Vijayanarayana Kunhikatta

The role of MMP-2 and MMP-9 as prognostic markers in the early stages of tongue squamous cell carcinoma

BACKGROUND Tongue cancer is the most common intra-oral malignancy with a high rate of morbidity and mortality owing to its increased propensity for tumor invasion and metastasis. These processes require a controlled degradation of the extracellular matrix. Matrix Metalloproteinase-2 (MMP-2) and Matrix Metalloproteinase-9 (MMP-9) are known to be important regulators of matrix lysis and play a significant role in the metastasis of malignancies. AIM AND OBJECTIVES To study the expression of MMP-2 and MMP-9 in the early stages of tongue squamous cell carcinoma and find the association between their expression and local recurrence, metastasis, and survival rates of the subjects. MATERIALS AND METHODS Fifty-nine tumor biopsy samples of tongue squamous cell carcinoma in T1 N0 M0 and T2 N0 M0 stages were immunostained with MMP-2 and MMP-9 antibodies. The immunohistochemical expression was compared with the patient characteristics and outcome. RESULTS Cytoplasmic expression of MMP-2 correlated with that of MMP-9 (r = 0.716, P < 0.001). Greater expression of MMP-2 and MMP-9 was observed in patients who subsequently developed local recurrence (P = 0.044 and P < 0.001, respectively), regional and/or distant metastasis (P < 0.001 and P = 0.001, respectively) of the tumor. Further, a higher expression of these biomarkers was associated with shorter survival. MMP-9 was found to have better specificity for local recurrence, metastasis and survival. CONCLUSION Our results showed that these biomarkers may serve as indicators of a patients risk potential for poor prognosis and presage the need for more aggressive treatment measures.

An appraisal of antibiotic sensitivity pattern and drug utilization in burn patients

Aim: To analyze the antibiotic sensitivity and resistance pattern and antibiotic consumption in defined daily dose (DDD)/100 bed days (BD). Materials and Methods: Burns patients admitted from January 2013 to December 2013 were identified retrospectively from medical record department registry using the International Classification of Diseases-(ICD) Codes T 30.1-39.9. Patient demographics, total body surface area (TBSA) of burn, treatment chart, hospitalization days, and antibiotic sensitivity/resistance profile were recorded. Cumulative sensitivity/resistance pattern of isolated microorganisms against various antibiotics was calculated (in percentage) from culture sensitivity reports. Total use of antibiotics in burn patients was calculated as DDD/100 BD using antibiotic consumption calculator-WHO ABC Calc version 3.1. Results: Of total 159 burn patients, the main cause of burns in these patients was thermal (81.8%). Cefoperazone-sulbactam (54.7%) was the most frequently prescribed antibiotic followed by amoxicillin-clavulanic acid (34%). Totally, 82 bacterial isolates were obtained, among which Pseudomonas aeruginosa (31.6%) was the most common organism. P. aeruginosa was sensitive to rifampicin and erythromycin but resistant to clindamycin. The DDD/100 BD was highest for parenteral cefoperazone (40.21). Conclusion: Proper antibiogram and DDD will facilitate conceptualizing and developing drug policies for improved patient outcomes in burns.