Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

Mucormycosis is an opportunistic fungal disease that commonly presents as cutaneous or rhinocerebral infections associated with immunocompromised states. It may exceptionally present as isolated involvement of the brain with a varied clinical presentation, which may be difficult to diagnose early, leading to increased mortality. Herein, we report the case of a 42-year-old immunocompetent female with left-sided limb weakness and a history of recurrent vomiting and headache for the last two years. Clinically, glioma was suspected, but histopathological examination revealed a few broad aseptate fungal hyphae. As no other organ was involved, the diagnosis of isolated cerebral mucormycosis was rendered. Reporting this case, we show an unusual presentation of a central nervous system mucormycosis masquerading a tumor in an immunocompetent patient. The case also highlights the importance of a careful histopathological examination to avoid missing the presence of occasional fungal hyphae. Ideally, recognition of fungal hyphae in the brain, during intraoperative consultation, can prompt brain tissue culture for definitive diagnosis and early empirical antifungal therapy, which may prove life-saving.

Prevalence and distribution of various human papillomavirus genotypes in women with high risk for cervical carcinoma

Background: In India, cervical cancer is second most common cancer in women and is the second most common cause of death due to cancers in women. Human papillomavirus (HPV), mainly genotype 16 and 18, are responsible for most of the precancerous lesions of cervix and for cervical cancer. Therefore, it is necessary to prevent the spread of HPV infection and its early treatment to decrease cervical cancer associated morbidity and mortality. Aims of this study was to find out the prevalence and distribution of various HPV genotypes in women high risk for cervical carcinoma. To find correlation between HPV DNA test and cytology report.Methods: An observational study was done on a total of 384 women who were at a high risk for cervical cancer.  Ectocervix and endocervix samples for conventional cytology along with cervical swab collection for HPV DNA isolation were obtained from women aged 21-65 years. Multiplex real time PCR used for HPV DNA isolation and genotyping and Bethseda classification 2014 was used for reporting cytology. Statistical analysis was done using SPSS version 22 and Microsoft excel 2010 software. Data assessment was done using independent t-test, Chi-square test or Fisher’s exact test.Results: Prevalence of HPV in women high risk for cervical cancer in our study was 14.58%. Most common high-risk genotypes were HPV 18 (7.03%) followed by HPV 16 (6.51%). All genotypes except genotype 31, were more frequently seen as a single infection rather than a multiple infection. In 323 subjects which were negative for Pap smear, 31 were positive for HPV DNA showing a statistically significant result with a p value of <0.0001.Conclusions: It was analysed that infection with HPV is very common (9.60%) even in women who had a negative Pap smear test showing a positive correlation between the two tests. HPV DNA testing can improve the detection rate of cervical intraepithelial lesions.

Clinico hematological profile of pancytopenia in pediatric patients: an institutional experience in North Himalayan region of India

Background: Pancytopenia is a common clinical pattern with an extensive differential diagnosis, but literature search shows only limited studies of pancytopenia in Pediatrics patients in Uttarakhand state of India. The present study was therefore conducted to study the spectrum of pancytopenia with bone marrow and haematological profile in Pediatrics patients in this north Himalayan state of India.Methods: Prospective observational study was conducted in the Department of Pediatrics in the teaching institute situated in Uttarakhand state of India over a period of 12 months. The study included all the patients of pancytopenia below 18 years of age who underwent bone marrow examination after written informed consent.Results: The study included total 50 pediatrics patients of pancytopenia with male to female ratio of 1.38:1. The mean age of patients was 10.58±4.94 with median age of 12 years. Mean hemoglobin was 5.31±2.09 g/dl, total leukocyte count was 2492.68±941.76/mm3, platelet count was 34724±26423/mm3, mean corpuscular volume was 90.95±16.65 fl, mean corpuscular hemoglobin was 30.11±6.07 pg, mean corpuscular hemoglobin concentration was 33.06±1.65% and reticulocyte count was 1.21±1.10%. Nutritional deficiency (28%) was the most common cause for pancytopenia followed by aplastic anemia (24%). Megaloblastic anemia was the commonest cause of nutritional deficiency anemia (71.42%) with pancytopenia.Conclusions: Pancytopenia is an important presentation in Pediatrics population with the most common cause being nutritional anemia and aplastic anemia. Megaloblastic anemia is the commonest cause of nutritional anemia with pancytopenia. The clinicians should be aware of spectrum of pancytopenia with clinical and haematological presentation in Pediatrics patients of this region so as to avoid unnecessary work ups and delay in treatment.

Male Genitourinary Tumors : 14 Years Experience in Garhwal Region of India.

Genitourinary tumors may show varied clinical presentation and frequency in different regions of the world. The present study was therefore conducted to analyze the frequency, clinical presentation and the histopathological types of the various male genitourinary tumors diagnosed over a period of 14 years in a major teaching institute of north Himalayan region of India. Material and Methods: Retrospective study was undertaken in the Pathology department of the Institute which included all the cases of male genitourinary tumors which were diagnosed on histopathology from the time period between 1 Jan 1997 till 31st Dec. 2010. Results: The study showed that prostate was the most common site for male genitourinary tumors with prostatic adenocarcinoma as the most common histopathological type of tumor. Testicular Non- Hodgkin’s lymphoma constituted about 8% of total tumors in testes which mostly presented in elderly age group. Renal cell carcinoma (66.2%) was the most common tumor in kidney with much lower frequency of Wilm’s tumor (16.9%). Occasional rare tumors such as hemangioma of urinary bladder and schwannoma of penis were also seen over 14 years. Conclusion: The study concludes clinically patients were associated with more severe symptoms as they presented late to the hospital from the remote areas of this Himalayan region leading to late detection of tumors. Prostatic adenocarcinoma was the most common tumor while renal cell carcinoma was most common tumor in kidney. The present study provides valuable information to clinicians and pathologists regarding frequency, clinical presentation and histopathological types of male genitourinary tumors in this region which can be further used to formulate strategies for better management of these tumors.

Transbronchial needle aspiration with rapid on-site evaluation: A prospective study on efficacy, feasibility and cost effectiveness.

Background. Transbronchial needle aspiration (TBNA) has an established role in diagnosis of hilar and mediastinal lesions. Rapid on-site evaluation (ROSE) of TBNA smears can determine the adequacy of TBNA smears that can obviate the need for repeat procedures, thus avoiding added cost. There is paucity of data from India showing efficacy and cost-effectiveness of ROSE. Hence, this study was carried out to assess the efficacy, feasibility and cost implications of ROSE assisted TBNA. Methods. Forty consecutive patients undergoing TBNA were enrolled and ROSE was performed on TBNA smears. The results were analysed using a comparative study design. Results. It was found that 45% of patients would have required a repeat bronchoscopy due to inadequacy of material, if ROSE was not used. Inadequate smears were more common in benign aetiologies than malignant ones. TBNA of mass lesions and lesions with endoluminal bulge give better results than TBNA of lymph nodes and without endoluminal bulge. Conclusions. ROSE was found to increase the yield of TBNA and help to prevent repeat procedures. It proved to be simple, cost-effective and feasible in Indian settings.

Patterns of Glomerulonephritis in Uttarakhand State 13 Years Single Centre Experience at Teaching Institute.

Aims : Glomerular disease is considered to be a common cause of chronic kidney disease and its prevalence and histological pattern differ according to geographical area, race, age in different regions of the world. The present study was therefore conducted to study the pattern of different histological types of glomerulonephritis in this area of Uttarakhand region of India over an extended period of 13 years. Material and Methods : Retrospective study was conducted in the tertiary care centre of Uttarakhand state which included cases of different types of glomerulonephritis diagnosed on histopathology over a period of 13 years. Age, sex, clinical presentation, relevant investigations and the histopathological type of glomerulonephritis were noted for every case. Results : Histopathological examination due to various non-neoplastic renal diseases was done in total 218 cases and out of these glomerular diseases was diagnosed in 178 cases. Proteinurea and edema was the most common presentation. Primary glomerulonephritis was observed in 88.5% cases and secondary in 9.9%. Mesangioprolifrative glomerulonephritis was the most common primary glomerulonephritis and nephropathy due to amyloidosis was the most common type of secondary glomerulonephritis. Conclusion : The study concludes that primary glomerulonephritis is the most common renal disease with mesangioproliferative glomerulonephritis as the most common primary glomerulonephritis and amyloidosis nephropathy as the most common secondary glomerulonephritis which differs from other regions of world. The study may be useful to pathologists, nephrologists and health care providers to formulate a basic platform for effective diagnostic, therapeutic and research base for glomerular diseases so as to prevent its complications.

Myocardial Infarction Associated with Plasmodium Falciparum Malarial Infection.

Cardiac functions are almost well preserved in malarial infection. We report a rare case with fatal complication of myocardial infarction in patient with delayed diagnosis of Plasmodium falciparum infection. The authors therefore, suggest that every case of fever especially if associated with risk factor for cardiovascular disease should be immediately investigated for malaria so as to prevent this grave complication. This is even more important for people living in malarial endemic areas.

First ovarian maturity and recovery response in common carp, Cyprinus carpio after exposure to carbofuran.

The present study embodies the observations on duration (45, 75 and 105 days) dependent effects of toxicologically low concentration (16 ppm) of a carbamate pesticide, carbofuran, on first ovarian maturity with correlative recovery response by withdrawal of treatment for 30 days in virgin yearlings of common carp, Cyprinus carpio var. Communis. In control fish histological organization of ovary and changes in gonado-somatic index (GSI) revealed the initiation of oocyte differentiation and development at the commencement of experiment in December-January and peak of maturation with fully grown yolky oocytes was attained by the time of termination of experiment in the end of March. In carbofuran exposed groups ovaries exhibited retardation of development and growth evident by significantly decreased GSI and predominace of immature oocytes passing through nuclear-cytoplasmic degeneration of variable magnitude. Severity of degenerative changes was more pronounced with prolonged duration. In recovery group ovaries had experienced regeneration as clued by the presence of oocytes of differential stages including vitellogenic and fully grown oocytes. In liver histopathological changes coupled with significant decrease in hepato-somatic index (HSI) attributed hepatic inactivation in all exposure groups whereas in recovery group an increase in HSI value with marked sign of hepatic reactivation was evidenced. No significant change in values of condition (CF) and somatic condition (SCF) factors substantiated the over all normal health of fish. Lipid and water content of ovary, liver and muscle registered the significant decrease at 105th day of exposure with concomitant augmented value for recovery group. These observations suggest that the commercial formulation of carbofuran, even at this toxicologically low concentration, is equally capable of affecting the first ovarian maturity with associated physiological implications but with reversibility in toxicity by withdrawal of pesticide exposure attributing regeneration in affected organs in due course time.