Abhinav Jain

Effect of orlistat on periostin, adiponectin, inflammatory markers and ultrasound grades of fatty liver in obese NAFLD patients

Orlistat is recommended in the treatment of obesity, which is an independent risk factor for nonalcoholic fatty liver disease (NAFLD). The reported findings of orlistat in NAFLD are divisive. Recently, periostin is identified as an important regulatory molecule in the pathogenesis of obesity-induced fatty liver. Therefore, this study aimed to evaluate the potential effects of orlistat in the treatment of NAFLD. A 16-week prospective observational study was conducted, with obese NAFLD patient (n=77) receiving orlistat (120 mg capsules, three times a day) with hypocaloric diet or hypocaloric diet only. Grades of fatty liver were determined using ultrasound (US) echogenicity of liver; serum levels of periostin, adiponectin, tumor necrosis factor (TNF)-α and interleukin-6 were determined using ELISA kits at 0 and 16 weeks. Correlations of US grades of fatty liver with these biomarkers were also determined. Orlistat significantly reversed the US grades of fatty liver (P=0.016), decreased serum levels of periostin (P=0.030) and TNF-α (P=0.040), and increased serum adiponectin levels (P<0.001) when compared with hypocaloric diet only. Serum interleukin-6 levels were not found to be significantly different in both groups after the treatment. In the orlistat group, the degree of reduction in grades of fatty liver was found to be positively correlated with the changes in serum levels of periostin (rs=0.306, P=0.041) and adiponectin (rs=0.314, P=0.036), whereas the associations were insignificant with the change in serum levels of TNF-α (rs=0.053, P=0.729). Mild gastrointestinal side effects (20%) were reported in the orlistat group. In conclusion, orlistat is effective in the treatment of NAFLD patients without fibrosis. This study demonstrated a positive association between the reduction of fatty infiltration in the liver and the changes in serum levels of periostin and adiponectin in obese NAFLD patients.

An Incidental Primary Papillary Carcinoma Arising in a Thyroglossal Duct Cyst: Report of a Rare Finding.

The thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of the thyroid, usually manifested as painless midline neck mass. Malignancy is very rare and is reported in around 1% of cases as an incidental finding after histopathological evaluation of resected cyst. Papillary carcinoma is the most common carcinoma reported in TGDC. Here, we report a case of 17-year-old-female, who presented with a gradually increasing midline neck mass which moves with swallowing. On imaging a diagnosis of infected TGDC was made. The Sistrunk operation was done and a diagnosis of primary papillary carcinoma arising in a TGDC was rendered histopathologically. The contemporary appearance of papillary carcinoma thyroid was reported in about 20% cases of TGDC carcinoma, thus it is essential to differentiate primary papillary carcinoma arising in a TGDC from those of metastatic papillary carcinoma thyroid by strict diagnostic criteria.

Cornual ectopic pregnancy: laparoscopic management step by step

Cornual (interstitial) ectopic pregnancy is an uncommon type of ectopic pregnancy which is located in the interstitial part of the fallopian tube. It accounts for 2%–4% of all ectopic pregnancies. Cornual pregnancies often pose a diagnostic and therapeutic challenge with a significant high morbidity and mortality as a result of massive intraperitoneal bleeding. A case of unruptured cornual ectopic pregnancy in a patient with abnormal uterine bleeding is reported which was successfully managed laparoscopically.

Unusual Histology in Hodgkin’s Lymphoma: Report of an Interesting Case

Hodgkin’s lymphoma has a significant presence in the Indian subcontinent. Microscopically, the hallmark of Hodgkin’s lymphoma (HL) is the Hodgkin and Reed-Sternberg (HRS) cell, which is usually surrounded by a cellular infiltrate of non-malignant inflammatory cells that constitute the majority of the tumor tissue. Cells which are known to be histologic mimics of HRS cells include immunoblasts, plasmablasts and rarely dendritic cells. We report a case of a 70-year-old male who presented with fever and lymphadenopathy. In the present case, the large cells with prominent nucleoli stained positively for both CD15 and CD30 and hence the possibility of angioimmunoblastic lymphadenopathy which was considered on the H&E-stained sections was excluded. In addition, noteworthy microscopic features in this case were angiogenesis and the presence of mast cells, both associated with a poor prognosis. The clinical impression was that of disseminated tuberculosis, but on histopathology, the final opinion was ‘Hodgkin’s lymphoma not classifiable with an unusual histology’. The aim of reporting this case is to highlight the unusual presentation in the form of prominent angiogenesis and mast cell infiltration in a case of HL, which is indicative of a poor prognosis.