Invasive growth requires degradation of extracellular matrix. Altered expression of matrix degrading enzymes may indicate an increased potential for invasive growth. We determined the expression patterns of matrix-metalloproteinases (MMP)-1, -2, and -3 and of the tissue inhibitors of metalloproteinases (TIMP)-1 and -2 by in situ hybridization with isotopically labeled RNA probes in normal breast tissue (n=6), fibrocystic disease (n=20), five cases of which contained radial scars, lobular carcinoma in situ (CLIS; n=5), ductal carcinoma in situ (DCIS; n=9) and invasive carcinomas (n=24). Only a few cells displayed MMP-1- and MMP-2-specific labeling in normal breast tissue and fibrocystic disease. Noninvasive ductal carcinomas showed elevated MMP-2 transcript levels in peritumor stromal cells in the absence of significant MMP-1 specific signals. In general, compared with adjacent normal breast tissue, a gradual increase of MMP-2 was found in noninvasive to invasive cancers. Invasive ductal and lobular carcinomas displayed co-expression of MMP-1 and MMP-2 by stromal cells, mainly of the invasion front, with high signal intensity particularly in high-grade invasive carcinomas. Tumor cells and peritumor stroma showed low MMP-3 transcript levels, especially in medullary carcinomas. TIMP-1 and -2 transcript levels were increased in invasive carcinomas correlating with the histological grade. These RNA expression patterns suggest an increased invasive potential in breast carcinomas even prior to histologically overt invasive growth.

TMS may be beneficial for depressed PD patients in multiple functional domains.

A 61 year old man developed acute pulmonary embolism while in hospital. His previous and admission electrocardiograms (ECGs) showed a typical left bundle branch block (LBBB) pattern. Immediately after the onset of acute pulmonary embolism, LBBB disappeared from his body surface ECG with sinus bradycardia, normalisation of QRS duration, prolonged QT interval, and marked T abnormalities to the right precordial leads. Recovery from pulmonary embolism resulted in reappearance of his left bundle branch pattern. Delayed conduction of the previously unaffected right bundle branch resulting in roughly equivalent onset of ventricular activation is the most likely reason. Rate dependent LBBB is also discussed.

Objective: To determine the association between the consumption of carbonated drinks and development of kidney stones. Study Design: Matched Case-control study. Setting: Liaquat National Hospital Karachi, Pakistan. Period: June 2017 to December 2017. Material & Methods: We recruited patients of nephrolithiasis admitted in Nephrology ward at Liaquat National Hospital as cases and controls from General Surgery ward. The sample size calculated was 186, with 93 cases and 93 controls, matched for age. Descriptive statistics of socio-demographic variables were computed. Multivariate logistic regression analysis was applied to determine the association between predictor and outcome variables. Results: A total of 186 patients participated in the study. Mean ages of the cases and controls were 34.92 (SD: 16.81) years and 31.76 (SD: 14.49) years, respectively. Around 66% of the cases and 75% of the controls had formal education. Approximately 16% of the cases and 10% of the controls were consuming soft drinks daily. Of them 77% were taking for more than 5 years. In multivariate analysis, we were unable to find significant associations between intake of carbonated drinks and kidney stones. However, the adjusted matched odds ratio (adj. mOR) for calcium intake was 6.36 (CI: 1.81- 22.33) and for caffeine intake was 7.9 (CI: 2.12 – 30.04). Those who had a past history of kidney diseases were at higher risk of developing kidney stones (mOR14.5; CI: 3.20- 65.76). Conclusion: The Study did not show any significant association of kidney stones with the intake of carbonated drinks. However, further longitudinal studies are required in order to confirm or refute any association between intake of carbonated drinks and nephrolithiasis.

Objective: To evaluate the anatomical positions of vermiform appendix and its association with acute appendicitis on Multidetector computed tomography (MDCT). Study design and setting: A cross sectional study based on hospital database was carried out in Department of Anatomy in collaboration with Department of Radiology, Liaquat National Hospital. Methodology: A total of three hundred and six 306 adult urban patients CT axial images were evaluated retrospectively over period of 6 months from March 2021 to August 2021 who had abdominal MDCT scan for acute abdomen after getting approval from ethical committee to find out anatomical variations of position of vermiform appendix in a tertiary care hospital among adult urban Karachi population and its association with appendicitis. Data was analyzed using SPSS version 25. All categorical variables were summarized as frequencies and percentages. Result: In present study 159(52%) were males and 147(48%) were females with mean age of 32.97 years. The subcecal anatomical position of vermiform appendix on MDCT was most common n=85(27.8%), followed by postileal n=78(25.5%), pelvic n=61(19.9%), postcecal n= 36(11.8%), preileal n=29(9.5%), ectopic n=17(5.6%). The association between appendicitis with anatomical position of vermiform appendix and age was analyzed by chi- square and was statistically significant (p =0.05). There was no significant association between position of vermiform appendix on MDCT and gender. Conclusion: The subcecal position of vermiform appendix is most common on MDCT and the postileal position was more frequent in the inflamed group of vermiform appendix