Histomorphological Patterns in Myocarditis in Postmortem Specimens- A Descriptive Observational Study over a Period of 4 Years at a Tertiary Care Centre in Kerala.

In cases of sudden death, myocarditis is not an unusual finding especially when communicable diseases of viral origin are on the rise. Detection of myocarditis poises a diagnostic challenge to clinicians due to the absence of specific symptoms and there is a possibility of this being masqueraded as myocardial infarction. Examination of autopsy specimens are of utmost importance to detect the underlying etiology. For diagnosis of myocarditis histopathological examination of cardiac tissue is the gold standard. This is carried out based on Dallas criteria.Aim- This study was done to assess the, gross and histopathology findings in myocarditis in post mortem specimens in a tertiary care hospital in Kerala over a span of 4 years.METHODSThis is a descriptive observational study. All cases of Myocarditis diagnosed in the Department of Pathology, Medical College, Kottayam during the period of 4 years from January 2012 to December 2015 were included. Age distribution, gross and histopathologic findings were studied using the registers, post mortem specimens and histopathology slides in the department. Immunohistochemical studies were done in paraffin blocks of all newly diagnosed cases of myocarditis and some previously diagnosed cases the data was analyzed using SPSS.RESULTSWe received a total of 82 cases of myocarditis. The age distribution ranged from 75 days to 83 years. There was greater predilection for males accounting for 62% of cases. Inflammation was found in all cases and the predominant inflammatory cells were lymphocytes seen in 73% of cases. Myocyte necrosis was found in majority of the cases (98%).CONCLUSIONSMyocarditis was found to be an important cause of sudden death accounting for 0.15%.The age group affected was more in the 3rd and 4thdecade,which was comparable with other similar studies. Viral myocarditis constituted the majority of cases and mononuclear inflammation was seen in myocardium. Myocarditis was seen as part of systemic inflammation in 70% of cases. Application of Dallas criteria was helpful in diagnosis but correlation with clinical details and meticulous examination of coronaries are also needed to exclude conditions which may mimic myocarditis.

Detection of parvovirus B19 in selected high-risk patient groups & their phylogenetic & selection analysis

Background & objectives: Human parvovirus B19V (B19V) is known to be associated with erythema infectiosum commonly in children, aplastic crisis, especially in persons with underlying haemolytic disorders, hydrops fetalis in pregnancies and arthritis. This cross-sectional study was aimed to determine the presence of B19V infection in childhood febrile illnesses, association of B19V with arthropathies and in adult patients with end-stage renal disease (ESRD) on dialysis. The genetic diversity among the sequences was also analysed. Methods: A nested polymerase chain reaction (nPCR) assay was used for B19V DNA targeting VP1/VP2 region and used for testing 618 patients and 100 healthy controls. Phylogenetic analysis on nucleotide and amino acid sequences was carried out to compare our sequences with other Indian strains and global strains. Results: Among 618 samples tested, seven (1.13%) were found positive. The phylogenetic analysis revealed that all the seven sequences belonged to genotype 1 and showed low genetic diversity. The clustering pattern of seven sequences was similar both by nucleotide and by predicted amino acid sequences. The fixed effects likelihood analysis showed no positive or negatively selected sites. Interpretation & conclusions: Seven samples (4 from non-traumatic arthropathies, 2 from patients with ESRD and 1 from febrile illness patient) were found positive by nPCR. When our seven sequences were compared with global strains, the closest neighbour was other Indian strains followed by the Tunisian strains.

Frequency of extended spectrum β-lactamase producing urinary isolates of Gram-negative bacilli among patients seen in a multispecialty hospital in Vellore district, India.

Extended‑spectrum beta‑lactamase (ESBL) producing strains of Coliform bacilli are on the rise and present a major threat especially in India. We assessed the frequency of ESBL producers among urinary isolates from patients presenting urinary tract infections. ESBL screening was done using Double Disk Synergy Test (DDST) and confirmed using E‑test and Polymerase Chain Reaction (PCR). With E‑test, 92.2% were positive for ESBL. In PCR, 100% strains were positive for any of the three gene targets tested. CTX‑M was positive in majority of the strains followed by TEM and SHV. Two (3.22%) strains were positive for all the three genes; 21% strains were positive for both TEM and CTX‑M genes. There was no statistically significant difference in the findings of E‑test and PCR testing in the determination of ESBL producers (Fisher exact test P = 0.15). The strength of agreement between them was ‘fair’ (k = 0.252). Continuous monitoring of ESBL producers among Indian strains is important to rationalize the antibiotic policy to be followed.

Molecular characterization of CTX-M type Extended Spectrum Beta Lactamase producing E. coli isolated from humans and the environment.

Purpose: Escherichia coli is a common pathogen causing community- and hospital-acquired infections. The infections caused by the Extended Spectrum Beta Lactamase (ESBL) enzymes-producing E. coli hinder antibiotic treatment. Materials and Methods: Plasmid DNA samples were subjected to PCR specifi c for TEM, SHV and CTX-M genes obtained from 110 E. coli strains isolated from hospitalized patients, healthy individuals and environment in Vellore, South India. Results: Among the 110 isolates tested, 21.8% were positive for TEM and 2.7% positive for SHV and 91.8% positive for CTX-M. The proportion of CTX-M positive E. coli was not statistically different between the study groups. Nineteen of 20 strains were CTX-M-15 type and the other was CTX-M-14 type. The phylogenetic analysis of 19 strains clustered with the pandemic CTX-M-15-ST131 strain, indicating this as an evolving global problem for antibiotic therapy. The geomapping of samples indicated ‘hotspot’ areas of healthy individuals, patients and the environmental samples. Conclusion: The spatial presentation of GIS mapping allowed identifi cation of clustering among patients and healthy individuals and contaminated environmental points.

Comparative Morphological and Anatomical Study on Thymus Gland of Human and Primate.

Context: The comparative morphological and anatomical study on thymus was carried out in human and primate. The prenatal stage of Macaca radiata was selected for the present study. Study Design: Cross sectional analytical type of study. Place and Period of study: Department of Anatomy, Dr. A.L.M. PG Institute of Basic Medical Sciences, Chennai from July 1999 to June 2000. Materials: The comparative morphology and anatomy of thymus of human embryonic, 10 weeks, 15 weeks and prenatal foetuses, and monkey foetus was carried out. Methods: Comparative micro-anatomical study was done by paraffin processing method. The sections were stained as per the method published by Culling (1974). Results: In monkey foetus, the thymus gland is slightly elongated, whereas in human foetuses it is not elongated and oval in shape. The size of the thymus is larger in human foetuses than monkey foetus. In both cases cells are parenchymal in nature. Due to spatial organization in human foetuses, the lymphocytes aggregation is more in cortex than in medulla. In monkey foetus the lymphocyte aggregation is simpler in arrangement through spatial organization is much less.

Incidence of extended spectrum beta lactamase producing Escherichia coli among patients, healthy individuals and in the environment.

We investigated the faecal carriage of extended spectrum β‑lactamases (ESBL) producing Escherichia coli in different groups of human subjects and in the environment. A total of 363 E. coli strains were isolated from stool samples of patients (n = 77), healthy subjects (n = 170) and from different environmental samples (n = 116). A total of 124 ESBL producing E. coli strains were isolated in this study. The frequency of ESBL producing E. coli was found to be highest (60.3%) among the strains isolated from patients, followed by healthy individuals (38%) and the environment (10.5%). The environment was observed to have a very low number of ESBL producing E. coli.

Atypical Presentation of Multiorgan Failure Leptospirosis (Weil’s Disease) without Fever.

Leptospirosis is a zoonotic disease of sporadic occurrence caused by bacteria that belongs to the genus Leptospira. Here we report a case of rare form of leptospirosis with multiorgan failure called Weil’s disease. This patient did not have a fever which is the most common presentation of leptospirosis.

Skeletal Maturity Indicators - Simplified Method For Clinical Reference.

The stage of Skeletal Maturation of an individual is essential for assessing the growth potential of an individual. This helps in formulating Diagnosis and Treatment Planning which may affect the final prognosis of the orthodontic treatment. The course of orthodontic treatment often depends upon the intensity of facial growth. Thus the knowledge of the timing of these growth velocity variations in craniofacial complex is important in clinical orthodontics. There are different methods of assessing skeletal maturity for orthodontic treatment purpose. The main source is Hand Wrist X-rays, Cephalograms and Radiographs for assessing the status of dental development. Review of Literature reveals a wide data on this aspect related to methods and the correlation between different methods. Most of them are academically oriented. The purpose of this article is to present a simplified method for clinical reference during treatment.

Could the products of Indian medicinal plants be the next alternative for the treatment of infections.

Indian medicinal plants are now recognized to have great potential for preparing clinically useful drugs that could even be used by allopathic physicians. Traditionally, practitioners of Indian medicine have used plant products in powder, syrup or lotion forms, without identification, quantification and dose regulation, unlike their allopathic counterparts. The present review explores the immense potential of the demonstrated effect of Indian medicinal plants on microbes, viruses and parasites. In the present context, with the available talent in the country like pharmaceutical chemists, microbiologists, biotechnologists and interested allopathic physicians, significant national effort towards identification of an "active principle" of Indian medicinal plants to treat human and animal infections should be a priority.

Comparative evaluation of two polymerase chain reactions targeting different genomic regions to detect Mycobacterium tuberculosis in sputum.

Purpose: Tuberculosis remains an important health problem all over the world, especially in resource poor settings like India. The Ziehl-Neelsen (ZN) staining of sputum smear is still the method of choice in the diagnosis of tuberculosis in spite of its low sensitivity and specificity. This paper evaluates comparison of two different polymerase chain reaction (PCR) assays with sputum smear findings to detect Mycobacterium tuberculosis. Materials and Methods: A total of 191 sputum samples were collected from 84 patients attending a tertiary care hospital, who were suspected of having pulmonary tuberculosis, were examined by PCR targeting two different genomic regions, namely, TRC 4 by non-nested format and IS6110 insertion element by nested format in comparison to ZN staining of sputum smears. Results: Among the patients tested, 20.24% (Mid-p 95%CI: 31.5-52.4) were smear positive, 7.14% (Mid-p 95%CI: 2.94-14.26) were positive by TRC 4 PCR and 41.67% (Mid-p 95%CI: 12.7-29.8) were positive by IS6110 nested PCR (nPCR). The median age of overall positive cases was 42 years. Among the nPCR positives, the median for age of rural and peri-urban community was 46 and 32 years, respectively. The kappa coefficient between smear findings and TRC4 PCR findings was 0.27 and an agreement of 0.83 was observed (Z = 2.99; one-tailed P = 0.001). TRC 4 PCR picked two unique positives that were negative by smear and IS6110 nPCR. Conclusion: The non-nested TRC 4 PCR showed inability for accurate detection of M. tuberculosis in sputum samples. The study concluded that the nPCR targeting IS6110 is superior and more sensitive than TRC4 PCR.

Evaluation of a nested PCR targeting IS6110 of Mycobacterium tuberculosis for detection of the organism in the leukocyte fraction of blood samples.

Purpose: Tuberculosis poses a serious health problem in resource-poor settings such as India. Polymerase chain reaction (PCR) is presently seen as a promising alternative to conventional smear microscopy and culture techniques. Undiagnosed fever is a condition where the aetiology could include tuberculosis in a significant percentage. This paper evaluates a nested PCR (nPCR) using Hotstar Taq for the detection of M. tuberculosis in patients with febrile illness using insertion element, IS6110 as a target. Material and Methods: A total of 355 samples (301 HIV status unknown and 54 HIV seropositives) from patients primarily with febrile illness were tested for the presence of M. tuberculosis. Blood culture was done in a commercial automated blood culture system and nPCR in DNA extracts from buffy coat samples. Hotstar Taq polymerase was used to enhance the sensitivity of nPCR and the lower limit of detection was determined by using cloned plasmid. Results: Among the patients tested, 2% were positive by automated culture system and 6.8% of patients were positive by nPCR. Majority of the positives were from HIV seropositive individuals. The sensitivity of the nPCR was 100% and the specificity was 95.1%. The lower limit of detection was less than 1 genome copy per microlitre. Among the nPCR positives, patients from rural community were significantly higher than from the peri-urban community. Conclusions: The nPCR had a high sensitivity and specificity on buffy coat samples using Hotstar Taq polymerase in the reaction mix. Thus the technique is a valuable tool in the diagnosis of tuberculosis.

Nanotechnology tools for single-virus particle detection.

The development and potential application of nanotechnology tools for single-virus particle detection by emergent nanotechnology is likely to revolutionise diagnosis and determining treatment endpoints for life threatening virus infections. Direct detection of biological macromolecules using semiconducting nanowires or carbon nanotubes for electrical field change measurements is a milestone application in this field. The promise of selective detection at a single particle level (stochastic sensing) with nanowire or nanotube field-effect transistor-based devices is a major breakthrough for outbreak situations, where a rapid and specific detection of the viral agent allows intervention at public health level. The same technology would be eminently suitable for bedside diagnosis and therapeutic intervention.

Sinonasal carcinoma masquerading as fungal sinusitis.

A 26-year-old man presented with swelling of his face and nose of three months duration. He had multiple hyperpigmented, hyperkeratotic plaques over the swelling, of one-month duration and an erythematous indurated plaque below the left nostril for two weeks. Based on a biopsy taken from the antral mass with special stain for fungus, he was treated as fungal sinusitis with intravenous amphotericin-B, but the lesion did not regress. Later a skin biopsy from the indurated lesion showed moderately differentiated squamous cell carcinoma. A diagnosis of sinonasal carcinoma was made and chemotherapy was started.

Jejunal leiomyosarcoma presenting as chronic intra-abdominal abscess.

We report a 35-year-old man with jejunal leiomyosarcoma who presented with chronic intra-abdominal abscess. He underwent drainage of the abscess initially but was re-explored four months later when a mass developed. Total excision of the tumor was done.

Late presentation of congenital factor V deficiency--a case report.

Congenital factor deficiency is a rare coagulation disorder, which is inherited in an autosomal recessive manner. The severity of bleeding symptoms in general is only partially related to the degree of factor V deficiency in plasma. In this report, a boy presenting with hemarthrosis in his late adolescence due to congenital factor V deficiency is reported.