Nay Thi Tun is currently in Residency Training of Internal Medicine Program in Easton Hospital, PA. She has obtained M.B.B.S in Yangon, Myanmar. She has done her residency training in Central Women’s Hospital in Yangon, Myanmar for Obstetrics and Gynecology. At present she is a committee member of “Blood Blank” in Easton Hospital and “Instiutional Review Board” in Easton Hospital as well as she is an acting as a student coordinator. She has participated in many medical meetings and publishes number of research works.
Epithelioid hemangioendothelioma (EHE) is a variant of epitheloid vascular tumors that originates from the vascular endothelium. EHE was first described by Weiss and Enzinger in 1982, and has been found in skin, lung, pleura, liver, bone, brain, heart, and other organs. The etiology of EHE remains unclear. Genetically, the translocation t (1;3)(p36.3,q25) has been found in two EHE cases. Although EHE is considered an intermediate malignancy between hemagioma and angiosarcoma, the clinical behavior of this vascular tumor is unpredictable. Management of EHE remains a therapeutic challenge due to the extremely low incidence of this vascular tumor, variable disease courses with different responses to surgery, chemotherapy or anti-angiogenic agents. We are presenting the case of a young woman who was diagnosed with metastatic EHE to liver and lung at the age of 26 years old. She was initially treated with Adriamycin without response, and subsequently chemo-embolization of bulky left hepatic disease that was causing intractable abdominal pain and left shoulder pain. Further progressive disease was managed with left lateral segmental hepatectomy, which was combined with aggressive loco-regional management of additional metastatic lesions with cryoablation and radiofrequency ablation. Unfortunately, the tumor relapsed about two years and nine months after this aggressive surgical approach. She then began treatment with interferon alpha 2b for approximately seven years, attaining a complete hepatic clinical remission on PET/CT after the first three years of treatment. She has been off treatment since March 2010, and to-date she remains free of disease with a Karnofsky scale of 100. The patient has therefore had a durable clinical response to interferon alpha 2b for more than ten years, with a complete hepatic clinical response for more than seven and a half years, since May 2006. One of the mechanisms of action for alpha interferon has been shown to be anti-angiogenesis, and it is possible that it is this mechanism of action that has successfully controlled this patient's aggressive metastatic EHE. Therefore, alpha interferon should be considered as a potential treatment for metastatic or recurrent metastatic EHE, since our patient has had a durable clinical response to alpha interferon for more than a decade since the treatment was initiated.
Dr. Ramakrishna Pai Jakribettu and Dr. Rekha Baloor M.D are affiliated with Father Muller Medical College - Department of Microbiology, Dr. Manoj P Rai - has been working as a research assistant Weill Cornell Medical College NY from past 1 year, Dr. Shridhar Avabrata M.D - Associate professor of Pediatrics, Father Muller Medical College, India. Andrew Thaliath is currently an Intern in Father Muller Medical College and Dr. Manjeshwar Shrinath Baliga Phd is the research chair for Father Muller Medical College, India.
During the course of Dengue infection, IgM is detected around 3-5 days following the onset of illness, reaching peak levels around 10th day to reach undetectable levels at 2-3 months. IgG dengue-antibody appears during first week of illness and has been noted to persist lifelong (WHO - 1997). Levels of Dengue IgM antibody during secondary dengue infection is significantly lower and undetectable compared to primary dengue infection. Hence, both dengue IgM and IgG antibody profiling are required for identification of secondary dengue infection (WHO.1997). A total of 69 of dengue positive and 93 dengue negative children aged <18 from Father Muller medical college, Mangalore with serological diagnosis based on Dengue NS1Ag and differential of IgM and IgG antibody results and IgM ELISA confirmatory test are enrolled. Correlation - Hemoglobin (p = 0.0003 r = 0.236), Total Count (p =< 0.001 r = -0.504), Platelet (p=<.001 r= -0.741). The results show statistically significant negative correlation for Total Count and platelet counts with stage of dengue determined on the basis of antibody type. Thus careful monitoring of hematological parameters at different time points of illness and its correlation with antibody typing could be helpful for evaluation of prognosis and careful interventions to curtail the complications would result in reduction of morbidity and mortality.