β-Delayed One and Two Neutron Emission Probabilities Southeast of ^{132}Sn and the Odd-Even Systematics in r-Process Nuclide Abundances

The β-delayed one- and two-neutron emission probabilities (P_{1n} and P_{2n}) of 20 neutron-rich nuclei with N≥82 have been measured at the RIBF facility of the RIKEN Nishina Center. P_{1n} of ^{130,131}Ag, ^{133,134}Cd, ^{135,136}In, and ^{138,139}Sn were determined for the first time, and stringent upper limits were placed on P_{2n} for nearly all cases. β-delayed two-neutron emission (β2n) was unambiguously identified in ^{133}Cd and ^{135,136}In, and their P_{2n} were measured. Weak β2n was also detected from ^{137,138}Sn. Our results highlight the effect of the N=82 and Z=50 shell closures on β-delayed neutron emission probability and provide stringent benchmarks for newly developed macroscopic-microscopic and self-consistent global models with the inclusion of a statistical treatment of neutron and γ emission. The impact of our measurements on r-process nucleosynthesis was studied in a neutron star merger scenario. Our P_{1n} and P_{2n} have a direct impact on the odd-even staggering of the final abundance, improving the agreement between calculated and observed Solar System abundances. The odd isotope fraction of Ba in r-process-enhanced (r-II) stars is also better reproduced using our new data.

The Role of Gut Microbiota and Metabolites in Obesity-Associated Chronic Gastrointestinal Disorders

The gut microbiota is a complex community of microorganisms that has become a new focus of attention due to its association with numerous human diseases. Research over the last few decades has shown that the gut microbiota plays a considerable role in regulating intestinal homeostasis, and disruption to the microbial community has been linked to chronic disease conditions such as inflammatory bowel disease (IBD), colorectal cancer (CRC), and obesity. Obesity has become a global pandemic, and its prevalence is increasing worldwide mostly in Western countries due to a sedentary lifestyle and consumption of high-fat/high-sugar diets. Obesity-mediated gut microbiota alterations have been associated with the development of IBD and IBD-induced CRC. This review highlights how obesity-associated dysbiosis can lead to the pathogenesis of IBD and CRC with a special focus on mechanisms of altered absorption of short-chain fatty acids (SCFAs)

Molecular Mechanism of Stimulation of Na-K-ATPase by Leukotriene D4 in Intestinal Epithelial Cells

Na-K-ATPase provides a favorable transcellular Na gradient required for the functioning of Na-dependent nutrient transporters in intestinal epithelial cells. The primary metabolite for enterocytes is glutamine, which is absorbed via Na-glutamine co-transporter (SN2; SLC38A5) in intestinal crypt cells. SN2 activity is stimulated during chronic intestinal inflammation, at least in part, secondarily to the stimulation of Na-K-ATPase activity. Leukotriene D4 (LTD4) is known to be elevated in the mucosa during chronic enteritis, but the way in which it may regulate Na-K-ATPase is not known. In an in vitro model of rat intestinal epithelial cells (IEC-18), Na-K-ATPase activity was significantly stimulated by LTD4. As LTD4 mediates its action via Ca-dependent protein kinase C (PKC), Ca levels were measured and were found to be increased. Phorbol 12-myristate 13-acetate (PMA), an activator of PKC, also mediated stimulation of Na-K-ATPase like LTD4, while BAPTA-AM (Ca chelator) and calphostin-C (Cal-C; PKC inhibitor) prevented the stimulation of Na-K-ATPase activity. LTD4 caused a significant increase in mRNA and plasma membrane protein expression of Na-K-ATPase α1 and β1 subunits, which was prevented by calphostin-C. These data demonstrate that LTD4 stimulates Na-K-ATPase in intestinal crypt cells secondarily to the transcriptional increase of Na-K-ATPase α1 and β1 subunits, mediated via the Ca-activated PKC pathway.

Mechanism of Na-K-ATPase Inhibition by PGE2 in Intestinal Epithelial Cells

The primary means of intestinal absorption of nutrients by villus cells is via Na-dependent nutrient co-transporters located in the brush border membrane (BBM). These secondary active co-transport processes require a favorable transcellular Na gradient that is provided by Na-K-ATPase. In chronic enteritis, malabsorption of essential nutrients is partially due to inhibition of villus Na-K-ATPase activity mediated by specific immune inflammatory mediators that are known to be elevated in the inflamed mucosa. However, how Prostaglandin E2 (PGE2), a specific mediator of nutrient malabsorption in the villus BBM, may mediate the inhibition of Na-K-ATPase is not known. Therefore, this study aimed to determine the effect of PGE2 on Na-K-ATPase in villus cells and define its mechanism of action. In vitro, in IEC-18 cells, PGE2 treatment significantly reduced Na-K-ATPase activity, accompanied by a significant increase in the intracellular levels of cyclic Adenosine Monophosphate (cAMP). The treatment with cAMP analog 8-Bromo-cAMP mimicked the PGE2-mediated effect on Na-K-ATPase activity, while Rp-cAMP (PKA inhibitor) pretreatment reversed the same. The mechanism of inhibition of PGE2 was secondary to a transcriptional reduction in the Na-K-ATPase α1 and β1 subunit genes, which was reversed by the Rp-cAMP pretreatment. Thus, the PGE2-mediated activation of the PKA pathway mediates the transcriptional inhibition of Na-K-ATPase activity in vitro.

Inverted Papilloma: Our Experience of Endoscopic Medial Maxillectomy and its Outcome in a Tertiary Care Center, Nepal

Background: Inverted Papilloma arises from the lateral wall of nose and is common in maxillary sinus. It is locally invasive, can recur and has malignant potential. Endoscopic medial maxillectomy is the preferred choice. Materials and Methods: This prospective study was conducted in the department of Otolaryngology, Nobel Medical College and Teaching Hospital, Biratnagar from June 2015 to June 2018. A total of 26 patients were included in the study, after informed consent and ethical clearance. Staging was done by Krouse method after imaging studies and preoperative endoscopic biopsy was performed. These patients then underwent endoscopic medial maxillectomy. All the data were collected in excel spreadsheet and analyzed in SPSS software. Results: Out of a total of 26 patients, male: female ratio was 1.6:1, with 16 male and 10female. Average age was 40.5 years (25-72years). According to Krouse staging, 2 patients were in Stage I, 7 patients in Stage II and 17 patients in Stage III. IP mostly involved the lateral wall of nose.  Unilateral nasal obstruction was the commonest presenting symptom. The commonest post-operative complication was nasal crusting. Most of the patients were treated with simple endoscopic medial maxillectomy. Conclusion: Inverted Papilloma is common in male in their 4th decade of life with lateral wall of the nose being mostly affected. Most patients were in stage III of Krouse’s staging system. Simple endoscopic medial maxillectomy was the commonest procedure.

Analysis of Gynecological malignancy in surgical specimens during Covid-19 pandemic

Aims: To determine the pattern of female genital tract malignancies in a teaching hospital in eastern Nepal. Methods: This is a retrospective cross sectional study performed in the Department of Pathology at Nobel Medical College, Biratnagar, Nepal. This study was conducted over a period of 4 months during Covid-19 pandemic from June 2020 to September 2020. The records of the pathology department were analyzed. Results: A total of 600 specimens were received in the Pathology Department out of which 224 (37.3%) were gynecology samples. Total number of gynecology malignancy was 14 (2.3%). The most common was cervical carcinoma (57%) followed by ovarian malignancy. More than 70% fell in 40-60 years age group. Conclusions: In conclusion, in this cross sectional study we found more cervical cancer than other gynaecological malignancies which was followed by cancers of ovary. Most of the patients were in the 41-50 years age group. Tumor imprint cytology could be an option in place of frozen section in resource constraint setting. Effective screening test for cervical cancer would help prevent invasive cervical cancer and its morbidity. Keywords: gynecological malignancy, high grade neoplasia, squamous cell carcinoma

Screening for Thalassemia in Healthy Population at a Tertiary Care Hospital in Eastern Nepal

Background: Thalassemia is a type of congenital anemia, where there is deficient synthesis of one or more type of globin subunits of normal hemoglobin. This study was undertaken with aims & objective to study the prevalence of thalassemia by comparing Red Blood Cell indices, Peripheral Blood Smear and Electrophoresis in adult volunteers. Material and Methods: The study comprised of 518 cases attending hematological department, who were enrolled in our study after proper informed consent, of which 462 cases were further studied. All cases were subjected to blood sampling for estimation of Hemoglobin, red cell indices and peripheral blood smear. Those samples where peripheral blood smear and Red cell indices were suggestive of thalassemia were subjected to Bio-Rad High Performance Liquid Chromatography based electrophoresis to observe the presence of any abnormal hemoglobin. Results: The mean age of screening sample was 42.91 ± 16.85 years with minimum age of 18 years and maximum age of 85 years. The highest number of cases was in between 21-30 years age groups (19.5%) followed by 41-50 years (17.7%). In the study group, 299 (64.7%) cases were male and 163 (35.3%) cases were female. The prevalence of anemia was found to be 48.16% in males and 68.71% in females with overall prevalence of 55.41%. On electrophoresis reports, 19 cases were diagnosed with thalassemia. The only thalassemia observed was thalassemia minor. The prevalence of thalassemia was found to be 4.11%. Conclusion: Significantly high prevalence of thalassemia minor is found in healthy population.

Primary Salivary Gland Tumors- A two years study at Nobel Medical College

Introduction: Salivary gland tumors are a heterogeneous group of neoplasms that are relatively rare but represent a wide variety of both benign and malignant histopathologic subtypes. The aim of this study was to find out the histopathological distribution of primary salivary gland tumors and correlate fine needle aspiration cytology reports with histological findings.Materials and Methods: A total of 83 patients attending the otorhinolaryngology department with salivary gland tumors were enrolled in our study. The histopathological findings were reported and correlated with cytological findings.Results: The mean age of the patient with salivary tumors was 43.11 ± 13.02 years. Out of 83 cases, 3 (3.6%) patients were diagnosed as inflammatory lesions, 64 (77.1%) patients had benign salivary gland tumors and 16 (19.3%) of patients had malignant salivary glands tumors in histopathology. The sensitivity and specificity of FNAC in this series for detecting salivary gland malignancy were 68.8% and 98.5% respectively with an overall diagnostic accuracy of 92.8%. The most common salivary gland tumor was found to be pleomorphic adenoma (56.6%) and the most common malignant salivary gland tumor was found to be mucoepidermoid carcinoma (19.3%). The comparison of the incidence of salivary gland tumors in various age groups showed a statisticallysignificant difference (p=0.009).  Conclusions: Benign salivary tumors are more common than malignant tumors with the most common occurrence in parotid glands. Pleomorphic adenoma is the most common benign tumor whereas; mucoepidermoid carcinoma is the most common malignant tumor in patients visiting Nobel medical college.

Diagnostic utility of imprint cytology of endoscopic gastric biopsy: A cyto-histo correlation study

Background: Upper gastrointestinal endoscopy is a common procedure done for suspected cases of gastric malignancies. Histopathological examination of gastric tissue has been a gold standard for the diagnosis. Imprint smears of the gastric biopsy specimen is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of gastric biopsy imprint cytology as compared to the histopathology. Materials and Methods: Imprint smears were made from all cases of gastric biopsy specimens taken from suspected cases of gastric malignancies. They were evaluated by three pathologists and categorized in to negative for malignancy, suspicious of malignancy and positive for malignancy. The diagnosis given by imprint smears was compared with histopathology. With the help of sensitivity, specificity & accuracy and Kappa score, the agreement between the imprint smear and histopathology was determined. Results: Among the total 79 cases, 49 cases were chronic non specific gastritis and 22 were adenocarcinoma. The sensitivity, specificity, and overall accuracy of gastric biopsy imprint smear were 92.0%, 98.11% and 94.93% respectively. Kappa core was 0.88. Conclusions: The gastric biopsy imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of gastric malignancies.

Role of Pap smear in the screening of cervical cancer: A hospital based study

Background: Incidence of cervical cancer has decreased in the developed world due to use of Pap smear as a screening tool. It has been proven as a sensitive screening tool for cervical cancer but its coverage is very low in Nepal. The objective of this study is to find out the incidence of cervical epithelial cell abnormality, its demographic distribution and common presenting symptoms. Materials and Methods: This retrospective comparative study was conducted in Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. A total of 950 patients attending gynecological department with various symptoms were enrolled. Only 902 patients were included in the study after excluding inadequate samples. Results: The mean age of patient was 37.94 ± 12.74 years with minimum age of 18 and maximum age of 79 years. The mean age of patients with epithelial abnormality was 47.88 ± 8.87 years. The highest number of Atypical squamous cells of undetermined significance was observed between 51-60 years (1.1%) whereas Low and High grade squamous intraepithelial lesion were mostly observed between 41-50 years (3.2% and 0.4% respectively). The most common symptom was vaginal discharge (41.6%) followed by pain abdomen (23.1%). Conclusions: Pap smear is a cost effective, sensitive and simple screening test for cervical premalignant and malignant lesions.

Inhibition of intestinal villus cell Na/K-ATPase mediates altered glucose and NaCl absorption in obesity-associated diabetes and hypertension

During obesity, diabetes and hypertension inevitably coexist and cause innumerable health disparities. In the obesity, diabetes, and hypertension triad (ODHT), deregulation of glucose and NaCl homeostasis, respectively, causes diabetes and hypertension. In the mammalian intestine, glucose is primarily absorbed by Na-glucose cotransport 1 (SGLT1) and coupled NaCl by the dual operation of Na-H exchange 3 (NHE3) and Cl-HCO3 [down-regulated in adenoma (DRA) or putative anion transporter 1 (PAT1)] exchange in the brush border membrane (BBM) of villus cells. The basolateral membrane (BLM) Na/K-ATPase provides the favorable transcellular Na gradient for BBM SGLT1 and NHE3. How these multiple, distinct transport processes may be affected in ODHT is unclear. Here, we show the novel and broad regulation by Na/K-ATPase of glucose and NaCl absorption in ODHT in multiple species (mice, rats, and humans). In vivo, during obesity inhibition of villus-cell BLM, Na/K-ATPase led to compensatory stimulation of BBM SGLT1 and DRA or PAT1, whereas NHE3 was unaffected. Supporting this new cellular adaptive mechanism, direct silencing of BLM Na/K-ATPase in intestinal epithelial cells resulted in selective stimulation of BBM SGLT1 and DRA or PAT1 but not NHE3. These changes will lead to an increase in glucose absorption, maintenance of traditional coupled NaCl absorption, and a de novo increase in NaCl absorption from the novel coupling of stimulated SGLT1 with DRA or PAT1. Thus, these novel observations provide the pathophysiologic basis for the deregulation of glucose and NaCl homeostasis of diabetes and hypertension, respectively, during obesity. These observations may lead to more efficacious treatment for obesity-associated diabetes and hypertension.-Palaniappan, B., Arthur, S., Sundaram, V. L., Butts, M., Sundaram, S., Mani, K., Singh, S., Nepal, N., Sundaram, U. Inhibition of intestinal villus cell Na/K-ATPase mediates altered glucose and NaCl absorption in obesity-associated diabetes and hypertension.

Diagnostic Role of Lymphnode Imprint: A Cyto-histopathological Correlation

Introduction: Lymphadenopathy is a very common condition for which excision biopsy is often recommended when fine needle aspiration cytology is not conclusive. Lymph node imprint cytology is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of lymph node imprint cytology as compared to the histopathology.Materials and Methods: Imprint smears were made from all cases of lymphadenopathy. The smears were evaluated by three pathologists and categorized into, inflammatory lesions and primary and metastatic tumors. Imprint smears were made from lymph node excision specimens and were stained with PAP and MGG stains. The diagnosis in imprints was compared with those given by histopathology. With the help of sensitivity, specificity & accuracy, the agreement between the imprint smear and histopathology was determined.Results: Among the total 92 cases, 40 (43.4%) cases were chronic non-specific lymphadenitis, 22 (23.9%) were tuberculosis and metastatic lesions each. The overall accuracy of lymph node imprint cytology was 96.73%, 96.74%, 96.74% and 100% for tuberculosis, chronic non-specific lymphadenitis, lymphoma, and metastatic lesions respectively.Conclusions: Lymph node imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of various lymph node disorders.

Tubercular Lymphadenitis Mimicking Findings of Metastatic Signet Cell Carcinoma in FNAC: A Case Report

Tubercular lymphadenitis is one of the most common extrapulmonary tubercular lesions presented in the Outpatient Department which is commonly diagnosed by Fine needle aspiration cytology. Cytological diagnosis of tuberculosis requires the presence of epithelioid cell granulomas demonstration with or without Langhan’s giant cells and necrosis. Sometimes, there can a proliferation of signet like cells without granulomas, which in a cervical lymph node can be given a false interpretation of metastatic signet cell carcinoma. A 35 year female patient with a complaint of cervical lymphadenopathy came to the medical OPD. FNAC was done which showed numerous scattered signet ring cells. However, epithelioid cell granulomas weren’t observed in the smears. Zeihl Neelsen stain for Acid fast bacilli was done but the organism wasn’t appreciated.  A biopsy was done and a histopathological slide showed epithelioid cell granulomas and Langhan’s giant cell. Zeihl Neelsen Stain for Acid fast bacilli, which was positive.

Unique Regulation of Na-K-ATPase during Growth and Maturation of Intestinal Epithelial Cells

Na-K-ATPase on the basolateral membrane provides the favorable transcellular Na gradient for the proper functioning of Na-dependent nutrient co-transporters on the brush border membrane (BBM) of enterocytes. As cells mature from crypts to villus, Na-K-ATPase activity doubles, to accommodate for the increased BBM Na-dependent nutrient absorption. However, the mechanism of increased Na-K-ATPase activity during the maturation of enterocytes is not known. Therefore, this study aimed to determine the mechanisms involved in the functional transition of Na-K-ATPase during the maturation of crypts to villus cells. Na-K-ATPase activity gradually increased as IEC-18 cells matured in vitro from day 0 (crypts) through day 4 (villus) of post-confluence. mRNA abundance and Western blot studies showed no change in the levels of Na-K-ATPase subunits α1 and β1 from 0 to 4 days post-confluent cells. However, Na-K-ATPase α1 phosphorylation levels on serine and tyrosine, but not threonine, residues gradually increased. These data indicate that as enterocytes mature from crypt-like to villus-like in culture, the functional activity of Na-K-ATPase increases secondary to altered affinity of the α1 subunit to extracellular K⁺, in order to accommodate the functional preference of the intestinal cell type. This altered affinity is likely due to increased phosphorylation of the α1 subunit, specifically at serine and tyrosine residues.

Diagnostic role of bronchoalveolar lavage: A cytohistopathological correlation

Background: Tumors of lung are common in Nepal. The risk of malignancy has to be judged prior to surgery for which bronchoscopy is often done. Brocho-alveolar lavage and bronchial biopsy are routine procedure done for diagnosis of lung cancer during bronchoscopy. This study was done to correlate the cytology of broncho-alveolar lavage specimen with histopathology in malignant tumors of the lug in our setup. Materials and methods: This study was conducted at department of pathology, Nobel Medical College from August 2017 to December 2018. Histopathology reports with malignancy were compared to their cytological diagnosis. Results: A total of 141 cases were included in the study. Among the study population,  Bronchogenic carcinoma was found more prevalent in female. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of broncho-alveolar lavage in the diagnosis of lung cancer were 88.1%, 97.98%, 94.7%, 95.1% and 95.03% respectively. Conclusions: Brochoalveolar lavage cytology has a greater accuracy for the diagnosis of lung cancer; however, benign cases need regular follow up as there are false negative cases.

Interpretation on coexistence or association of thrombocytopenia with malaria

Background: Malaria is a major health problem especially in developing countries. It is a major causeof morbidity and mortality especially in the tropics. There are several hematological changes in thisparticular disease, which includes thrombocytopenia, anemia , atypical lymphocytosis and infrequentlyintravascular coagulation. The aim of the study is to detect and compare the severity of varioushematological changes, especially thrombocytopenia in the particular type of malaria.Materials and Methods: This was an observational study done on the patients attending the outpatientand inpatient departments clinically suspected for malaria in Nobel Medical College, Biratnagar, Nepal.Thick and thin slides were made and stained with Leishman’s stain for malarial parasites and also antigentests were included wherever necessary. Other tests included were, complete blood counts.Results: Amongst the included 800 patients with suspicion of malaria, 135 (17%) patients demonstratedmalarial parasites on peripheral blood film. Male predominance in male to female predominance of 3.5:1was observed. Total number of 120 out of 135 had thrombocytopenia. Thrombocytopenia was observedhigher in P. Vivax (79.3%) followed by Mixed infection (17%) and P. falciparum (3.7%) respectively.Conclusion: Anemia with mainly thrombocytopenia was mainly seen in P. Vivax type followed by P.Falciparum. Since thrombocytopenia is associated with malaria, which is demonstrated in our study,treating physicians should keep malaria as one of the differential diagnosis in patients with fever and lowplatelets.

Study on Correlation between Serum Prostate Specific Antigen and Various Prostatic Pathology

Introduction: Prostatic enlargement that may due to any cause may give rise to bladder outlet obstruction. Prostatic specific antigen is the enzyme that is responsible for liquefaction of semen within a few minutes after it has clotted. Prostatic specific antigen is a widely used tumor marker for prostatic cancer. Prostatic specific antigen levels in the blood go up if the barrier between the lining epithelium and the blood stream is damaged. This study was done to determine the correlation between serum Prostatic specific antigen level and histological diagnosis in prostatic biopsy.Material and Methods: This is a one year prospective study carried out in the Department of Pathology, Nobel Medical College from August 16, 2016 to August 15 2017. A total of 175 cases were included in the study. Patient Prostatic specific antigen level were noted and biopsy specimen was collected after operation. Histopathological examination was done and correlation between HPE diagnosis and serum Prostatic specific antigen level was done.Results: Benign Prostatic Hyperplasia was the most common diagnosis that was encountered. Majority of the cases had a serum Prostatic specific antigen level less than 10 ng/ml. Serum Prostatic specific antigen level of more than 30 ng/ml was seen only in prostatic carcinoma.Conclusions: Serum Prostatic specific antigen is organ specific but not a disease for prostate. It can be used to monitor the carcinoma of the prostate rather than the diagnosis of the carcinoma.

A correlation study of cervical cytology on Pap smear with cervical biopsy in a tertiary hospital of Eastern Nepal

Background: Carcinoma cervix is among a curable cancer, if identified at an early stage. Pap smear is a simple, safe, noninvasive, outdoor and effective method for detection of lesions of the cervix but it fails to localize the lesion. Cervical biopsy, on the other hand is a gold standard but invasive technique.Materials and Methods: A prospective cross-sectional study was done in Nobel medical college from January 16, 2017 to January 15, 2018 where all pap smears received in a Department of Pathology were included in the study. However, only cases that had undergone both Pap smear and cervical biopsy were compared. Out of the 1492 pap smears, 118 cases underwent biopsy. Correlation was then done regarding cytological and histological diagnosis.Results: Majority of the cytological findings were normal. 7 patients of HSIL revealed moderate dysplasia and higher lesions in biopsy. 2 cases were that of adenocarcinoma which were diagnosed as inflammatory smear in Pap smear.Conclusion: Cervical Pap smear is reliable screening test to identify high grade squamous cell lesions and carcinoma, but it fails to localize the lesion and adenocarcinoma is hard to identify in a pap smear. Hence, cervical biopsy should be carried out to confirm the findings of Pap smear and in case of strong clinical suspicion.

Spectrum of Urothelial lesions in Cystoscopic biopsies: A Histopathological Perspective

 Background: Urinary Bladder lesions are one of the most common presenting lesions in the Outpatient department. On the other hand neoplastic conditions of the urinary bladder are the major cause of morbidity and mortality. Bladder carcinoma is the 7th most common carcinoma worldwide and is the major cause of morbidity and mortality.Material & Methods: All the cystoscopic biopsy received in the Department of Pathology at Nobel medical college and teaching hospital from August 1st 2016 to July 31st 2017 was included in the study. Received cystoscopic biopsies were processed and classified as per 2004 WHO/ISUP classification of urothelial tumors Patients were also categorized according to the age and sex to find out the prevalence of urothelial lesions on them.Results: Out of the 78 patients 54 were males and 24 were females. Very few (n=15, 19.23%) cases of non neoplastic lesions were biopsied. Low grade urothelial carcinoma was the most common diagnosis in the patients which accounts for 49.2 % (n=31) of the total neoplastic conditions.Conclusion: Low grade urothelial carcinoma was the most common lesion encountered with the peak age range of 61-70 years.Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 6-10

Aspiration and non-aspiration technique in the study of thyroid gland lesion cytology

Background: Fine needle aspiration cytology is used as a primary diagnostic tool in thyroid lesions. But the bloody smears caused by negative pressure during aspiration compromise cellular concentration and cell morphology which may lead to its improper interpretation. FNNAC avoids active aspiration and depends on capillary tension to collect tissue sample in the needle bore, thus reducing bleeding and tissue trauma to the highly vascular thyroid. Material and Methods: This is a one year prospective study where FNNAC and FNAC were done on 87 patients. Cytopathologist was blind folded regarding the technique used and was asked to score the quality of slide base of Mair scoring system.Results: FNAC yielded significantly better material on the basis of hemorrhage and cellularity. Fifty six (64.37%) cases showed adequate diagnostic material in FNNAC technique while 54/87 (62.05%) cases showed adequate diagnostic material in FNAC technique. Twelve (13.79%) cases showed unsuitable diagnostic material in FNNAC technique and 26/ 87 (29.89%) cases unsuitable diagnostic material in FNAC technique. Among the individual criteria used in Mair scoring system, background clot/ blood was significantly low in FNNAC than FNAC with the p value less than 0.001. Amount of cellular material was significantly more in FNNAC with p value less than 0.001.Conclusion: FNNAC yielded more cellular and less hemorrhagic material and more diagnostic superior material than FNAC. Since thyroid is a highly vascular gland, FNNAC should be used instead of FNAC for less hemorrhagic and more cellular material.

Co-existence of gastric adenocarcinoma and neuroendocrine carcinoma: a rare entity

A mixed adenoneuroendocrine carcinoma is a tumor composed of both adenocarcinoma and neuroendocrine carcinoma components, with each comprising  at least one-third of the lesion, as defined by the World Health Organization classification of neuroendocrine neoplasms in 2010.. A 67-years-old male was admitted to the hospital with symptoms suggesting gastric cancer. Histopathology examination from endoscopic biopsy revealed adenocarcinoma. Later partial gastrectomy specimen examination the lesion show presence of well differentiated adenocarcinoma along with neuro endocrine carcinoma.

Role of fine needle aspiration cytology in Metastatic lymphadenopathy

Background The most common site for metastases is lymph nodes for various types of cancers. It is a reliable and easy approachable as well as inexpensive method of diagnosis for the patient as well as for the pathologist. So, the recognition and establishing a preliminary diagnosis on patients presenting clinically with lymphadenopathy is of importance and especially categorizing whether it is an inflammatory lesion or metastatic or primary neoplastic lesion itself of the lymphnode.Material and Methods A prospective study in 1000 patients was performed of all presenting with cervical lymphadenopathies. This study was performed in the department of pathology, Nobel Medical College and Teaching hospital, Biratnagar, Nepal from the period of January 2013 to January 2016.Results Total number of cases included was 1000 of fine needle aspiration cytology in patients presenting with cervical lymphadenopathies. Out of the total 1000 cases 800 cases were benign lesions, 110 were malignant lesions, 70 cases were inflammatory lesions while 20 cases were inconclusive. Out of the 110 malignant cases, most common malignancy was squamous cell carcinoma, adenocarcinoma followed by ductal carcinoma of breast, small cell and non-small cell carcinoma, papillary carcinoma of thyroid and few cases of malignant melanoma and undifferentiated carcinoma.Journal of Nobel Medical College Vol.5(2) 2016; 26-31

Implementation of Bethesda system in thyroid aspirate: A cyto-histopathological correlation study

Background: Thyroid lump is a common clinical problem in Nepal. The risk of malignancy has to be judged prior to surgery for which fine needle aspiration cytology is widely used. To bring the uniform reporting of thyroid aspirates, the Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced in 2007. This study was done to evaluate the various cytomorphological patterns of thyroid aspirate and to correlate the Bethesda system with final histopathology report.Materials and Methods: Fine needle aspiration were performed and were evaluated as per TBSRTC criteria. Fine needle aspiration cytology report were compared with biopsy specimen whenever possible.   Result: A total of 386 cases were studied. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of TBSRTC were 75.2%, 98.2%, 90.0%, 94.7% and 94.03% respectively. Conclusion: Use of TBSRTC in reporting thyroid cytopathology has a greater accuracy; however, benign cases need regular follow up as there are false negative cases.

Histopathological analysis of endometrial biopsies in dysfunctional uterine bleeding

Background: It is estimated that 9-30% of women of reproductive age suffer from menorrhagia. Because most cases are associated with anovulatory menstrual cycles, adolescent and perimenopausal women are particularly vulnerable to this particular condition. The aim of this study was to evaluate the histopathological pattern of endometrial biopsy from patients presenting with dysfunctional uterine bleeding.Materials and Methods: This is a cross-sectional observational study done in Nobel Medical College, Biratnagar, Nepal for a period of three years from June 2012 to June 2015. All the patients presenting with dysfunctional uterine bleeding and who underwent endometrial biopsy were included in this study. Distribution of various histopathological patterns was observed in the different age groups.Results: A total of 300 cases were included in my study. The commonest pattern in these patients was proliferative endometrium 61 (%). The commonest pathology was simple cystic hyperplasia (13.3%). Other patterns identified were secretory endometrium, chronic endometritis and pill endometrium. Malignant lesion comprised of 8 (2.7%) of patients and the majority was in >50 years followed by in between 41-50 years of age. Atrophic endometrium was the commonest finding in post menopausal bleeding, comprising of 11 cases (3.6%), followed by endometrial carcinoma of 8 cases (2.7%).Conclusion: As observed from the study, there is an age specific association of endometrial bleeding, with highest incidence in perimenopausal age group. Hence, dilatation and curettage is helpful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of dysfunctional uterine bleeding. 

Cerium oxide nanoparticles attenuate acute kidney injury induced by intra-abdominal infection in Sprague-Dawley rats

Background

Intra-abdominal infection or peritonitis is a cause for great concern due to high mortality rates. The prognosis of severe intra-abdominal infection is significantly diminished in the presence of acute kidney injury (AKI) which is often characterized by renal tubular cell death that can lead to renal failure. The purpose of the current study is to examine the therapeutic efficacy of cerium oxide (CeO₂) nanoparticles for the treatment of peritonitis-induced AKI by polymicrobial insult.

Results

A one-time administration of CeO₂ nanoparticles (0.5 mg/kg) in the absence of antibiotics or other supportive care, attenuated peritonitis-induced tubular dilatation and the loss of brush border in male Sprague–Dawley rats. These improvements in renal structure were accompanied by decreases in serum cystatin-C levels, reduced renal oxidative stress, diminished Stat-3 phosphorylation and an attenuation of caspase-3 cleavage suggesting that the nanoparticle treatment improved renal glomerular filtration rate, diminished renal inflammation and reduced renal apoptosis. Consistent with these data, further analysis demonstrated that the CeO₂ nanoparticle treatment diminished peritonitis-induced increases in serum kidney injury molecule-1 (KIM-1), osteopontin, β-2 microglobulin and vascular endothelial growth factor-A (VEGF-A) levels. In addition, the nanoparticle attenuated peritonitis-induced hyperglycemia along with increases in blood urea nitrogen (BUN), serum potassium and sodium.

Conclusion

CeO₂ nanoparticles scavenge reactive oxygen species and attenuate polymicrobial insult induced increase in inflammatory mediators and subsequent AKI. Taken together, the data indicate that CeO₂ nanoparticles may be useful as an alternative therapeutic agent or in conjunction with standard medical care for the treatment of peritonitis induced acute kidney injury.

Inhibition of MAP kinase/NF-kB mediated signaling and attenuation of lipopolysaccharide induced severe sepsis by cerium oxide nanoparticles

Sepsis is a life threatening disease that is associated with high mortality. Existing treatments have failed to improve survivability in septic patients. The purpose of this present study is to evaluate whether cerium oxide nanoparticles (CeO2NPs) can prevent lipopolysaccharide (LPS) induced severe sepsis mortality by preventing hepatic dysfunction in male Sprague Dawley rats. Administration of a single dose (0.5 mg/kg) of CeO2NPs intravenously to septic rats significantly improved survival rates and functioned to restore body temperature, respiratory rate and blood pressure towards baseline. Treatment-induced increases in animal survivability were associated with decreased hepatic damage along with reductions in serum cytokines/chemokines, and diminished inflammatory related signaling. Kupffer cells and macrophage cells exposed to CeO2NPs exhibited decreases in LPS-induced cytokine release (TNF-α, IL-1β, IL-6, HMGB1) which were associated with diminished cellular ROS, reduced levels of nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), and decreased nuclear factor-kappa light chain enhancer of activated B cells (NF-kB) transcriptional activity. The findings of this study indicate that CeO2NPs may be useful as a therapeutic agent for sepsis.

Lipopolysaccharide induced MAP kinase activation in RAW 264.7 cells attenuated by cerium oxide nanoparticles

High mortality rates are associated with the life threatening disease of sepsis. Improvements in septic patient survivability have failed to materialize with currently available treatments. This article represents data regarding a study published in biomaterials (Vellaisamy et al., Biomaterials, 2015, in press). with the purpose of evaluating whether severe sepsis mortality and associated hepatic dysfunction induced by lipopolysaccharide (LPS) can be prevented by cerium oxide nanoparticles (CeO2NPs) treatment in male Sprague Dawley rats. Here we provide the information about the method and processing of raw data related to our study publish in Biomaterials and Data in Brief (Vellaisamy et al., Biomaterials, 2015, in press; Vellaisamy et al., Data in Brief, 2015, in press.). The data contained in this article evaluates the contribution of MAPK signaling in LPS induced sepsis. Macrophage cells (RAW 264.7) were treated with a range of cerium oxide nanoparticle concentration in the presence and absence of LPS. Immunoblotting was performed on the cell lysates to evaluate the effect of cerium oxide nanoparticle treatment on LPS induced changes in Mitogen Activated Protein Kinases (MAPK) p-38, ERK 1/2, and SAPK/JNK phosphorylation.

Cerium oxide nanoparticles inhibit lipopolysaccharide induced MAP kinase/NF-kB mediated severe sepsis

The life threatening disease of sepsis is associated with high mortality. Septic patient survivability with currently available treatments has failed to improve. The purpose of this study was to evaluate whether lipopolysaccharide (LPS) induced sepsis mortality and associated hepatic dysfunction can be prevented by cerium oxide nanoparticles (CeO2NPs) treatment in male Sprague Dawley rats. Here we provide the information about the methods processing of raw data related to our study published in Biomaterials (Selvaraj et al., Biomaterials, 2015, In press) and Data in Brief (Selvaraj et al., Data in Brief, 2015, In Press). The data present here provides confirmation of cerium oxide nanoparticle treatments ability to prevent the LPS induced sepsis associated changes in physiological, blood cell count, inflammatory protein and growth factors in vivo. In vitro assays investigation the treated of macrophages cells with different concentrations of cerium oxide nanoparticle demonstrate that concentration of cerium oxide nanoparticles below 1 µg/ml did not significantly influence cell survival as determined by the MTT assay.

Prevalence of Hyperuricemia among People of Morang District of Nepal

Hyperuricemia refers to an elevation in the serum uric acid concentration. The blood levels of uric acid are a function of the balance between the breakdown of purines & the rate of uric acid excretion. Theoretically, alterations in this balance many account for hyperuricemia. Prolonged hyperuricemia often associated with gout, is an important risk factor for damaged joints. The present study is undertaken with the aim to find out the prevalence of hyperuricemia by age & sex, to establish the statistically significant correlation between serum creatinine & triglyceride concentration with uric acid concentration & to study the relation between alcohol drinking & hyperuricemia in Morang District, by routine health examinations in the out Patients Department (OPD) of Nobel Medical College, Biratnagar from January 2012 to January 2013. The study reveals that 28.57% (male – 30.06%., female -26.61%) of patients have been suffering from hyperuricemia. It indirectly indicates hyperuricemia is very frequent in developing country like Nepal. The present study denoted that hyperuricemia is directly related to alcohol consumption in both male & female.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12228Journal of Nobel Medical College Vol. 3, No.1 Issue 6, 2014, Page: 1-6

Swertia chirayita: The Himalayan Herb

Swertia chirayita is a native Himalayan herb typically found in the altitude of 1500 to 3100m. Swertia species are commonly used as primary medicines in fever, digestive and enteric diseases; especially S. chirayita is of principal importance. The pharmacological and ethno-medicinal perspective of the plant is well understood traditionally and pharmaceutically. Its secondary metabolites including glycosides and xanthones show promising bioactivity making it a powerful herb. Mixing of Swertia chirayita with its other species is done routinely in chiretta trade. Extensive wild collection and lack of sustainable conservation has led to the vulnerable status of the wild cultivar. DOI: http://dx.doi.org/10.3126/ijasbt.v2i4.11281 Int J Appl Sci Biotechnol, Vol. 2(4): 389-392

Evaluation of AgNoR scores in aspiration cytology smears of breast lesions and their correlation with histopathology

Background: Breast cancer is the leading cause of cancer-related deaths in Asia. The number of intra-nuclear silver stained structures, termed AgNORs, is significantly higher in malignant cells than in normal, reactive or benign cells. The main purpose of this study was to evaluate the AgNOR scores in aspiration cytology smears of breast lesions and their correlation with histopathology.Materials and Methods: This was a prospective study conducted over a period of 24 months from October, 2009 to 2011. A total of 40 cases were included in the study, including fine needle aspiration and biopsy. AgNOR stain was done in both cytology and histopathology slides and scoring was done and analyzed.Results: The mean AgNOR counts were 1.734 for benign cases and 4.508 for malignant cases. Statistically significant ‘P’ value < 0.05 for both benign and malignant cases was observed. The AgNOR dots morphology was homogenous, symmetric with regular contours in both FNAC and histopathology slides of benign breast lesion. In malignant breast lesions, the dots were asymmetric with irregular contours and were aggregated, smaller and more scatteredConclusion: The mAgNOR counts were significantly higher in smears from malignant breast lesions than in those from benign. These results were similar to those obtained for tissue sections and were comparable to established data. Both AgNOR counts and SAPA score gave similar results done in this study, indicating that SAPA is also as convenient, reproducible and rapid method of AgNOR evaluation.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11592 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 649-653

Study of Serum Lipid Profile in Renal Failure Patients attending Nobel Medical College, Biratnagar

Journal of Nobel Medical College Vol. 2, No.2 Issue 4 May-October 2013 Page 24-29 DOI: http://dx.doi.org/10.3126/jonmc.v2i2.8801

Two year audit of perinatal mortality at Kathmandu Medical College Teaching Hospital

INTRODUCTION

Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths.

AIMS AND OBJECTIVES

This study was carried out to determine perinatal mortality rate (PMR) and the factors responsible for perinatal deaths at KMCTH in the two year period from November 2003 to October 2005 (Kartik 2060 B.S. to Ashoj 2062).

METHODOLOGY

This is a prospective study of all the still births and early neonatal deaths in KMCTH during the two year period from November 2003 to October 2005. Details of each perinatal death were filled in the standard perinatal death audit forms of the Department of Pediatrics, KMCTH. Perinatal deaths were analyzed according to maternal characteristics like maternal age, parity, type of delivery and fetal characteristics like sex, birth weight and gestational age and classify neonatal deaths according to Wigglesworth's classification and comparison made with earlier similar study.

RESULTS

Out of the 1517 total births in the two year period, 22 were still births (SB) and 10 were early neonatal deaths (ENND). Out of the 22 SB, two were of < 1 kg in weight and out of 10 ENND, one was of <1 kg. Thus, perinatal mortality rate during the study period was 19.1 and extended perinatal mortality rate was 21.1 per 1000 births. The important causes of perinatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and associated maternal factors like antepartum hemorrhage and most babies were of very low birth weight. According to Wigglesworth's classification, 43.8% of perinatal deaths were in Group I, 12.5% in Group II, 28.1% in Group III, 12.5% in Group IV and 12.5% in Group V.

DISCUSSION

The perinatal death audit done in KMCTH for 1 year period from September 2002 to August 2003 showed perinatal mortality rate of 30.7 and extended perinatal mortality rate of 47.9 per 1000 births. There has been a significant reduction in the perinatal mortality rate in the last 2 years at KMCTH. Main reasons for improvement in perinatal mortality rate were improvement in care of both the mothers and the newborns and the number of births have also increased significantly in the last 2 years without appropriate increase in perinatal deaths.

CONCLUSION

Good and regular antenatal care, good care at the time of birth including appropriate and timely intervention and proper care of the sick neonates are important in reducing perinatal deaths. Prevention of preterm births, better care and monitoring during the intranatal period and intensive care of low birth weight babies would help in further reducing perinatal deaths. Key words: Perinatal mortality rate (PMR), still births, early neonatal death (ENND), Total perinatal death (PND).

Anaplastic carcinoma of the thyroid - clinicomorphological spectrum and review of literature

Background: Thyroid cancer is fairly common. The worldwide annual incidence ranges from 0.5 to 10 cases per 100,000 people. Anaplastic thyroid carcinoma, comprising less than 10% of all thyroid carcinomas, remains one of the most virulent of all cancers in humans with a 10 year survival rate of only 0.1 %. In the present study we looked into the clinical, cytological and histological spectrum of anaplastic carcinoma and compared our experience with recent literature. Materials and Methods: This was a hospital based retrospective study from January 2000 to November 2010. Clinical, cytological and histopathological data of all the diagnosed anaplastic thyroid carcinoma cases were reviewed and analyzed. Results: Of the 59 thyroid malignancies diagnosed in the same period, 7 cases were anaplastic carcinoma. The mean age was 63 years and was predominantly found in females. All of the cases presented with a neck mass that lasted for a mean of 5.7 months. The mean tumor size was 14.9 cm and the most common sub-type was the spindle cell type. Atypical mitosis of more than 5 per high power field and necrosis was noted in all cases. Conclusion: Due to the markedly aggressive nature of this tumor and its association with areas of endemic thyroid disease, early diagnosis and aggressive therapy is essential, especially in the Himalayan and Sub-Himalayan belt. Keywords: Anaplastic carcinoma; Thyroid carcinoma; Spindle cell variant DOI: 10.3126/jpn.v1i1.4451 Journal of Pathology of Nepal (2011) Vol.1, 45-48