Study on Estimation of Serum Prostate Specific Antigen Level and Prostate Volume with Trans-Abdominal Ultrasonography Finding in Benign Prostate Hypertrophy at Tertiary Care Hospital : A Cross Sectional Descriptive Study

Introduction: The periurethral and transition zones of the prostatic gland develop benign prostatic hyperplasia and represent an inevitable phenomenon for the ageing male population. Prostatic specific antigen, is a serine protease, level rises in the blood if the barrier between thelining epithelium and the blood stream is damaged. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised. Prostate volume also increases according to age, which can be estimated by trans-abdominal ultrasonography. Objective: The aim of the study is to estimate the PSA level in blood and its relationship with prostate volume in benign prostatic hyperplasia patients. Methodology: It is a descriptive cross-sectional study which was carried out between a periods of 1st April 2018 to 31st March 2019 at Birat Medical College Teaching Hospital. All the patients diagnosed with benign prostate hyperplasia at the department of urology were included in the study. Blood samples of patients were analyzed for Prostate specific antigen level estimation by chemiluminescence immunosorbent assay. Prostatic volume of the patients was measured by Transabdominal ultrasound technique. Data were entered and analyzed in Microsoft Excel. Results: A total of 68 patients were diagnosed with benign prostate hyperplasia. The mean age of the patients was 61.8±12.3 years. The maximum number 23 of patients with BPH was there in age group 51-60. The maximum no of patients 38 were having their PSA level between the range of 4.0-10.0 ng/ml. The maximum no of patients 28 was having Prostate volume in the range of 40-60 gm. The maximum number of patients 31 was having diabetes mellitus as a co-morbid association. The maximum mean PSA level and prostate volume in the patients were observed in age group >80 years,which was 20.1±8.6 ng/ml and >80 gm respectively. Conclusion: The prostate specific antigen level and prostate volume both increase in advance age group of patients suffering with benign prostate hyperplasia.

The proteolytic inactivation of protein Z-dependent protease inhibitor by neutrophil elastase might promote the procoagulant activity of NETs

Septic shock is the archetypal clinical setting in which extensive cross talk between inflammation and coagulation dysregulates the latter. The main anticoagulant systems are systematically impaired, depleted and/or downregulated. Protein Z-dependent protease inhibitor (ZPI) is an anticoagulant serpin that not only targets coagulation factors Xa and XIa but also acts as an acute phase reactant whose plasma concentration rises in inflammatory settings. The objective of the present study was to assess the plasma ZPI antigen level in a cohort of patients suffering from septic shock with or without overt-disseminated intravascular coagulation (DIC). The plasma ZPI antigen level was approximately 2.5-fold higher in the patient group (n=100; 38 with DIC and 62 without) than in healthy controls (n=31). The elevation’s magnitude did not appear to depend on the presence/absence of DIC. Furthermore, Western blots revealed the presence of cleaved ZPI in plasma from patients with severe sepsis, independently of the DIC status. In vitro, ZPI was proteolytically inactivated by purified neutrophil elastase (NE) and by NE on the surface of neutrophil extracellular traps (NETs). The electrophoretic pattern of ZPI after NE-catalyzed proteolysis was very similar to that resulting from the clotting process - suggesting that the cleaved ZPI observed in severe sepsis plasma is devoid of anticoagulant activity. Taken as a whole, our results (i) suggest that NE is involved in ZPI inactivation during sepsis, and (ii) reveal a novel putative mechanism for the procoagulant activity of NETs in immunothrombosis.

Solitary Lung Metastasis From Primary Prostate Cancer With Normal Prostate Specific Antigen Level: a Case Report and Literature Review

Background: Pulmonary involvement from prostate cancer is a well-known condition, but solitary lung metastasis is rare, with its associated clinical characteristics not yet fully elucidated.Case presentation: A 77-year-old man, with a history of radical prostatectomy for primary prostatic carcinoma 14 years prior, presented to our institution with a low-grade fever. Upon consultation, biochemical recurrence was suspected due to a gradual increase in prostate-specific antigen level. Salvage radiation therapy was considered but not performed since there was no recurrent macroscopic tumor. Computed tomography showed a solitary nodule with spiculation located on the upper lobe of the left lung while positron emission tomography suggested malignancy without metastasis. Based on these findings, primary lung cancer was suspected and thoracoscopic left upper lobectomy with lymph node dissection was performed. Pathological diagnosis of the tumor was a solitary lung metastasis of prostate cancer. The postoperative recovery was uneventful. Conclusion: We report a case with normal prostate-specific antigen level, along with a literature review. According to previous case reports, there are some pitfalls leading misdiagnosis as a primary lung tumor. However, we consider that surgical resection is associated with increased diagnostic accuracy and long-term survival.

MO980OUTCOMES OF RABBIT ANTI-THYMOCYTE GLOBULIN VERSUS IL-2 RECEPTOR ANTAGONIST INDUCTION THERAPIES IN 2DR MISMATCH RENAL TRANSPLANT RECIPIENTS

Background and Aims 2DR HLA mismatch indicates high immunological risk renal transplant. Induction therapy with rabbit Anti-thymocyte Globulin (r-ATG) and IL-2 Receptor Antagonist (IL-2RA) resulted in marked reduction of acute allograft rejection rate and improved graft survival. However, the outcomes in 2DR (HLA-DR) mismatched renal transplant recipients (RTRs) in the era tacrolimus-mycophenolate mofetil maintenance immunosuppression remains understudied. Method This was a retrospective cohort study using data from the United States Organ Procurement and Transplantation Network, all 2 DR mismatched RTRs who were maintained on tacrolimus and mycophenolate mofetil immunotherapy between 2005 and 2015 were included. Follow up data was until September 2020. Patients who received transplants from living donors were included in the study. Collected data included recipient factors (age, sex, ethnicity, diabetes, body mass index), transplant factors (delayed graft function, cold ischemia time, number of previous transplants, panel reactive antibodies, HLA-mismatches, induction therapies, maintenance immunotherapy, and donor factors (donor type, donor age). RTRs were divided into 2 groups: based on induction therapy r-ATG and IL-2RA. Instrumental variable regression models were used to assess effect of induction therapy on acute rejection episodes at 6 months post-transplant and on graft survival. Type of induction therapy was instrumented for the transplant centre to reduce the centre effect on the choice of the induction therapy. Cox proportional hazard regression analysis was performed to assess the effect of induction therapy on graft survival. The regression models were adjusted for collected recipient, donor and transplant factors. Results 3052 patients received IL2-RA while 5143 patients received R-ATG induction. Using instrumental variables regression models, there were no significant differences between IL2-RA versus R-ATG induction in acute rejection episodes (OR=1.49, 95% CI ranges from 0.73 to 3.05, P=0.27), or graft survival (coefficient=0.95, 95% CI: -0.18 to 2.10, P=0.10). Using Cox proportional hazards regression, there was no significant difference in graft survival between either induction therapies (HR=0.90, 95% CI: 0.74 to 1.09, P=0.29). Conclusion This study showed no significant difference in acute rejection episodes or graft survival when using ATG or IL-2RA in 2DR HLA mismatched renal transplant recipients in the current tacrolimus-based maintenance immunosuppression era. Therefore, IL2-RA is a safe induction therapy in this group of patients and non-inferior to R–ATG induction therapy. Moreover, this study also highlights the fact that antigen level 2DR mismatches are not a risk factor for rejection and HLA matching should be based on epitope level rather than antigen level.