Phyllodes tumor is a rare benign breast cancer that carries malignant potential. Malignant phyllodes tumors are histologically sarcomas as they originate from the connective tissue of the breast. We present a case of a 38 year old female who presented with complaints of a slow growing painful lump in her left breast over for one and a half year that later ruptured and became necrotic. She was operated upon with a provisional diagnosis of a fungating breast growth; however, subsequent histopathology report confirmed the tissue as a malignant phyllodes tumor.

BACKGROUND: Dietary habits and physical activity play an important role in maintaining a healthy body mass index. Studies among medical students worldwide report high burden of underweight (10 to 20.5%) and obesity (11.7 to 23.1%). This study was conducted to assess the nutritional status among undergraduate medical students of a medical college in Tamil Nadu, India and to examine the association of nutritional status with dietary practices and physical activity.

 METHODS: A cross sectional study was conducted among undergraduate medical students (final year MBBS, Part I) of a medical college in Tamil Nadu, India. A standardized, semi-structured questionnaire was used to collect data on dietary habits and physical activity. Body weight and height was recorded using standard methods and body mass index (BMI) was calculated. BMI 18.5 to 22.9 kg/m² was defined as normal, < 18.5 kg/m² as underweight, ≥ 23 to 24.9 kg/m² as overweight and ≥ 25 kg/m² as obese. Appropriate statistical tests were used for analysis.

RESULTS: Eighty-five students (56.7%) were in the normal BMI range, 15 students (10%) underweight, 36 students (24%) overweight and 14 students (9.3%) were obese. Factors such as fruit intake, duration of physical activity, sleep and sedentary behavior had significant association with nutritional status (p < 0.05).

 CONCLUSION: The frequency of underweight and overweight is high among medical students. This study reinforces the need for creating awareness among this population regarding positive effects of normal nutritional status and adoption of healthy lifestyle habits.

BACKGROUND: 5 HT-2A receptor gene polymorphisms are associated with various psychiatric disorders, including anxiety and depression. However, no study has investigated 5HT 2A gene polymorphisms in anxiety and depression in a distressed society such as a conflict area. To study 5HT-2A -1438 A/G single nucleotide polymorphism in depression and anxiety disorders in India-controlled Kashmir.

METHODS:  Thirty patients with depression disorders, 31 patients with anxiety disorders, and 40 unrelated healthy volunteers (controls) were studied in a case-control study design. Polymorphism was determined using polymerase chain reaction and agarose gel electrophoresis after digestion with the restriction enzyme MspI. Genotypes and allele frequencies were compared using chi square and Fischer’s exact tests, and p value of <0.05 was considered to be statistically significant.

RESULTS: The mean±standard deviation of age for the anxiety, depression and control groups was 33.5±11.7, 32.4 ± 9.9 and 29.7 ± 10.1 respectively and was not statistically significant (p= 0.32). In the anxiety group, GG genotype (41.9 %) was significantly more prevalent (p= 0.045) than the control group (17.5%). Similarly, depression group had higher prevalence of GG genotype (50%) (p=0.004) than the control group (17.5%). Comparison of allelic frequencies found a statistically significant excess of G allele in the depressive group (68.3%) as compared with the control group (36.2%) (P ≤0.0001, OR=3.8 (1.9 to 7.7).

CONCLUSION: In a conflict area, we found that the -1438 A/G single nucleotide polymorphism in the promoter region of 5HT-2A gene was associated with anxiety and depressive disorders. Our findings confirm the role of this locus in psychiatric disorders and further show that the association remains robust in a distressed society.

We report the first known case of synchronous infratentorial glioblastoma multiforme (iGB) associated with a frontotemporal oligodendroglioma. A 44 year old female presented to the Neurosurgical clinic with a 2 month history of vomiting which was projectile in nature. It was associated with generalized body weakness and one episode of altered mental status where she was described to suddenly fall out of bed and start praying in a loud voice. There was no hematemesis or association with food intake or seizures. There were no known co-morbidities and a negative family history. She was repeatedly treated with anti-emetics and antibiotics prior to presentation before having an MRI which showed space occupying lesions in two different areas of the brain along with obstructive hydrocephalus. The patient made an uneventful recovery following surgery however she expired one week after discharge while undergoing oncological review.

Staphylococcus haemolyticus is a commensal on skin in human beings and a member of coagulase negative staphylococci (CoNS). It is abundantly found in inguinal areas, perineum and axillae. S. haemolyticus is a well-known opportunistic pathogen and the most recurrently isolated among CoNS after S. epidermidis. It is the second most frequent cause of nosocomial infections associated with the insertion of medical devices. Staphylococcus haemolyticus also represents a multi-drug resistant phenotype recognized among CoNS. Its ability and pattern of forming bio-films that are different from other staphylococcus species makes it a complicated pathogen to treat. A multidisciplinary approach towards the awareness and control of infections due to CoNS will reduce the disease burden. This review describes the characteristics of S. haemolyticus along with mechanism of antimicrobial resistance, pathogenecity and clinical importance.

BACKGROUND: VEGF (vascular endothelial growth factor) is one of the growth factors, which directly affects vascular endothelial cells and evokes proliferation, migration and chemotaxis of endothelial cells. Studies have provided inconsistent results about the expression of VEGF in the squamous cell carcinoma (SCC) or oral mucosa. The purpose of the present study was to assess the frequency of VEGF expression in oral normal, dysplastic and SCC mucosa

METHODS:  In this analytical-descriptive study, formalin fixed and paraffin embedded tissue of 20 normal mucosa, 20 dysplastic mucosa, and 20 SCC were studied for the expression of VEGF, using immunohistochemical technique and standard Biotin Streptavidin method. The results were analyzed by Kruscal Wallis and Mann Whitney tests.

RESULTS: The mean expression of VEGF in SCC was 24.65, 16.35 in dysplastic mucosa and 15.5 in normal mucosa. VEFG expression was significantly higher in the SCC group as compared to the dysplastic group (p=0.02) or normal group (P=0.001). On the other hand, there was no difference in the VEGF expression between the dysplatic mucosa and normal mucosa groups (p=0.11)

CONCLUSION: VEGF expression is significantly higher in the SCC group as compared to dysplastic and normal mucosa. Our results highlight the importance of vascular development in the development of SCC or oral mucosa and suggest possible therapeutic modalities targeted to VEGF and/or vascular development.

Cavitary pulmonary tuberculosis (TB) is extremely rare in infancy. Cavitation in lung in an infant usually suggests the diagnosis of staphylococcal pneumonia or congenital anomaly. Here we are reporting a 7 month, BCG vaccinated infant who presented with high-grade fever and cavitation on the chest x-ray.  Reverse contact tracing did not reveal TB in parents or close relatives. We established the diagnosis of tuberculosis by demonstrating acid-fast bacilli in his gastric aspirate by smear and culture. We suggest that even in absence of suggestive history of TB, early morning gastric aspirate should be examined in all cases of non-resolving cavities in infants.

BACKGROUND: Development of taste in higher organisms is fascinating yet poorly understood among the five senses. Many events including the development of taste receptors, neuronal connections and the gustatory cortex determine the overall advent of taste in a human fetus. This study was designed to assess the changes in the tongue epithelium of human fetuses over the age group of 14 to 20 weeks.

METHODS:  Sagittal sections of tongue from 5 human fetuses of ages ranging from 14 to 20 weeks were used to study the appearance of taste buds under light microscope using hematoxylin and eosin staining, and also to observe the expression of synaptophysin, a 38 kDa integral membrane protein using immunohistochemistry with anti-synaptophysin monoclonal antibody.

RESULTS: With increasing age, an increase in the number of papillae on the dorsum of tongue was noted with maturation from primary to secondary papilla. In the 22 week fetus, probable taste buds were identified, which showed higher level of cellular organization. Faint expression of synaptophysin was seen in the epithelium and within the muscle layer in age groups of 20th and 22nd weeks, suggesting the beginning of synaptogenesis and vesicle formation in the 20 and 22 week old fetuses. From 16th week onwards, lingual glands were observed in the posterior part of the tongue, another important observation regarding taste development.

CONCLUSION: The work indicated that the maturation of taste buds and synaptic vesicles in human fetal tongue epithelium had started at around 20-22 weeks of age. This observation will pave the way for future understanding of the development of taste reception in utero.

Bomb explosions frequently cause devastating multiple injuries (polytrauma).  Medical students should have an appreciation of the pattern and mechanism of the injuries caused by bomb blast and the early care of the injured.  This review focuses on the traumatic brain injury (TBI) caused by bomb blast including the pattern of injury, the multidisciplinary aspects of the treatment, the surgical principles and the prognosis. The outcomes of severe blast TBI’s are generally better than high velocity gunshot wounds to the brain.  The best outcomes will occur when well-developed trauma systems are in place.