Expression of EZH2 and H3K27me3 predicts tumor biology of urothelial carcinoma

Background: Enhancer of zeste homolog 2 (EZH2) is one of the major epigenetic modifiers involved in the transcriptional repression of target genes through trimethylation of H3K27 (lysine 27 residue of histone H3). Deregulated expression of both EZH2 and H3K27me3 has been implicated in the biological behavior and prognostic outcome of various malignancies. Aim: To assess the role of EZH2 and H3K27me3 in the carcinogenesis of urothelial carcinoma of urinary bladder. Materials and Methods: One hundred fifty consecutive urothelial carcinoma cases of urinary bladder (54.7% high-grade) were included in this study. Immunohistochemical analysis for EZH2 and H3K27me3 was performed on whole tissue sections. A multiplication score obtained by multiplying staining intensity and proportion of positively stained neoplastic cells was used for assessment. Results: EZH2 showed a significant correlation with the tumor grade and lamina propria invasion (p < 0.001). The cases with high EZH2 expression showed a significantly high proliferative index (Mean- 32.7%; p < 0.001). In contrast, negative and low expression of H3K27me3 was significantly more common in high-grade cases (p = 0.006). The expression of H3K27me3 was significantly associated with lamina propria (p = 0.01) and deep muscle invasion (p = 0.007). EZH2 showed a significantly higher expression in the high-grade invasive areas as compared to the high-grade non-invasive areas of the same tumor (p = 0.03). Conclusions: This study establishes an important role of the key epigenetic regulators EZH2 and H3K27me3 in the pathobiology of urothelial carcinomas. Strong expression of EZH2 and weak expression of H3K27me3 are associated with higher grade, proliferative index and invasive behavior.

Utility of orcein stain and comparison with Masson trichrome stain in chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIPO) is caused by a plethora of primary and secondary causes, dominantly involving the neuromuscular tissue, interstitial cells of Cajal, or the connective tissue framework. The lack of the connective tissue framework, known as desmosis, is evaluated by Masson's trichrome (MT) or picrosirius red stains, both of which are recommended in the London classification. We evaluated the orcein stain in detecting desmosis in comparison to the MT stain. We performed both orcein and MT stains in six previously published cases of complete or partial desmosis along with six age-matched controls. Our results showed comparable results of the orcein stain as compared to the MT stain. Additional advantages of lower cost and a clearer background in orcein stain were noteworthy, whereas MT stain can be used for the detection of additional pathology. We believe that orcein stain can be used as a cheap alternative in resource-limited settings.

Characteristics and Outcomes of COVID-19 during the Third Wave of COVID Pandemic: A Single-center Descriptive Study

Aim: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been causing a global pandemic of Coronavirus (COVID-19) disease in recurring waves. On November 24, 2021, a new SARS-CoV-2 variant (B.1.1.529) was identified in South Africa. We aimed to study the clinical profile, laboratory parameters, complications, and outcomes in patients hospitalized with COVID-19 infection during the third wave in India. Materials and methods: This was a single-center cross-sectional study conducted from 10th January 2022 to 10th February 2022. Data on demographic profile, clinical symptoms, laboratory findings, complications, and clinical outcome was collected and compared between nonsevere and severe cases. Results: A total of 74 patients were included. Four (5.4%) had a severe disease while 70 (94.6%) had a nonsevere disease. The most common symptoms were fever (60.8%), cough (52.7%), and sore throat (45.9%). There was a significant difference between severe and nonsevere groups in terms of vaccination history (p = 0.0412), and time elapsed from symptom onset to hospitalization (p ?0.001). The severe disease group also had significantly higher levels of leukocyte count, C-reactive protein (CRP), D-dimer, ARDS, sepsis, and a higher need for respiratory support (p < 0.001). A total of 70 (94.6%) patients were discharged while four (5.4%) patients succumbed to complications of COVID-19 infection. Complete vaccination against COVID was associated with significantly lower chances of severe disease [odds ratio (OR) 0.083, 95% confidence interval (CI) 0.0080–0.8632]. Conclusion: As compared to the previous two waves, the current wave of the pandemic had milder symptoms, less severe disease, and fewer ICU admissions and deaths. Successful completion of vaccination against COVID was associated with significantly lower morbidity and mortality.

Self-medication and its associated factors in Amdanga block of West Bengal

Background: The WHO defines the use of medications without prior medical consultation regarding indication, dosage and duration of treatment as self-medication. The practice is a global problem. Aims and Objectives: The study was conducted to describe the care seeking behavior of rural self-medicators living in Amdanga Block of West Bengal and to assess the belief in medicines by the self-medicators. Material & Methods: A descriptive cross-sectional study was conducted by interviewing with a pretested semi-structured questionnaire on 665 self-medicators out of 1740 adults who were interviewed in 80 villages of Amdanga Block, West Bengal. A three-stage sampling method was used to reach the study population. A three month recall on self-medication practice was considered operationalizing the “pull” and “push” factors of self-medicators using a Pshycho-social framework. The variables were Socio-demographic factors, Care Seeking Behaviors, Health System related factors, Belief in Medicines according to the framework. Results: The prevalence of self-medication was found to be 38.2%. 63% of the study subjects were female and 56.3% had a literacy status of middle school and above. 54.4% relied on their old prescription for self-medication. 68.7% had an initial choice to consult a doctor but later self-medicated of whom 53.2% changed their choice due to monetary and transport issues while 38.5% thought of self-medication considering their disease was mild in nature. Conclusion: Awareness and health education can link rural subjects with primary care facility and right decisions on care can be provided.

Two Unusual Presentations of Gestational Trophoblastic Neoplasia: Cutaneous Metastasis and a Large Solitary Lung Lesion

Gestational trophoblastic tumors, an uncommon group of pregnancy-related neoplasms, should be considered in any premenopausal patient presenting with metastatic disease from an unknown primary. A raised hCG and exclusion of pregnancy are often the only requirement in this situation. Although a potentially curable condition, a late diagnosis and the extent of the metastatic disease often determine the prognosis. Here we describe two young women with metastatic GTN, the first presenting with a very unusual finger metastasis and the second with a rare large solitary lung lesion with brain metastasis.

揂ir Bubble Sign� and Fibreoptic Bronchoscopy in Complicated Pulmonary Hydatid Cysts: Steps in the Right Direction

Intact pulmonary hydatid cysts are often discovered incidentally on chest X-rays (CXRs) as rounded opaque lesions with smooth borders. Cyst rupture and infection (complicated hydatid cyst) often change the radiologic appearance delaying diagnosis. Air bubble sign on computed tomography is recognized as a sign of high sensitivity and specificity in the diagnosis of complicated hydatid cysts when compared to other classical radiologic signs. Bronchoscopy is not a preferred investigation in patients with intact hydatid cysts but may have a major role in patients with complicated hydatid cysts with atypical presentation. In the present case series, we attempt to highlight the importance of the 揳ir bubble sign� and the identification of a whitish membrane at bronchoscopy in the diagnosis of complicated hydatid cysts.

Neurological Manifestations and Their Effect on Outcome in Second Wave of COVID-19 Pandemic: A Retrospective Cohort Study

Aim: There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19. Materials and methods: This was a retrospective study. All patients ?18 years in age, admitted with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 were included in the study. Their clinical records were accessed for collecting demographic and laboratory data. The data collected were analyzed for prevalence and pattern of neurological symptoms at admission and neurological complications developed during hospitalization. It was also analyzed to find the relation of neurological manifestations with duration of hospital stay, requirement of bilevel positive airway pressure (BiPAP) or ventilator, severity of disease, development of neurological complications, and mortality. Results: A total of 440 patients were included. The mean age was 59.28 ± 13.28 years. The most common neurological symptom at presentation was headache while the most common neurological complications were altered sensorium, cerebrovascular stroke, seizure, and encephalitis. Significantly, more patients with neurological complications than those without had severe disease and needed ventilation. Duration of hospitalization was significantly longer (16.26 ± 5.15 vs 12.73 ± 4.89, p = 0.0173) and mortality was also significantly higher (OR 6.59, 95% CI 2.23–19.43; p = 0.0006) in patients with neurological manifestations. Conclusion: The presence of neurological manifestations is associated with greater morbidity and mortality in patients with COVID-19 and thus warrants more aggressive treatment. However, a study of association of individual neurological manifestation with severity of COVID-19 will provide a more meaningful insight regarding the approach to the management of such patients

Type 2 DM An Independent Risk Factor For Poor Outcome In Moderate To Severe COVID-19

Background:Diabetes Mellitus has been shown to be a risk factor for severe COVID-19 disease. Few studies asse ssed effect of diabetes on the outcome exclusively in moderate to severe COVID 19 disease. Objective: To compare the clinical characteristics and outcome of hospitalized moderate and severe COVID-19 disease among patients with and without diabetes. Material And Methods:This retrospective study was conducted at Parul Sevashram Hospital from 1stApril 2021-30thApril 2021. Data on demographic profile, clinical symptoms, laboratory findings, complications and clinical outcome was collected and compared between patients with and without diabetes.Result:Total 319 patients were included with mean age 54.81±11.72 years. 28.5% had diabetes. The most common symptoms were fever, cough and shortness of breath. As compared to patients without diabetes, these patients had significantly higher levels of leucocyte count, CRP, Ferritin, LDH and D-Dimer. They also had more complications like ARDS, secondary infection and stroke and higher need of respiratory support (92.3% vs. 69.7%, P < 0.001). We also observed significantly greater mortality in patients with diabetes compared to those without diabetes (29.7% vs. 13.6%; P = 0.0014). These findings held true even on comparingpatients with only diabetes as comorbidity to those without any comorbidity.Conclusion:The study confirms that diabetes is an independent risk factor for higher inflammatory markers, risk of complications and in hospital mortality during hospitalization with moderate to severe COVID 19. New strategies are needed for more aggressive management of COVID 19 cases with diabetes to improve prognosis in these cases.

Identifying Risk Factors For ICU Admission During The Second Wave Of COVID 19 In A Tertiary Care Centre In Western India

Background:The substantial morbidity and mortality seen during second wave of coronavirus disease 2019 (COVID-19) pandemic necessitated identifying demographic, clinical and laboratory markers to assist the clinicians in early recognition of severe disease. We aimed to identify new factors or confirm previously identified factors for risk of ICU (Intensive care unit) admission during the second wave of COVID-19 infection. Material And Methods:This retrospective, single-centre study was conducted from April 1 2021-May30 2021. Data on demographic profile, clinical symptoms, and laboratory findings on admission was collected and compared between ICU and non-ICU patients. Result:Total 440 patients were included. Among these, 184(41.8%) needed ICU admission. The mean agewas 52.75±14.46years. 283(64.3%) patients were males. The most common symptoms were fever (70.7%), cough (65.5%), and shortness of breath (54.1%). As seen in previous studies, mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidities like diabetes mellitus, COPD, obesity were found more commonly in ICU patients as compared to non-ICU patients. (P= 0.0107, 0.0447 and 0.0314 respectively for diabetes, COPD and obesity). Presence of more than one comorbidity was associated with greater ICU admission (ICU vs. Non-ICU: 92(50%) vs. 99 (38.7%), p=0.0234).Time from symptom onset to hospitalization was also significantly longer in ICU patients (7.5±1.05 days vs 4.0±1.26 days; p=0.004). Conclusion:The study confirms that COVID patients who need ICU admission have significantly higher mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidity. In addition, COVID patients in ICU had significantly lower s. albumin levels and late presentation to hospital.

A clinico-epidemiological study of the first outbreak of Nipah virus in India – report from ground zero

Introduction: The first Nipah Virus (NiV) outbreak occurred in India in the year 2001 at Siliguri. The second outbreak happened at Nadia in 2007. Nipah Virus exhibits neurological and pneumonic tropism with the predominant clinical presentation being encephalitis in humans. Material and Methods: The present study was a record based prospective study on 67 cases admitted with pyrexia of unknown origin in North Bengal Medical College during the period from 18.02.2001 to 30.02.2001 and a parallel study on epidemiological record carried out by PSM department also taken into account. All necessary investigations including autopsy examination, pathological, and microbiological study were done. Results: There was a clustering of cases around Bhaktinagar. There was a strong H/O Medinova Nursing Home Contact among the patients. 18 out of 20 cases were staff of that Nursing Home. Serum samples tested show NiV specific IgM and IgG in 9 out of 17 samples with one sample which was positive for IgG only suggesting past infection. The cases were admitted with predominant neurological symptoms (53.73% cases) but about 80% recovered with no residual neuro deficit. The natural reservoir of NiV is present in Bangladesh and in Northern India. Conclusion: When NiV infection is suspected, infection control practices must be strengthened to avoid an outbreak in a hospital setting. Here the present study is presenting the experience in the first outbreak of the Nipah virus in India at Siliguri for awareness of clinical personnel to control further outbreak at the very beginning.

Prevalence and pattern of childhood injuries in Siliguri City, West Bengal, India

Background: Children are vulnerable to injuries, and childhood injury is a complex phenomenon precipitated by a set of factors. In India, the magnitude and nature of childhood injury are not clearly known owing to the absence of a proper injury surveillance system. However, in recent days few studies demonstrated a substantially high burden of childhood injury. Objectives: To find out the prevalence, pattern, and the factors associated with injury among children of 0� years in the Siliguri city of West Bengal. Methods: A cross-sectional study was conducted among 780 children aged 0� years residing in the Siliguri Municipal Corporation area selected through cluster sampling technique (30 clusters [wards] with a cluster size of 26). Relevant data were collected by interviewing the mothers of children as respondents and was analyzed using SPSS software, binary logistic regression was applied to test the association between injury and other risk factors. Results: Of total 780 children, 165 had reported a total of 220 injury events with an overall period prevalence of 21.2% and a mean of 0.28 injury events per child. Majority of injuries were superficial in nature (53.2%); due to fall (56.4%), extremities were mostly involved (62.3%), and 12.8% cases were moderate-to-severe grade. Under-five children were most vulnerable. Injury was significantly related to socioeconomic status, presence of siblings, outdoor activities, and the presence of supervising person during travelling. Conclusions: Childhood injury is still highly prevalent in the area with its unique pattern and few preventable risk factors requiring a multifaceted comprehensive approach.

Are household food security, nutrient adequacy, and childhood nutrition clustered together? A cross-sectional study in Bankura, West Bengal

Background: Research on different measures of food security and their interrelation in order to identify vulnerable households are scarce in India. Objectives: The objective was to assess household food security (HHFS), nutrient adequacy, dietary diversity, and nutritional status of under-five children along with their interrelation in the slums of Bankura Municipality, West Bengal. Methods: A cross-sectional study was conducted during 2016–2017 among 240 households using two-stage 30-cluster random sampling. Information regarding socioeconomic characteristics, availability, and utilization of different poverty alleviation schemes was collected. HHFS was assessed by a validated HHFS scale-short form in Bengali and nutrient adequacy with 24-h recall method. The eldest under-five child in the family was measured for anthropometry using standard procedure and for dietary diversity with the Individual Dietary Diversity Score. Results: Overall, 74 (29.1%) households had “food security,” whereas 102 (44.3%) and 64 (26.6%) had, respectively, low and very low food security. Among 190 under-five children, 63 (35.3%) had single and 50 (25.5%) had multiple anthropometric failures. Overall, 89 (36.1%) households were deficient for both energy and protein and 111 (47.6%) had deficiency of either of these two. Indicators on the utilization of different poverty alleviation schemes were associated with low/very low food security. A “Composite Index of Food Scarcity” comprising of HHFS, nutrient adequacy, and dietary diversity was proposed which was found to have dose–response relationship with grades of anthropometric failure of under-five children. Conclusions: An index comprising of three indicators might help identify the vulnerable households in relation to food security more effectively than a single indicator.

Extranodal histiocytic sarcoma mimicking colorectal lymphoma: Case report and review of literature

Histiocytic sarcoma is a rare malignant neoplasm that demonstrates mature histiocytic traits as characterized by immunohistochemistry. We report a case of extranodal histiocytic sarcoma (ENHS) of colon in a 56-year-old man presenting with gastrointestinal symptoms. Radiological findings were indicative of lymphoma or diffuse metastatic disease in colon. Histopathology of colectomy specimen was suggestive of ENHS, and immunohistochemical studies confirmed the uncommon diagnosis. The patient refused further therapy and succumbed to systemic complications of metastatic disease within a month of diagnosis. There have only been seven previous reports in world literature of ENHS involving large intestine.

Ocular infection by a psychrophile: Pseudomonas fluorescens

Accurate identification of infectious pathogens is essential for appropriate management of ocular infections. Routine laboratory protocols typically support bacterial growth at 37°C. We report a case, wherein we serendipitously isolated Pseudomonas fluorescens – an organism that prefers lower temperatures for optimal growth (psychrophilic) in the environment – from eviscerated contents of an eye with total corneal melt. This case highlights the need for being vigilant for organisms with different temperature sensitivities in culture media than that found in routine protocols.

Correlation among perceived stress, emotional intelligence, and burnout of resident doctors in a medical college of West Bengal: A mediation analysis

Background: Perceived stress and burnout are by-products of powerless responsibility imposed on resident doctors. Emotional intelligence (EI) works as an adapting and coping tool. Objective: The objective of this study is to find out the role of work-related perceived stress on burnout and influence of EI on it. Methods: A descriptive cross-sectional study was conducted from February to April 2016 among 63 resident doctors of different departments of Bankura Sammilani Medical College and Hospital. Data were collected through a self-administered questionnaire for background characteristics and work-related variables. Cohen perceived stress scale, Trait EI, and Shirom-Melamed burnout questionnaire were applied for measuring perceived stress, EI, and burnout, respectively. Statistical analysis was done with of SPSS version 22.0, and for mediation analysis, Andrew F. Hyne抯 SPSS macro was adopted. Nonparametric bootstrapping was done assuming small sample. Results: Out of complete responses, 67%, 22.9%, and 9.8% were from clinical, paraclinical, and preclinical specialties, respectively. Burnout had a significant positive correlation with perceived stress and in negative correlation with EI-well-being and positive correlation with EI-self-control and sociability. Physical fatigue factor of burnout had a significant positive correlation with EI-emotionality. Perceived stress had a negative correlation with EI-well-being. On mediation analysis, assuming EI as a mediator, total, direct, and indirect effects of perceived stress on burnout were significant (<0.05). Mediation was proved to act with percent mediation of 0.07. Conclusion: There was definite mitigating effect of EI on burnout by perceived stress among resident doctors. This necessitates more attention by decision-makers toward this burning problem for the sake of care of caregivers.

Changing paradigm of Cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India.

Background: Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and signifi cant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients. Materials and Methods: Patients admitted to a tertiary care centre between 2005 and 2013 with confi rmed CM were included in the analysis. Details of the clinical presentation, laboratory fi ndings, treatment details, risk factors for infection and outcome were documented and analysed. Results: During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference between the cerebrospinal fl uid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group. Conclusion: HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance.

Foot Length As A Marker of Pubertal Onset.

This observational study was conducted on 973 healthy children between 8 and 16 years to evaluate the relation between changes in foot length and pubertal maturation. The right foot length of study children was recorded and SMR staging was done. The difference in mean foot length was statistically significant between SMR 1 and 2 (P<0.0001). No significant difference in the mean foot lengths was found thereafter. Smoothed standard deviation curves were constructed for foot length as a function of SMR stage using the LMS method. Foot length was found to rise sharply in SMR 2, which coincides with the onset of puberty.

Mediastinal hydatid disease: An unusual presentation.

Hydatid disease is a significant health problem in endemic areas. While occurrence of the cysts in the liver and lung is common, mediastinal localisation is extremely rare. We report the case of a 35-year-old male who presented with a painless swelling on the right side of the neck and features of superior vena caval obstruction. Chest radiography and computed tomography (CT) suggested a cyst in the right upper lobe, extending into the right supraclavicular region as well as another cyst in the left lung. Thoracotomy revealed that the right-sided cyst was actually mediastinal in location and had herniated through the thoracic inlet compressing the superior vena cava (SVC). Both cysts were removed in two separate operations and symptoms of SVC compression subsided after removal of the right-sided cyst. Histopathology was consistent with a hydatid disease.

Synchronous occurrence of anaplastic, follicular and papillary carcinomas with follicular adenoma in thyroid gland.

Various combinations of thyroid carcinomas have been reported including those between different cancers of follicular cell origin and those between follicular and C-cell histogenesis. Accordingly, anaplastic carcinomas have been seen to coincide with simultaneous papillary and follicular cancers. We report a case of composite anaplastic and papillary cancer on one thyroid lobe with a follicular carcinoma in the other lobe in a female patient aged 64 years. The patient also had a separate and independent follicular adenoma in the same lobe as the composite anaplastic and papillary carcinoma. The papillary carcinoma was continuous with the anaplastic carcinoma. The findings were supported by immunohistochemistry. The patient was managed by a total thyroidectomy with bilateral modified radical neck dissection followed by chemotherapy. However, she died two months after surgery. The common follicular cell origin will explain the concurrent presence of all these cancers. This could result from the dedifferentiation of a pre-existing differentiated carcinoma.