A comparative study of antibody response, virus neutralization efficiency & metabolites in SARS-CoV-2-infected adults & children

Background & objectives: COVID-19 has been a global pandemic since early 2020. It has diverse clinical manifestations, but consistent immunological and metabolic correlates of disease severity and protection are not clear. This study was undertaken to compare seropositivity rate, antibody levels against nucleocapsid and spike proteins, virus neutralization and metabolites between adult and child COVID-19 patients. Methods: Plasma samples from naïve control (n=14) and reverse transcription (RT)-PCR positive COVID-19 participants (n=132) were tested for reactivity with nucleocapsid and spike proteins by ELISA, neutralization of SARS-CoV-2 infectivity in Vero cells and metabolites by 1H nuclear magnetic resonance (NMR) spectroscopy. Results: An ELISA platform was developed using nucleocapsid and spike proteins for COVID-19 serosurvey. The participants showed greater seropositivity for nucleocapsid (72%) than spike (55.3%), and males showed higher seropositivity than females for both the proteins. Antibody levels to both the proteins were higher in intensive care unit (ICU) than ward patients. Children showed lower seropositivity and antibody levels than adults. In contrast to ICU adults (81.3%), ICU children (33.3%) showed lower seropositivity for spike. Notably, the neutralization efficiency correlated with levels of anti-nucleocapsid antibodies. The levels of plasma metabolites were perturbed differentially in COVID-19 patients as compared with the naive controls. Interpretation & conclusions: Our results reflect the complexity of human immune response and metabolome to SARS-CoV-2 infection. While innate and cellular immune responses are likely to be a major determinant of disease severity and protection, antibodies to multiple viral proteins likely affect COVID-19 pathogenesis. In children, not adults, lower seropositivity rate for spike was associated with disease severity

Management of DVT (Deep Vein Thrombosis) Through Shaman Sneha and Shaman Aushadh

DVT is called as Phlebothrombosis. It is semisolid clot in the vein which has got high tendency to develop pulmonary embolism and sudden death. Most frequent site of thrombosis is calf region. A 60 yr male diagnosed with Deep vein thrombosis (DVT), complaining of pain and swelling on left leg (calf muscle) for 3 months, came in Panchkarma OPD in Chaudhary Brahm Prakash Ayurveda Charak Sansthan New Delhi. Pain and swelling increased with prolonged standing and walking. In Ayurveda Samhitas DVT is not mentioned as separate disease but the symptoms can be correlated with Siraj granthi or Siraja vata. Management: Case was managed according to general guidelines of Sotha, Rakta gata vata and Shiragata dosha. Shaman aushadh and Shaman sneha was given for 3 months. Result: Mild swelling and pain decreased in 15 days of medication. After 2 months, venous Doppler reports suggest partial thrombus noted in external iliac vein, deep femoral vein and popliteal vein shows resolution of thrombus as compared to previous Doppler wells score decreased up to 2

A Histopathological Study of Congenital Pouch Colon and its Impact on Management

Background: Congenital Pouch colon(CPC) is a rare variant of anorectal malformations (ARM) whose etiopathogenesis and management are not yet standardized. This prospective study seeks to establish the histopathological characteristics and it’s inference on the etiopathogenesis, management and prognosis of CPC. Methods: This was a prospective comparative study including all neonates with CPC and other high ARM. The excised pouch from the neonates with CPC and a strip of sigmoid colon from other high ARM patients were sent for biopsy and the histopathological features compared. Results: Histopathogical abnormalities were seen involving all the layers of the colonic pouch including mucosa, submucosa and muscularis propria. The statistically significant histopathological differences in the colonic pouch as compared to normal sigmoid colon were mucosal necrosis, focal erosions, inflammation and haemorrhage, muscularis mucosa fibrosis, submucosal congestion and haemorrhage, widening, fibrosis and presence of lymphoid follicles and circular and longitudinal muscle disarray and fibrosis. Also seen was a significant inflammatory infiltrate permeating all the layers of the pouch. Conclusion: CPC has histopathological abnormalities in all the layers of the colon. It is thus pathologically abnormal tissue. The widespread inflammatory reaction in all layers of the CPC raises the possibility of some environmental factor having a role in etiopathogenesis of CPC.

A rare case of vaginal sarcoma in pregnancy

Vaginal Sarcoma is an extremely rare tumour in pregnancy. Authors are presenting a case report of a pregnant woman who presented with vaginal mass and urinary retention at 32 weeks of gestational age. USG confirmed a live baby with possibility of cervical fibroid. Before further investigations for diagnosis of the mass her emergency LSCS has to be done. Histopathology and immunohistochemistry then confirmed sarcoma.

Osteoclastic variant of anaplastic thyroid carcinoma: A case report of rare entity

Anaplastic thyroid carcinoma (ATC) is a rare, highly malignant thyroid tumor with dismal prognosis. Osteoclastic giant cell variant of ATC is extremely rare and is characterized by the presence of a large number of multinucleated giant cells resembling osteoclasts. We report here this unusual variant in a 67-year-old female with a history of long-standing goiter of 13 years duration. Histologically, many multinucleated osteoclast-like giant cells were seen accompanying the malignant spindle cell component. Despite extensive sampling, no evidence of differentiated thyroid malignancy could be elucidated

Mongolian spots.

Mongolian spots (MS) are birthmarks that are present at birth and their most common location is sacrococcygeal or lumbar area. Lesions may be single or multiple and usually involve < 5% total body surface area. They are macular and round, oval or irregular in shape. The color varies from blue to greenish, gray, black or a combination of any of the above. The size varies from few to more than 20 centimetres. Pigmentation is most intense at the age of one year and gradually fades thereafter. It is rarely seen after the age of 6 years. Aberrant MS over occiput, temple, mandibular area, shoulders and limbs may be confused with other dermal melanocytoses and bruises secondary to child abuse, thus necessitating documentation at birth. Although regarded as benign, recent data suggest that MS may be associated with inborn errors of metabolism and neurocristopathies. Mongolian spots usually resolve by early childhood and hence no treatment is generally needed if they are located in the sacral area. However, sometimes it may be required for extrasacral lesions for cosmesis.

Depigmentation therapies in vitiligo.

Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas. Various aspects of this therapy such as the cost, treatment time, course, permanency of depigmentation, side effects, and the possibility of repigmentation should first be discussed with the patient. At present, there is no ideal depigmenting therapy available, but many agents in the market have been in use for many years. Monobenzyl ether of hydroquinone (MBEH) is the mainstay and Food and Drug Administration (FDA) approved in USA but takes many months to depigment and is associated with local side effects and risk of repigmentation. Other agents which are also used are 4-methoxy phenol and 88% phenol. Physical therapies for depigmentation include Q-switched ruby and alexandrite lasers and cryotherapy. Second-line agents which can be explored for depigmentation include imatinib mesylate, imiquimod, and diphencyprone. Many possible experimental agents are being explored like various phenol derivatives, melanoma vaccines, interferon gamma, busulfan, etc. A major lacuna still exists in this area and a lot more research is desirable to give satisfactory cosmesis to these patients with extensive vitiligo.