PubMed Health⌕ Search

Biomedical subjects

V Nirmala

Publications and source records attributed to V Nirmala.

At least 19 recordsLinked to original sources
PubMed2006

The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients.

BACKGROUND: Gastric cancer is the most common cancer in Oman and a leading cause of cancer death. The variation in survival rates between countries and ethnic groups has been attributed to early detection policies, differences in clinicopathological features, treatment approaches, and biological characteristics. There were no previous reports on gastric cancer from Oman and very few studies on Asian Arabs. AIM: To evaluate the impact of clinicopathological and treatment variables on the survival prospects of Omani Arab patients diagnosed with gastric cancer. METHODS: The medical records of 339 Omani Arab patients diagnosed with invasive gastric adenocarcinoma during the period 1993-2004 were retrospectively reviewed. The relative importance of clinicopathological features and surgical and medical treatments were assessed using univariate and multivariate analyses. RESULTS: Most patients had distal ulcerating-type gastric cancer and presented at advanced stages. The median survival time for the entire cohort was 12 months (95% CI 9.7-14.4) with a 5-year overall survival rate of 16.7%. On univariate analysis of 237 patients who underwent surgical resection, the following positive prognostic factors emerged as significant: early overall TNM stage, early T stage, negative lymph nodes, tumor size <5 cm, ulcerating macroscopic appearance, and curative surgical attempt. The independent prognostic factors on multivariate analysis were T stage and lymph node involvement. CONCLUSION: The overall T and N stages are the most important determining factor for survival in Omani Arab patients. More efforts need to be made for the early detection of gastric cancer in developing countries such as Oman, while continuing to employ the standard surgical and medical treatments.

Adenocarcinoma↗
PubMed2006

Pattern of chronic diarrhoea in children: a prospective analysis of causes, clinical features and outcome.

OBJECTIVES: To determine the pattern of chronic diarrhoea in children in Oman. STUDY DESIGN: This is a prospective study carried out over a 7 year period at the Sultan Qaboos University Hospital, Muscat, Oman. SUBJECTS: Sixty two children (37 M:25 F), aged 3 months to 13 years who presented with chronic diarrhoea, defined as diarrhoea persisting for more than 4 weeks, were studied. RESULTS: Principal identifiable causes in the study population include post-gastroenteritis syndrome in 50% of cases, enteric infections and infestations in 27%, and coeliac disease in 13%. On presentation 63% were malnourished, 27% were anaemic while 39% were dehydrated. The median duration of hospital admission was 50 days. Majority of the patients responded to conservative therapy with correction of dehydration, and careful nutritional supplementation, in addition to specific therapy where necessary. Mortality was low (1.5%) resulting from immunodeficiency and gram-negative septicaemia. CONCLUSION: Chronic diarrhoea remains an important cause of morbidity especially malnutrition in children and early and adequate nutritional rehabilitation plays a pivotal role in the management.

Adolescent↗
PubMed2005

The prognostic significance of p53, p27 kip1, p21 waf1, HER-2/neu, and Ki67 proteins expression in gastric cancer: a clinicopathological and immunohistochemical study of 121 Arab patients.

BACKGROUND: The variability of prognosis within a pathological stage of gastric cancer (GC) at presentation, underscores the need for specific biological markers to identify subgroups of patients with aggressive course for intensive treatment. To our knowledge, this is the first study from an Arab population reporting on the relationship of p53, p27 kip1, p21 waf1, HER-2/neu, and Ki67 expression, and clinicopathological features and their prognostic significance. METHODS: Formalin-fixed paraffin-embedded tumors were studied by immunohistochemistry, using monoclonal antibodies to p53, p27 kip1, p21 waf1, HER-2/neu, and Ki67. The results were correlated with clinicopathological features and survival. RESULTS: M:F = 80:41; median age = 60 years; stage III and IV = 71%; and median follow-up = 34.4 months. Positive expression rates of p53, p27 kip1, p21 waf1, Ki67, and HER-2/neu were 54%, 40%, 8.3%, 70%, and 12% respectively. p53 expression correlated with age <60 years (P = 0.03), tumor size >5 cm (P = 0.01), p27 kip1 and Ki67 expression (P = 0.0001), and HER-2/neu (P = 0.04). p21 waf1 correlated inversely with T-stage (P = 0.008) and Her-2/neu expression correlated with histological grade (P = 0.04) and T-stage (P = 0.008). Univariate analysis showed that p53 overexpression (P = 0.01), fungating and infiltrative macroscopic appearance (P = 0.02), size >5 cm (P = 0.0001), lymph node metastasis (P = 0.0001), p T3 and T4 disease (P = 0.01), and overall stage III and IV (P = 0.0001) disease were adverse prognostic factors. Patients with tumor profiles p53 (-)/p27 (+) had better survival than those with p53 (+)/p27 kip1 (-)(P = 0.02). On multivariate analysis by Cox regression model, the expression of p53 (P = 0.03) and lymph node involvement (P = 0.01) were significant adverse prognostic factors for overall survival. CONCLUSIONS: The expression of p53 in Arab patients with GC correlates with aggressive tumor characteristics and is an independent prognostic factor. The combined analysis of p53 and p27 kip1 is of added prognostic value.

Adult↗
PubMed2004

The outcome of treatment of breast cancer in a developing country--Oman.

The aim of the present study was to evaluate the outcome of treatment of breast cancer in Oman with an analysis of clinico-pathological features, treatment modalities utilized, and prognostic factors. One hundred fifty-two breast cancer patients diagnosed between January 1996 and June 2002 were evaluated retrospectively. Their mean age was 48.5 (S.D. +/- 10.8) years, and 48% of the female patients were premenopausal. The mean tumor size according to pathology was 4.6 (S.D. 3.29)cm, and 34.9% and 15.8% of patients had stage III or IV disease, respectively. Only 26.3% of the patients had breast-conserving surgery, and neoadjuvant chemotherapy was underutilized. The overall 5-year relapse-free survival (RFS) and overall (OS) survival rates were 62% and 64%, respectively. On multivariate analysis, axillary lymph node involvement and tumor differentiation were predictive of RFS and OS, respectively. Thus, breast cancer patients in Oman present with advanced stages of the disease at younger ages than their counterparts in the West and have lower survival rates. Increasing awareness and the introduction of screening programs and of a multidisciplinary approach are essential in Oman and other developing countries to improve the outcome of treatment.

Adult↗
PubMed2003

Significance of p53, Bcl-2, and HER-2/neu protein expression in Omani Arab females with breast cancer.

Racial disparity in the presentation of breast cancer and the outcome of its treatment is well established. However, the causes remain unexplained. The scarcity of reports about the prognostic significance of p53, bcl-2, and HER-2/neu in Arab females with breast cancer has been the impetus to this study. We evaluated the prognostic significance of altered expression of p53, bcl-2, HER-2/neu in Omani Arab females with non-metastatic breast cancer with correlation to other established prognostic factors. We have retrospectively analyzed the immunohistochemical expression of p53, HER-2/neu and bcl-2 in paraffin embedded blocks of 72 females diagnosed with invasive breast cancer between 1992 and 2002. The expression of the above proteins was correlated with other prognostic factors and univariate and multivariate analysis was carried out for all prognostic factors. Overexpression of p53 significantly correlated with younger age (<40), pre-menopausal status, poor differentiation with inverse correlation with bcl-2 expression. Expression of bcl-2 immunopostivity significantly correlated to low histological grade and positive estrogen and progesterone receptor status. On univariate and multivariate p53 overexpression and lack of bcl-2 immunostaining resulted in worse survival outcome, but not Her-2/neu overexpression. Expression patterns of p53 and bcl-2 are independent predictors of survival in Omani Arab population which may help to stratify these patients into different risk groups.

Adult↗
PubMed1999

Intramural müllerian papilloma of the vagina.

A 24-year-old pregnant woman was found to have a mass in the posterior vagina; a partly cystic and partly solid lesion was excised. Histology showed a papillary mural neoplasm covered by intact squamous epithelium. Immunohistochemical staining showed diffuse positivity with CAM 5.2, EP4, CEA, and EMA and focal immunoreactivity with CA-125. This lesion was interpreted as an intramural mullerian papilloma, only the second such tumor described in the vagina and the first in an adult.

Adult↗
PubMed1999

Can we diagnose early Barrett's oesophagus?

OBJECTIVES: The definition of Barrett's oesophagus, has been of late, is stressed on the presence of specialised columnar epithelium with goblet cells and not on other metaplastic epithelia, which however could be the early, immature, undifferentiated cell types such as junctional and gastric types. Hence this study was carried out to find out the ways of detecting the early metaplastic cell forms before the goblet cells appear. METHODS: Among 134 cases of reflux oesophagitis selected in the prospective study of 7 years from January 1992 to December 1998, 31 biopsies were diagnosed as Barrett's oesophagus (BO). These were compared with 20 age matched control biopsies from gastro-oesophageal junction. They were studied morphologically, morphometrically and histochemically for acid, neutral and sulphomucins using alcian blue (AB), alcian blue-periodic acid Schiff (AB-PAS) and high iron diamine-alcin blue (HID-AB) stains. RESULTS: Twelve of the cases were of junctional type, 16 of specialised columnar intestinal metaplastic (IM) type (Type I = 0, Type II = 5, Type III = 11) and three showed a combination of both junctional and Type I IM. Mucins were a mixture of neutral mucin, sialomucin and sulphomucin while the control biopsies showed chiefly neutral mucin. Morphometrically, the epithelial cells in BO were taller (mean 28u in junctional types and 32u in IM) in comparison to the control (mean 24.5 u). CONCLUSION: When the classical specialised columnar epithelium (with goblet cells) in oesophagus is absent, presence of metaplastic junctional type of mucosa, may, for all probabilities be considered as the initial step towards transformation to the classical Barrett's mucosa. In such situations, it is essential to differentiate it from the normal gastro-oesophageal junctional epithelium and is possible with histochemical analysis of the biopsy material aided by morphometry, especially so when the level of biopsy is not indicated.

Adult↗
PubMed1998

Acute GVHD involving the gastrointestinal tract and infestation with Blastocystis hominis in a patient with chronic myeloid leukaemia following allogeneic bone marrow transplantation.

A 21-year-old female underwent allogeneic bone marrow transplantation (ABMT) from her HLA matched brother for chronic myeloid leukaemia in the chronic phase. Four weeks post transplant she developed tenesmus, mucoid stool mixed with blood and lower abdominal pain. This rapidly progressed to greenish watery diarrhoea with flakes of mucous membrane floating in it, conforming to the classical clinical description of acute GVHD of the bowel. Stool microscopy showed profuse numbers of Blastocystis hominis, a parasite with doubtful pathogenicity in an immunocompetent host. In the present case the parasite played a pathogenic role as evidenced by the profuse number in the stool sample, focal neutrophil infiltration of the rectal mucosa, initial presentation of the patient with dysentery, and requirement for prolonged metronidazole therapy to eradicate the parasite and cure the diarrhoea. She also had grade I GVHD of the liver and skin. In developing tropical countries, hitherto unreported parasitic infestations may complicate the picture of acute GVHD.

Acute Disease↗
PubMed1997

Primary ectopic meningioma of the palatine tonsil--a case report.

Meningiomas can occur at excranial and extraspinal sites such as the nose, nasopharynx and paranasal sinuses. Meningioma of the tonsil has seldom been described. We report a case of ectopic meningioma of the left palatine tonsil, in a 50-year-old male with no clinical or radiological evidence of an intracranial lesion. Follow-up at six months revealed no evidence of recurrence.

Humans↗
PubMed1996

Post-transplantation epididymitis associated with cytomegalovirus.

Cytomegalovirus (CMV) infection, though usually systemic, has been known to cause localised involvement of organs like lung, liver, testis and gastrointestinal tract. We report a case of cytomegaloviral infection involving the epididymis without systemic manifestations in an young male one month after renal transplantation. The diagnosis was made on histopathologic examination of the epididymo-orchidectomy specimen. Clinical improvement occurred after the emergency epididymo-orchidectomy. To the best of our knowledge, only three cases of CMV epididymitis have been described in the world literature--two in transplant patients and one in an AIDS patient.

Adult↗
PubMed1994

Thymic carcinoma with glandular differentiation arising in a congenital thymic cyst.

A case of thymic carcinoma with glandular differentiation arising in congenital thymic cyst in a 50-year-old male is reported. Neoplasia in congenital thymic cyst is a rare phenomenon and is seldom associated with glandular differentiation. It is important to differentiate these neoplasms from carcinomas of the lower respiratory tract and from thymic carcinomas with secondary cystic degeneration, in view of their relatively good prognosis and the therapeutic implications.

Cell Transformation, Neoplastic↗
PubMed1994

Mast cells and macrophages in endometrial lesions.

One hundred and forty cases of endometrial lesions including 128 endometrial polyps, 7 cases of atypical hyperplasia and 5 cases of endometrial carcinoma were studied for mast cells and macrophages. Thirty six uteri with normal cyclic variations served as a control group. A cyclical variation in the mean mast cell value was observed in the control group with an increase in the secretory phase. Endometrial polyps showed a decrease in average mast cell count compared to the proliferative phase controls. Mast cells were significantly decreased in atypical hyperplasia and were absent in endometrial carcinoma. The observations indicate a hormonal basis for the significant variation in mast cell. Their presence probably suggests benign nature of the lesion. PAS positive macrophages were seen only in 4 endometrial polyps, too small for assessment of their significance.

Adult↗
PubMed1994

Peanut agglutinin binding by gastric mucosal epithelial cells in Helicobacter pylori associated gastritis.

Gastric biopsies (42) from patients with peptic ulcer disease were classified into Helicobacter pylori positive (32) and negative (10) groups, based on the results of tissue urease test and microscopic demonstration of spiral bacteria. A statistically significant difference in peanut agglutinin (PNA) binding between the two groups was observed, attributable to exposure of sialic acid residues on gastric epithelium in the H. pylori positive group. That the negative binding was due to sialic acid, was further confirmed by application of sialidase digestion technique. These results support the existing biochemical evidence for exposure of sialic acid residues on H. pylori colonized epithelium.

Adolescent↗