CONTEXT: Survivin is an inhibitor of apoptosis that is selectively over-expressed in common human cancers, but not in normal tissues, and that correlates with aggressive disease and unfavorable outcomes. AIMS: To identify the role of survivin in bladder carcinogenesis and the correlation between survivin protein expression and the occurrence of spontaneous apoptosis, proliferative activity of cancer cells. SETTINGS AND DESIGN: Retrospective analysis. METHODS AND MATERIAL: Bladder transitional cell cancer (BTCC) tissue samples for 128 patients were investigated, with normal bladder tissues serving as controls. From these tumor samples, 42(32.8%) were grade I, 59(46.1%) were grade II, and 27(21.1%) were grade III; 72(56.2%) were superficial, 56(43.8%) were invasive. The survivin protein level was quantified by Western blot analysis. The apoptotic index (AI) using in situ labeling apoptotic DNA fragment kit and the Ki-67 labeling index (Ki-67LI) with an anti-Ki-67 monoclonal antibody were analyzed in these tumors, respectively. STATISTICAL ANALYSIS USED: Differences in the S/β ratio between tumor grade and stage were evaluated by using unpaired t-test and F-test. The relationships between the S/β ratios and AIs, Ki-67LIs of tumors were evaluated by Pearson correlation coefficient. RESULTS: High survivin levels were detected by Western blot analysis in tumor tissue extracts. None of the expression of survivin protein was found in normal bladder tissues. Survivin levels were significantly different from different clinical stages and pathological grades of the tumors (P < 0.05, respectively). Spearman rank correlation test revealed a positively correlation between survivin protein level and the proliferative activity (P < 0.001) and failed to find significant correlation between AI and survivin protein level (P > 0.05). CONCLUSIONS: Survivin protein expression played an important role in the malignant progression of BTCC.

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BACKGROUND: As adolescent tobacco use has been found to be a major predictor of future use, preventive efforts need to be focused on this section of population. OBJECTIVES: To assess the role of knowledge regarding tobacco, risk-taking attitude, peers, and other influencers on tobacco and areca nut use, amongst adolescents. SETTINGS AND DESIGN: A school-based cross-sectional study covering two schools. Students of classes IX and XI, of selected schools, participated in the study (n = 596). METHODS: A pretested and validated, close ended, self-administered questionnaire was used. Sociodemographic factors, awareness regarding tobacco, risk-taking attitudes, role of peers and other influencers, and tobacco, areca nut and alcohol use, were studied. Statistical analysis: 0 Point estimates, 98% Confidence Intervals, tests of significance, bivariate and multivariate analysis (multiple logistic regression). RESULTS: Almost 42% of tobacco users started before the age of 12 years. Peer pressure, general stress, and media were important influencers. Logistic regression analysis showed that students in public school were using more tobacco [Odds ratio (OR) = 1.85, P = 0.174] and tobacco/areca nut (OR = 1.14, P = 0.02). The difference in use between the genders and class in which studying was statistically not significant. Lesser proportion of those possessing adequate knowledge regarding tobacco used it as compared to those without adequate knowledge (OR = 0.13, P < 0.001) however, possession of adequate knowledge was not a good predictor of areca nut consumption (OR = 0.86, P = 0.585). The most important correlate for tobacco use (OR = 6.41, P < 0.001) and areca nut use (OR = 11.17, P < 0.001) was risk-taking attitude. CONCLUSION: Multipronged and concerted efforts targeting children at an early age are required to prevent tobacco and areca nut use among adolescents.

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A 55-year-old man presented with intermittent episodes of urinary leak through the left groin following an abscess drainage at that site at the age of 5 years. Since then he had been suffering from recurrent urinary tract infections and urinary leak, which used to be treated symptomatically. Intravenous urogram (IVU), voiding cystourethrogram (VCU), and cystoscopy done in our institution revealed a bladder diverticulum with a stone in situ, which was communicating with the fistulous opening located in the left groin. Diverticulectomy and excision of the fistulous tract cured the patient. A long-standing fistula arising from a bladder diverticulum at relatively distant site is of extreme rarity. Vesicocutaneous fistula from an iatrogenic injury to vesical diverticulum resulting from a groin surgery has not been reported so far.

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Mediastinal compression syndrome is a commonly seen entity. Mediastinal compression, mostly due to a space-occupying lesion, is distinct and different from mediastinitis/mediastinal fibrosis, which could also lead to superior vena cava syndrome. Idiopathic mediastinal fibrosis should also be considered as differential diagnosis of mediastinal structures with various radiological, CT and MRI and histological features if feasible. Medical therapy is disappointing while surgical cure has limitations. This interesting patient presented as mediastinal compression syndrome, which on investigation was postulated as idiopathic mediastinal fibrosis, as a diagnosis on exclusion of other causes, which is rare, hence is being reported.

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BACKGROUND: DNA fingerprinting of Mycobacterium tuberculosis (MTB) based on IS6110 has been shown to be a powerful epidemiologic tool. Restriction enzyme analysis (REA) is a fingerprinting technique, which is used for differentiation and investigation of genetic diversity among mycobacterial species. AIMS: To investigating the genetic heterogeneity in MTB isolates in Ahvaz, Iran. SETTINGS AND DESIGN: It was a cross-sectional study conducted in Ahvaz, Iran. METHODS AND MATERIAL: One hundred and eighty clinical isolates of MTB were collected from TB reference unit, PHLS, Ahvaz, Iran. The PCR-REA employed uses a simple DNA extraction followed by a PCR step involving a single primer based on the insertion sequence IS6110. Restriction enzyme analysis was performed on the amplification products using HaeIII enzyme. STATISTICAL ANALYSIS: Data was analyzed using SPSS software and chi-square test/Fishers' exact test was applied wherever applicable. RESULTS: The isolates were divided into four clusters based on their REA patterns. Cluster I contained 71.1% of strains with two fragments of 72 and 118. Cluster II with three fragments of 72, 118, and 194; cluster III with three fragments of 118, 194, and 234; and cluster IV with four fragments of 72, 118, 194, and 234 base pairs. As many as 73.8% of the identical fingerprint patterns were seen in male patients. Accounting the men as the major population in the study, there was no significant difference between REA patterns and sex; similarly, with age, patients' occupation and degree of smear positivity. However, we found significant correlation between REA patterns and patients' origin. As many as 61.6% of identical patterns were found in the patients who were lived in the same suburb. CONCLUSIONS: By PCR-based REA typing, the isolates studied were grouped into four clusters each containing between two and four fragments. However, in order to ascertain the level of heterogeneity of MTB isolates in their sample, further testing with a more discriminatory method is needed.

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Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of 4 years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of 6 months to evaluate the progress of disease. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions.

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