excision of the tumor with deltopectoral flap was done.

Extra genital heterologous malignant mixed mullerian tumor of primary peritoneal origin

The case of an extragenital heterologous malignant mixed müllerian tumor (MMMT) of primary peritoneal origin occurring in a 76-year-old female is presented. A large tumor was seen between the uterus and rectosigmoid occupying the entire pelvis. The uterus, fallopian tubes and ovaries were uninvolved. The tumor was composed of carcinomatous areas showing endometrioid and serous papillary differentiation and sarcomatous areas showing cartilaginous differentiation. The extragenital primary MMMTs of the female peritoneum are thought to originate from the secondary müllerian system. This case is presented for its rarity. To the best our knowledge, this is the first case of extragenital MMMT of primary peritoneal origin in Indian literature.

Duodenal stenosis secondary to tuberculosis

An 18-year-old man presented with complaints of epigastric pain, vomiting after meals, loss of appetite and weight, evening rise of temperature, and irregular bowel movements. Barium meal follow-through revealed a dilated stomach and first and second parts of the duodenum and stenotic lesion in the second part of the duodenum. Endoscopic biopsy of the stenotic lesion revealed acute on chronic nonspecific duodenitis with fibrosis. Isoperistaltic antecolic gastrojejunostomy was done to bypass the obstruction, and enlarged lymph nodes were biopsied. The biopsy of the enlarged lymph nodes revealed changes consistent with tuberculosis; therefore, the patient was started on antituberculous drugs in the postoperative period.