Background: The increasing prevalence of multiple co-morbidities among anemic patients with chronic diseases have made the use of serum ferritin (which is also an acute phase reactant) and transferrin saturation more challenging in diagnosing iron deficiency. Microscopic examination of bone marrow aspirate is the gold standard" for assessing marrow iron store. However, conventional Gale's method assesses iron in marrow fragments alone which provides little valuable information about functional iron deficiency seen in many chronic diseases. Aim: To perform an intensive bone marrow iron grading by assessing iron in fragments, in macrophages around fragments and in erythroblasts and to correlate the marrow iron store results with serum ferritin. Materials and Methods: A descriptive study of Perl's Prussian blue stained bone marrow aspirate smears of 80 adult patients with moderate to severe anemia. Bone marrow iron was assessed by both the Gale's method and the intensive method and correlated with serum ferritin. Results: The intensive grading system revealed normal iron stores in 37.5% cases, depleted iron stores in 16.25% patients while 23.75% and 22.5% patients had functional iron deficiency and combined deficiency, respectively. Mean log ferritin concentration was significantly lower in patients with depleted iron stores (0.91 μg/l) in comparison to those with normal iron stores (2.13 μg/l; P = 0.001), functional iron deficiency (2.65 μg/l; P = 0.000), or combined deficiency (2.04 μg/l; P = 0.002). Conclusion: Intense marrow iron examination provides a useful iron status classification which is of particular importance in cases of chronic diseases and inflammation.

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Background: Enterococci have emerged as important nosocomial pathogens and have been found to possess many virulence factors, some of which are considered very important in the pathogenesis of diseases caused by them. The following study was carried out to evaluate some of the virulence determinants elaborated by strains of enterococci in our setup and to ascertain if these strains differ considerably from commensal strains of enterococci in the expression of these virulence determinants. Materials and Methods: One hundred and fifty-seven isolates of Enterococcus species from clinical specimens were evaluated for the presence of virulence determinants like hemolysin production, gelatinase production and biofilm formation by phenotypic tests. The presence of enterococcal surface protein (esp) gene in the isolates was detected using polymerase chain reaction (PCR). Thirty strains of Enterococcus isolated from fecal samples of patients admitted to the hospital were also tested for the presence of these virulence factors. Strains of Enterococcus from clinical specimens and those present as commensals were compared with respect to the elaboration of virulence factors using Fisher's exact test. Results: The association between biofilm formation and presence of the "esp" gene was not found to be statistically significant. Among the virulence determinants studied, gelatinase production and the "esp" gene were found to be significantly more common in clinical isolates than commensal strains of Enterococcus species. Conclusion: Among the virulence factors, gelatinase and the "esp" gene were more common in clinical isolates than commensal strains. The association between biofilm formation and the presence of "esp" gene was not found to be statistically significant.

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Malignant mesonephric tumors are rare variants of cervical adenocarcinoma, derived from remnants of mesonephric ducts and are associated with mesonephric remnants and/or mesonephric hyperplasia. Few cases have been described in literature. We report an unusual case of cervical mesonephric adenocarcinoma of endometrioid type with squamous morules in association with diffuse mesonephric hyperplasia involving the cervical walls and extending into the myometrium.

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Context: Thyroid cancer is the most common malignant endocrine tumor. Nowadays tissue biopsy and pathological assessment are the best diagnostic modalities for thyroid lesions. Differential diagnosis between adenomas and follicular variant of papillary thyroid carcinoma (PTC) is an important issue in pathology. Aims: This study is designed to show any association between expressions of CD56 and nm23 and types of thyroid lesions (benign vs. malignant). Settings and Design: In this cross-sectional study, 78 paraffin-embedded tissue blocks of thyroid tissue from a tertiary care center were selected, and assessed by using immunohistochemistry for expressions of CD56 and nm23 genes. Materials and Methods: we studied 39 benign and 39 malignant thyroid lesions, CD56 and nm23 expressions were determined by immunohistochemical staining, and the results were used for differentiation of benign and malignant lesions of thyroid. Statistical Analysis: The obtained results were analyzed and evaluated using SPSS (Version 18). Results: CD56 was expressed in 93% of benign specimens and in only 5% of malignant types. The sensitivity and specificity of this test were 94.8% and 92.3, respectively (P = 0.001). All malignant specimens and 95% of benign specimens were positive for nm23. The sensitivity and specificity of nm23 were 100% and 5%, respectively. Conclusion: Considering high sensitivity and specificity of CD56, it is possible to apply immunohistochemistry for definite diagnosis and differentiation of benign lesions from PTC. We conclude that by using this marker, the diagnostic mistakes in pathologic diagnosis of thyroid cancer versus benign lesions like thyroid adenoma will decrease.

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Background: Urothelial carcinomas (UC) is of the most common cancers urinary bladder. Aim: The aim of the study is to assess the immunohistochemical staining differences between p63 and p53 according to the pathological stage and histological grade of the tumor in urinary bladder carcinomas. Materials and Methods: Totally 62 urinary bladder transurethral resection materials diagnosed with urothelial carcinoma in the pathology department of our hospital were included in the study. On pathological examination, cases were dichotomized as noninvasive and invasive, whereas noninvasive cases were dichotomized as low grade and high grade and invasive cases were dichotomized as pT1 and pT2. Subsequently, the cases were evaluated by means of p63 and p53 immunohistochemical staining. Statistical analyses were performed by SPSS program, and Chi-square and Fisher's exact tests. Results: When pTa was evaluated in terms of p63 immunoreactivity, no statistically significant difference was observed between LGPUC and HGPUC, noninvasive papillary UC, regarding staining percentages ( P > 0.05), whereas statistically significant relation was observed for pT1 and pT2 regarding p63 staining percentages ( P < 0.05). For pTa, no statistically significant relation was observed between LGPUC and HGPUC, noninvasive papillary UC, in terms of p53 staining percentages ( P > 0.05). However, highly significant relationship was observed for pT1 and pT2 in terms of p53 staining percentages ( P < 0.01). No significant relationship was observed between the staining percentages of p53 and p63 ( P > 0.05). Conclusion: The role of p53 and p63 immunoreactivities in the differential diagnosis and prognosis of urinary bladder carcinomas according to the pathological stage and histological grade of the tumor will be understood better with the increasing number of long term investigations performed with large series at a molecular level.

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Background and Aim : The development of gastrointestinal symptoms following pelvic radiotherapy depends on morphological and functional modifications of the intestinal epithelium after radiation. The aim of this study was to evaluate and compare the effects of preventive administration of the preparation ''5'' Strain Dophilus and Hylak on the fecal microflora after radiotherapy in patients during radiotherapy. Materials and Methods : Fourteen patients were randomly selected and subdivided into two groups: The first group was administered ''5'' Strain Dophilus (L Group) and the second group was administered Hylak (H Group). Radiation was delivered by a Cobalt 60 unit by using the four field box technique. The doses were divided into 2 Gy per day over 5 to 7 weeks to give the total cumulative dose of 50 Gy (2 Gy/day). High risk patients (e.g., patients with prostate cancer), received dosage 65 67 Gy (2 Gy/day). Results : Both experimental and clinical studies have shown that probiotics can effectively modulate intestinal inflammation by altering the composition and the metabolic and functional properties of gut indigenous flora. Conclusions : Many bacteria were found to be sensitive to irradiation. It would be necessary to check the possible effects of cytostatics on bacteria in larger studies.

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Introduction: Hemoglobinopathies constitute entities that are generated by either abnormal hemoglobin or thalassemias. high pressure liquid chromatography (HPLC) is one of the best methods for screening and detection of various hemoglobinopathies but it has intrinsic interpretive problems. The study was designed to evaluate the different mutations seen in cases of hemoglobinopathies and compare the same with screening tests. Materials and Methods: 68 patients of hemoglobinopathies were screened by HPLC. Mutation studies in the beta globin gene was performed using the polymerase chain reaction (PCR)-based allele-specific Amplification Refractory Mutation System (ARMS). Molecular analysis for the sickle cell mutation was done by standard methods. Results: The IVS 1/5 mutation was the commonest mutation seen and it was seen in 26 (38.23%) of the cases. This was followed by the IVS 1/1, codon 41/42, codon 8/9, del 22 mutation, codon 15 mutation and the -619 bp deletion. No mutation was seen in eight cases. There was a 100% concordance between the sickle cell trait as diagnosed by HPLC and genetic testing. Discussion and Conclusion: Our study underlies the importance of molecular testing in all cases of hemoglobinopathies. Although HPLC is a useful screening tool, molecular testing is very useful in accurately diagnosing the mutations. Molecular testing is especially applicable in cases with an abnormal hemoglobin (HbD, HbE and HbS) because there may be a concomitant inheritance of a beta thalassemia mutation. Molecular testing is the gold standard when it comes to the diagnosis of hemoglobinopathies.

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Ovarian sex cord-stromal tumors are relatively infrequent neoplasms that account for approximately 8% of all primary ovarian tumors. They are a heterogeneous group of neoplasms composed of cells derived from gonadal sex cords (granulosa and Sertoli cells), specialized gonadal stroma (theca and Leydig cells), and fibroblasts. They may show androgenic or estrogenic manifestations. We report such a tumor associated with markedly raised serum alpha-fetoprotein (AFP) levels in a young female presenting with a mass and defeminising symptoms. Serum AFP levels returned to normal on removal of tumor.

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Placental mesenchymal dysplasia (PMD) is a recently recognized, rare placental vascular anomaly characterized by placentomegaly and grape-like vesicles mimicking partial molar pregnancy. It is associated with significant fetal morbidity and mortality. We describe the histologic features of PMD in two different cases with different disease outcomes, one in a preterm intrauterine death (IUD) and another in a live birth. Placental examination in both the cases revealed large placenta with multiple vesicles and mesenchymal dysplasia.

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Background: Toxoplasmosis is a common parasitic infection of man, and reactivation of latent disease in HIV-infected patients can cause fatal encephalitis. Diagnosis depends on demonstration of parasite-specific antibodies in serum. In HIV-infected patients, IgM is often undetectable, whereas IgG remains detectable in the majority. Urine sample is very easily available and has not been evaluated for immunodiagnosis of toxoplasmosis. Aim: The study was an effort to find whether urine sample can be used in place of serum for immunodiagnosis of toxoplasmosis. Materials and Methods: Enzyme-linked immunosorbent assay (ELISA) was carried out in serum and urine samples collected from 100 HIV-infected patients to detect anti-toxoplasma IgG and IgM antibodies and whether positivity correlated with the CD4 T-cell counts of patients. Results: In this study, we observed that there was no significant difference in positivity of anti-toxoplasma IgM and IgG between serum and urine samples of HIV-infected patients by ELISA. There was a negative correlation between CD4 count and seropositivity. Conclusion: Urine sample can be satisfactorily used in place of serum for immunodiagnosis of toxoplasmosis.

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Metastatic renal cell carcinoma of the nasopharynx, nasal cavity, and paranasal sinuses can be misdiagnosed as primary malignant or benign diseases. A 33-year-old male attended our outpatient clinic complaining of difficulty breathing through the nose, bloody nasal discharge, postnasal drop, snoring, and discharge of phlegm. Endoscopic nasopharyngeal examination showed a vascularized nasopharyngeal mass. Under general anesthesia, multiple punch biopsies were taken from the nasopharynx. Pathologically, the tumor cells had clear cytoplasm and were arranged in a trabecular pattern lined by a layer of endothelial cells. After the initial pathological examination, the pathologist requested more information about the patient's clinical status. A careful history revealed that the patient had undergone left a nephrectomy for a kidney mass diagnosed as renal cell carcinoma 3 years earlier. Subsequently, nasopharyngeal metastatic renal cell carcinoma was diagnosed by immunohistochemical staining with CD10 and vimentin. Radiotherapy was recommended for treatment.

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Most of the pulmonary arterial sarcomas arise from multi-potential mesenchymal intimal cells and are designated as intimal sarcomas. These tumors grow in the direction of blood flow into peripheral arteries producing clinical features mimicking pulmonary thromboembolism. Retrograde extension is rare. We report one such case of intimal sarcoma that had a retrograde extension into the right ventricular outflow tract, and review such a presentation in the last ten years.

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Background: P-cadherin is cell-cell adhesion glycoprotein which can be used as a myoepithelial cell (MEC) marker in the breast lesions. MEC layer is retained in most benign lesions and loss of this outer layer is hallmark of infiltrating carcinomas in the breast. Aim: To evaluate the expression of P-cadherin as MEC marker in the differential diagnosis of benign and malignant breast lesions. Materials and Methods: Immunohistochemical staining was done using P-cadherin-specific antibody on formalin fixed paraffin-embedded sections of 25 benign and 15 malignant breast lumps. Results: All 25 cases of benign breast lesions showed positive P-cadherin immunostaining, while only 4 out of 15 cases of infiltrating ductal carcinoma showed positive immunostaining for P-cadherin. In the case of benign lesions, staining index varied from 4 to 6 or 7 to 9, while in case of malignant lesions, 11 cases showed staining index from 1 to 3. Only 4 out of 15 malignant cases had staining index from 4 to 6. None of them showed index from 7 to 9. Conclusions: P-cadherin as a MEC marker can be used in differentiating benign and malignant breast lesions.

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A 57-year-old Japanese man visited our hospital with a moist cough. Chest radiographic imaging showed a left hilar shadow. Adenocarcinoma cells were found on cytologic screening of fresh sputum. Although multiple metastases including brain were detected, no tumor was observed in the kidneys. The patient underwent whole-brain irradiation and chemotherapy for advanced-stage lung cancer. One month before his death, carcinomatous meningitis was detected. Hyponatremia, hypo-osmolality, and hypertonic urine suggested the syndrome of inappropriate antidiuresis. Restricting water intake improved the hyponatremia; however, he developed fever and hematuria. Despite systemic administration of an antibacterial drug, he died. Primary tumor in the lung was absent, but adenocarcinoma of the right kidney was evident on autopsy. Lectin histochemical analysis of the carcinoma revealed its distal nephron origin, confirming collecting duct carcinoma. Severe carcinomatous meningitis, which is possibly caused the syndrome of inappropriate antidiuresis, was observed, with no cancer involvement of the pituitary gland and hypothalamus.

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