Nevin Manimala

Med Gas Res. 2022 Oct-Dec;12(4):146-152. doi: 10.4103/2045-9912.337996.

ABSTRACT

Dexmedetomidine is an α₂ agonist and remifentanil is a short-acting μ opioid agonist. We aimed to compare the dexmedetomidine and remifentanil infusions used for conscious sedation in geriatric patients undergoing outpatient cataract surgery in terms of sedation quality, side effects, and surgeon satisfaction. Eighty patients were allocated into two groups as per the administration of dexmedetomidine (dexmedetomidine group) and remifentanil (remifentanil group) infusion in this randomized, prospective, double-blinded study. In dexmedetomidine group (n = 40), after a loading of 1 μg/kg dexmedetomidine in 10 minutes, 0.4 μg/kg/h infusion was administered. In the remifentanil group (n = 40), remifentanil at a dose of 0.05 μg/kg was administered for 10 minutes, and then 0.05 μg/kg/min infusion was continued. Observer Assessment Warning/Sedation Scale values evaluating sedation quality were lower in the dexmedetomidine group than in the remifentanil group, although it was not statistically significant (P > 0.05). Bispectral Index values evaluating sedation quality were lower in the dexmedetomidine group according to the remifentanil group (P < 0.05). The dexmedetomidine group had lower Verbal Rating Scale and Visual Analogue Scale scores evaluating pain intensity compared with the remifentanil group (P < 0.05). The nausea Visual Analogue Scale values evaluating the severity of postoperative nausea in the dexmedetomidine group were lower than those in the remifentanil group (P < 0.05). The surgeon satisfaction was found to be greater in the dexmedetomidine group compared with the remifentanil group (P = 0.015). In geriatric patients, the targeted sedation and analgesia levels were achieved more easily with dexmedetomidine infusion, without hemodynamic and respiratory side effects, compared to remifentanil infusion.

PMID:35435426 | DOI:10.4103/2045-9912.337996

Indian J Pathol Microbiol. 2022 Apr-Jun;65(2):362-368. doi: 10.4103/IJPM.IJPM_1004_20.

ABSTRACT

INTRODUCTION/CONTEXT: Hypertensive disorders of pregnancy (HDP) are major complications of pregnancy and seen in about 5% to 10% of all pregnancies. Among these, pre-eclampsia is a leading cause of perinatal and fetal morbidity and mortality. It is a multifactorial and multisystemic disorder that results in a variety of histomorphologic features, some of which may be missed if a diligent examination is not performed.

AIMS AND OBJECTIVES: The present study aimed to propose a checklist and novel scoring system to ensure comprehensive placental examination. We also aimed to evaluate the correlation, if any, between histopathological and morphometric findings in HDP and with fetal growth.

MATERIALS AND METHODS: A total of 100 placentas of women diagnosed with hypertensive disorders of pregnancy were included in our cross-sectional, observational study. Morphometric features and histological features that are known to be seen in HDP were analyzed, and each of them was given a numerical score based on their severity.

STATISTICAL ANALYSIS USED: Pearson correlation coefficient test was applied to correlate these findings, and ANOVA test was used to assess the correlation of these findings with fetal growth restriction (FGR).

RESULTS: More than 50% of the placentas studied recorded maximum scores for weight and volume. At least 25% of the placentas showed the presence of all histo-pathological features under study. The association of total morphometric and histological scores was not found to be statistically significant (P-value = 0.239). We found a significant difference between means of morphometric scores of cases with normal fetal growth and cases showing FGR (P-value = 0.008).

CONCLUSION: Uneven distribution and presentation of the lesions in these cases may lead to the absence of correlation between morphometry and histopathology, as seen in our study. Morphometric derangements in the placenta correlate with FGR. Our proposed checklist and scoring system can be utilized to standardize reporting of placental specimens in the evaluation of placentas with HDP, in order to facilitate and standardize the placental reporting.

PMID:35435372 | DOI:10.4103/IJPM.IJPM_1004_20

Indian J Pathol Microbiol. 2022 Apr-Jun;65(2):328-335. doi: 10.4103/IJPM.IJPM_871_20.

ABSTRACT

BACKGROUND: NOTCH1 pathway activation has been recently described to be a key player in gastric carcinogenesis, enhance the survival and proliferation of cancer stem cells (CSCs) and mediate chemoresistance in several malignancies.

AIM: This study investigated the correlation between NOTCH1 and CSC marker OCT4 (octamer binding transcription factor-4) expression and the clinicopathological properties, survival and treatment outcome in patients with gastric carcinoma (GC) receiving adjuvant chemotherapy. Materials and.

METHODS: NOTCH1 and OCT4 were immunohistochemically detected in 50 post-operated specimens of GC. Patients’ data regarding disease-free survival (DFS), overall survival (OS), and the response to the chemotherapy was statistically analyzed.

RESULTS: NOTCH1 and OCT4 overexpression was detected in 60% and 52% of GC tissues, respectively, and that was significantly higher than the rates in adjacent non-neoplastic gastric mucosa (P < 0.05). A significant correlation was detected between overexpression of NOTCH1 and OCT4 in GC and aggressive clinicopathological features; poor differentiation (P = 0.021, P = 0.037, respectively), depth of tumor invasion (P < 0.001 for both), TNM stage (P < 0.001 for both), lymph node metastasis (P = 0.002, P = 0.003, respectively) and distant metastasis (P < 0.001 for both). NOTCH1 was positively correlated with OCT4 (P = 0.002). Survival analysis disclosed that upregulation of NOTCH1 and OCT4 was associated with worse DFS (P = 0.013, P < 0.001, respectively) and OS (P < 0.001 for both). Overexpression of NOTCH1 and OCT4 correlated with poor response to chemotherapy (P = 0.013, P = 0.005, respectively) and worse clinical outcome.

CONCLUSION: Combined detection of these proteins might disclose even better predictive value for shorter survival and resistance to chemotherapy.

PMID:35435367 | DOI:10.4103/IJPM.IJPM_871_20

Indian J Pathol Microbiol. 2022 Apr-Jun;65(2):321-327. doi: 10.4103/IJPM.IJPM_535_20.

ABSTRACT

CONTEXT: HER2-targeted therapy has been shown to benefit HER2-positive gastric cancer. It is very important to determine the HER2 expression level correctly to select the appropriate test and sampling method.

AIM: In this study, we investigated the frequency of overexpression of HER2 and intratumoral heterogeneity of HER2-positive cases, comparison of HER2 used immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) performance in biopsy and resection specimens, the correlation of HER2 status between biopsy and resection specimens, and its relationship with clinicopathological findings.

MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded specimens of a total of 40 surgically resected and biopsy specimens of gastric cancer were analyzed. HER2 status was examined using both IHC and FISH techniques, and the findings and their association with different clinicopathological parameters were evaluated.

RESULTS: The concordance rate between the results of IHC and FISH in biopsy and resection specimens was 96.6% and 86.6%, respectively. In paired 20 cases, the overall concordance rate of HER2-IHC and HER2-FISH status between biopsy and resection specimens was 90% and 100%, respectively. HER2-IHC analysis revealed that 5/40 cases were IHC 2+ and only 1 of 5 IHC 2+ cases demonstrated HER2-FISH amplification.

CONCLUSION: Our results showed that HER2-IHC was well concordant with FISH in cases with a score of 0/1+ or 3+ and demonstrates strong concordance between biopsy and resection specimens. FISH should be performed when the IHC result is equivocal. In our study, no statistically significant correlation was observed between HER2 positivity and clinicopathological parameters. Overall, both biopsy and resection specimens are appropriate for HER2 testing.

PMID:35435366 | DOI:10.4103/IJPM.IJPM_535_20

Indian J Pathol Microbiol. 2022 Apr-Jun;65(2):316-320. doi: 10.4103/IJPM.IJPM_1335_20.

ABSTRACT

INTRODUCTION: Helicobacter pylori infection is a chronic bacterial infection associated with some extragastric diseases as well as gastric involvements that occur most commonly worldwide. In our study, we aimed to investigate the usability of immature granulocytes as a basic indicator that can reflect the severity of helicobacter pylori inflammation, to the best of our knowledge, for the first time.

MATERIALS AND METHODS: Patients who underwent upper gastrointestinal endoscopy between April 2019 and April 2020 and were diagnosed with antral gastritis were included in this study. The relationship between helicobacter infection and its severity detected in gastric biopsies of patients and immature granulocyte count (IGC), immature granulocyte percentage (IG%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) were investigated.

RESULTS: Of the 868 patients, 210 were HP negative, 658 were HP positive (218 mild HP positive, 293 moderate HP positive, and 147 severe HP positive). There were statistically significant differences between the HP negative and HP positive groups in terms of IGC, IG%, NLR, and PLR. However, IG% and IGC were not clinically useful because the median IG% (0.3 vs 0.3) and IGC (0.02 vs 0.02) were the same in the HP negative and total HP positive groups.

CONCLUSION: In our study, IGC and IG% were not found useful to detect H. pylori intensity and severity of inflammation.

PMID:35435365 | DOI:10.4103/IJPM.IJPM_1335_20

Indian J Pathol Microbiol. 2022 Apr-Jun;65(2):311-315. doi: 10.4103/IJPM.IJPM_1229_20.

ABSTRACT

BACKGROUND: Invasive solid papillary carcinomas (ISPC) are rare malignant neoplasms in the classification of WHO 2019 breast tumors.

AIMS: We aimed to investigate the correlations between programmed cell death ligand-1 (PD-L1) expression status of tumor and immune cells and clinicopathological parameters by molecular classification of this rare morphological subtype. This study will contribute to the literature about the PD-L1 expression state of ISPCs for the first time.

MATERIAL AND METHODS: The study included 19 invasive solid papillary carcinoma cases diagnosed between 2009 and 2019 in Pathology Department. Molecular subtyping was performed in 19 cases by immunohistochemical studies (ER/PR, Her-2/neu, Ki-67), and PD-L1 expression was evaluated in neoplastic and immune cells.

RESULTS: PD-L1 expression was detected in 4 (21%) cases, 3 (75%) of them were in luminal B and 1 (25%) were in the luminal A group. The correlation between molecular subtypes and PD-L1 expression was statistically significant (P = 0.016). Patients with PD-L1 expression had a higher Ki-67 index than patients without PD-L1 expression (P = 0.037). In addition, there was a statistically significant correlation between PD-L1 expressions of intratumoral lymphocytes and PD-L1 expressions of neoplastic cells (P = 0.004).

CONCLUSIONS: While predicting the group that will benefit more from immunotherapy in solid papillary carcinoma cases, not only PD-L1 expression of tumor cells but also PD-L1 expression in tumor infiltrating lymphocyte (TIL) can help. In addition, PD-L1 staining rates of tumor cells as well as clinicopathological parameters (molecular subtype, high Ki-67 index, presence of TIL) can be predictive about immunotherapy.

PMID:35435364 | DOI:10.4103/IJPM.IJPM_1229_20

Indian J Pathol Microbiol. 2022 Apr-Jun;65(2):305-310. doi: 10.4103/IJPM.IJPM_1129_20.

ABSTRACT

BACKGROUND/AIMS: As targeted therapies are promising in the treatment of lung cancer (LC), it is important to identify the genetic variations in tumors. The present research aimed to determine the regional prevalence of alterations in ALK, ROS1, and EGFR genes. Materials and.

METHODS: ALK rearrangement in 1152, ROS1 rearrangement in 390, and EGFR mutations in 1054 cases with LC were evaluated.

RESULTS: Alteration rates of ALK, ROS1, and epidermal growth factor receptor (EGFR) genes were 3.5%, 0.4%, and 11.2% in the samples, respectively. ALK rearrangements were mainly detected in young patients (P < 0.01) and in females (P < 0.01). Females were also more often inflicted by EGFR variations, especially from the exon 19 deletion. Exon 21 L858R mutations were more frequently found in men. However, any statistical significance between EGFR alterations and gender or age was not discovered.

CONCLUSION: In this study, molecular changes were less frequent than expected. We thought that this low rate confirmed the aphorism of “smokes like a Turk, ” which could be because almost all patients were active or passive smokers.

PMID:35435363 | DOI:10.4103/IJPM.IJPM_1129_20

Biosci Trends. 2022 Apr 17. doi: 10.5582/bst.2022.01019. Online ahead of print.

ABSTRACT

Hepatocellular carcinoma (HCC) has been the fifth most common malignancy worldwide and is the second most common cause of tumor-related mortality globally. In China, a high proportion of patients with HCC present with an advanced stage of the disease, so HCC is a major challenge to the healthcare system and a substantial socioeconomic burden. The last decade has witnessed an expansion of the treatment landscape for HCC. Various approaches have been explored as potential conversion therapies for advanced HCC. Despite controversies, mounting data have indicated that successful conversion therapy followed by subsequent surgery is achievable in a population of patients with advanced HCC. This conversion therapy is a safe and promising treatment strategy to prolong long-term outcomes. Based on preliminary research, this review has assembled and summarized current clinical experience with and evidence of the efficacy of conversion therapies followed by subsequent surgery for advanced HCC.

PMID:35431288 | DOI:10.5582/bst.2022.01019

J Neuromuscul Dis. 2022 Apr 12. doi: 10.3233/JND-220789. Online ahead of print.

ABSTRACT

BACKGROUND: Prompt treatment after genetic NBS for SMA substantially improves outcome in infantile SMA. However, deficiency of SMN-protein can cause damage of motor neurons even prior to birth.

OBJECTIVE: To describe the neurological status at the time of NBS and the reversibility of neurological deficits in a cohort of patients with only two copies of the SMN2 gene.

METHODS: We present motor, respiratory, and bulbar outcomes of 21 SMA patients identified in newborn screening projects in Germany. Inclusion criteria was initiation of SMN targeted medication at less than 6 weeks of age and a minimum age of 9 months at last examination.

RESULTS: Twelve patients (57%) developed completely normally, reaching motor milestones in time and having no bulbar or respiratory problems. Three children (14.5%) caught up after initial delay in motor development. Six patients (29%) developed proximal weakness despite early treatment: Three of them (14.5%) achieved the ability to walk with assistance and the other three (14.5%) showed an SMA type 2 phenotype at the age of 16-30 months. One patient (4.8%) had respiratory problems. Three children (14.5%) had mild chewing problems and two individuals (9.5%) needed feeding via gastrotube. Initial CHOP-INTEND values below 30 could be indicative of a less favourable outcome, whereas values above 50 could indicate a good outcome, however in-depth statistic due to the small case number is not predictive.

CONCLUSION: More than 70% of SMA patients with two SMN2 copies can achieve independent ambulation with immediate initiation of therapy. However, caregivers and paediatricians must be informed about the possibility of less favourable outcomes when discussing therapeutic strategies.

PMID:35431259 | DOI:10.3233/JND-220789

J Alzheimers Dis. 2022 Apr 11. doi: 10.3233/JAD-220073. Online ahead of print.

ABSTRACT

BACKGROUND: Epidemiologic evidence suggests that physical activity benefits cognition, but results from randomized trials in sedentary individuals are limited and inconsistent.

OBJECTIVE: To evaluate the effects of physical activity on cognition among sedentary older adults.

OBJECTIVE: A systematic literature search for eligible studies published up to January 1, 2021, was performed on six international (PubMed, Cochrane Library, Web of Science, Sinomed, FMRS, and OVID) and three Chinese databases (Wanfang, China National Knowledge Infrastructure, and VIP). We estimated the effect of physical activity on the cognition of sedentary elderly by standardized mean differences (SMD) and 95% confidence intervals (CI) using a random-effects model. We evaluated publication bias using funnel plots and heterogeneity using I2 statistics. Subgroup analyses were conducted by baseline cognition, intervention duration, activity type, and country.

RESULTS: Seven randomized controlled trials (RCTs) comprising 321 (experimental group, 164; control group, 157) sedentary older adults were included in the meta-analysis. Physical activity significantly improved cognition in sedentary elderly adults compared with controls (SMD: 0.50, 95% CI:0.09-0.92). Subgroup analyses showed significant effects of baseline cognition impairment (SMD: 9.80, 95% CI: 5.81-13.80), intervention duration > 12 weeks (SMD: 2.85, 95% CI: 0.73-4.96), aerobic exercise (SMD: 0.74, CI: 0.19-1.29), and countries other than the United States (SMD: 10.50, 95% CI: 7.08-13.92).

CONCLUSION: Physical activity might have a general positive effect on the cognition of sedentary older adults. Intervention > 12 weeks and aerobic exercise can effectively delay their cognitive decline; however, more rigorous RCTs are needed to support our findings.

PMID:35431253 | DOI:10.3233/JAD-220073