Study of Admitted Patients of Mucormycosis : Experience of A Tertiary Care Centre

A prospective study was done during mid-April to mid-June 2021 to analyze the sudden rise in cases of Mucormycosis. We assessed characteristics, related comorbidities, disease locale, steroid administration and disease outcome in patients. Cases of Mucormycosis associated with RTPCR positive for Coronavirus disease (COVID-19) and Mucormycosis occurring in patients with negative RTPCR for COVID-19 were compared. A total of 103 Mucormycosis patients were analyzed, 84 (81.55%) were RTPCR positive. Uncontrolled Diabetes Mellitus (70.87%) was the most common comorbidity present among RTPCR positive and negative Mucormycosis patients. Rhino-orbital and Rhino-sinusoidal sites were equally involved (44.0%), followed by Rhino-orbital-cerebral (11.9%) region. We ascribe the spike in Mucormycosis episodes to the trio of diabetes, excessive corticosteroid usage in the face of the COVID-19 Pandemic.

Cervical Thymic Cyst with parathyroid tissue - a diagnostic conundrum

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.

Epithelioid angiomyolipoma with tumor thrombus in IVC and right atrium

Epithelioid angiomyolipoma is an uncommon subtype of renal angiomyolipoma associated with potentially malignant behavior and is considered a distinct entity by the World Health Organization classification of renal tumors. We present a case of an epithelioid variant of angiomyolipoma with extension into the renal vein, inferior vena cava reaching up to the right atrium. Pre-operatively, a diagnosis of renal cell carcinoma was considered based on imaging findings. Intra-operatively due to extensive adhesions, surgical resection was not performed and only tissue sampling was performed for histopathology. Microscopic examination revealed short fascicles of spindle cells and perivascular epithelioid cells. A differential diagnosis of renal cell carcinoma with sarcomatoid differentiation was considered. The immunohistochemical profile showed tumor cells that express Melan-A and smooth muscle actin, while they were negative for pan-cytokeratin, PAX8, CK7, CD117 and CD34. Therefore a diagnosis of epithelioid angiomyolipoma was rendered. The presence of intravascular thrombi on radiological investigation and carcinoma-like growth pattern on light microscopy may compound an erroneous diagnosis of renal cell carcinoma. Hence, it is prudent for the urologist to consider differential diagnosis other than renal cell carcinoma when confronted with a renal neoplasm presenting with intravascular thrombi. In these cases, a core biopsy should be planned pre-operatively and diagnosis should be made with aid of appropriate immunohistochemical markers.

Study of Ascitic Fluid by Liquid Based Cytology and Its Comparision with Conventional Cytosmears and Cell Block Preprations.

Background: Ascites refers to increased volume of fluid collecting within peritoneal cavity which becomes clinically detectable when atleast 500 ml has accumulated. Cytological examination of ascitic fluid gives information about inflammatory and noninflammatory lesions including malignancies, which is done by conventional cytosmears, SurePath liquid based cytological smears and cell block preparations. Aims: The aim of our study was to study the different causes of ascites and their comparison on liquid based cytology with conventional cytology and cell blocks. Methods: Ascitic fluid was obtained from 75 patients of either sex. Microscopic examined was carried out by SurePath liquid based cytology, conventional fixed sediment smears, and cell blocks. Results: Observations were categorised into inflammatory, malignant and inconclusive. Out of 75 cases examined by conventional smears, cytological diagnosis of inflammatory or benign was rendered in 45(60%), 7(9.3%) were diagnosed as malignant and 5(6.7%) were given suspicious of malignancy and 18(24%) were inconclusive. By liquid based cytology 53(70.7%) were rendered inflammatory or benign, 12 (16%) as malignant, 2(2.7%) as suspicious of malignancy and 8(10.7%) were rendered inconclusive. By cell block methodology 52(69.3%) were rendered inflammatory or benign, 11(14.7%) as malignant and 12(16%) as inconclusive. Statistical analysis: Revealed that liquid based cytology was most sensitive (85.71%) and accurate (97.33%) method for analysis of ascitic fluid and conventional smears were least sensitive (50%) and accurate (90.67%). Conclusion: Liquid based cytology showed more sensitivity and accuracy than conventional cytosmears and cell block methods in diagnosing malignant lesions.

Circulating nucleic acids damage DNA of healthy cells by integrating into their genomes.

Whether nucleic acids that circulate in blood have any patho-physiological functions in the host have not been explored. We report here that far from being inert molecules, circulating nucleic acids have significant biological activities of their own that are deleterious to healthy cells of the body. Fragmented DNA and chromatin (DNAfs and Cfs) isolated from blood of cancer patients and healthy volunteers are readily taken up by a variety of cells in culture to be localized in their nuclei within a few minutes. The intra-nuclear DNAfs and Cfs associate themselves with host cell chromosomes to evoke a cellular DNAdamage- repair-response (DDR) followed by their incorporation into the host cell genomes. Whole genome sequencing detected the presence of tens of thousands of human sequence reads in the recipient mouse cells. Genomic incorporation of DNAfs and Cfs leads to dsDNA breaks and activation of apoptotic pathways in the treated cells. When injected intravenously into Balb/C mice, DNAfs and Cfs undergo genomic integration into cells of their vital organs resulting in activation of DDR and apoptotic proteins in the recipient cells. Cfs have significantly greater activity than DNAfs with respect to all parameters examined, while both DNAfs and Cfs isolated from cancer patients are more active than those from normal volunteers. All the above pathological actions of DNAfs and Cfs described above can be abrogated by concurrent treatment with DNase I and/or anti-histone antibody complexed nanoparticles both in vitro and in vivo. Taken together, our results suggest that circulating DNAfs and Cfs are physiological, continuously arising, endogenous DNA damaging agents with implications for ageing and a multitude of human pathologies including initiation of cancer.

Neck Dissection in Verrucous Carcinoma: A Surgical Dilemma.

Oral verrucous carcinoma (OVC) is a distinct low grade variant of squamous cell carcinoma (SCC) of the oral cavity. OVC is a rare tumor representing only 3-4% of all carcinoma. OVC is characterized by a slow growing, painless, broad based verrucous or wart like papillary lesion. Th e lesion lacks ulceration and has a propensity for local invasion rather than metastatic spread. Transformation of VC to anaplastic or poorly diff erentiated SCC is about 30-40%. Surgical excision with adequate margins of resection seems to be the clear preference for treatment. Th e need for neck dissection is an important consideration in planning therapy for OVC. Th e aggressive clinical presentation of the tumor often sways clinical judgment in favor of performing lymph node dissection, especially in the presence of clinical lymphdenopathy. It is reasonable to consider a selective neck dissection such as supra-omohyoid neck dissection in situations where there is uncertainty regarding the pathological diagnosis in the phase of clinically suspicious lymphdenopathy. Here we are presenting a case report of OVC in 65-year-old male patient treated with surgical excision and right side supra-omohyoid neck dissection.

A study of regenerative ability of liver after repetitive heat stress induced liver injury.

Background: It is well known that heat stress produces liver injury. It is also known that liver regenerate after injury. This way, there should be almost no or minimal alteration in the size of the liver after regeneration. Aims & Objective: In the present study, after heat induced liver injury, the ability of liver to regenerate itself was assessed. Liver injury was assessed by biochemical [Serum Glutamic Pyruvate Transaminase (SGPT); Serum Glutamic Oxaloacetic Transaminase (SGOT); and Alkaline Phosphatase (ALKP)], morphological, and morphometric changes. On the other hand, Liver regeneration was evaluated by morphological and morphometric observations of male adult albino rats (Wistar strain). Material and Methods: The experimental animals were subjected to repetitive heat stress for 4 hours daily, at 37 ± 0.5 ˚C in a Biological Oxygen Demand (BOD) incubator (relative humidity 65 - 82%) for 2 and 5 consecutive days. Biochemical assessment was done on blood collected from left ventricle of beating heart of rats. Morphometric and morphological studies were conducted under light microscope on paraffin sections (H&E) of liver from control and experimental animals. The morphometric analysis was done by intersection – point counting method, using simple square lattice test system. Relative Liver Wet Weight of all animals was calculated. Results: Progressively degenerative changes in morphological observations (disruption of cell plates in liver lobules and Kupffer cell hyperplasia), progressively increased statistical significance of morphometric (numerical density of Kupffer cells on area - Nak), and biochemical parameters informed that increasing liver damage was present with increased repetition of heat exposures in 2 and 5 days heat exposed experimental albino rats. With this liver degeneration, Relative Liver Wet Weight of all the experimental animals should have been decreased but it was not, reiterating about well-known fact of regenerative ability of liver. Along with progressive changes of heat induced liver injury, progressively increasing regenerative changes were also evident on morphological (binucleate cells and anisocytosis) observations supported by statistically significant morphometric (volume density of hepatocytes – Vvh and numerical density of hepatocytes - Nvh) parameters in experimental animals. Conclusion: The above findings suggested that the regenerative ability of liver progressively increased with progressively increasing liver injury.

Behavioral changes in albino rats due to repetitive heat stress of moderate level.

Background: There are a number of studies showing the effect of severe heat stress on behaviour. Severe heat stress has been well reported to cause changes in activity level, attitude/mood, and behaviour. But, the effect of repetitive heat stress of moderate level on all these parameters has not been studied extensively. Aims & Objective: In the present study, the effect of repetitive heat stress of moderate level was assessed on activity level, attitude / mood, and behaviour (spontaneous and provoked) of adult albino male rats (wistar strain). Material and Methods: The experimental animals were subjected to repetitive heat stress for 4 hours daily, at 37±0.5ºC in a Biological Oxygen Demand (BOD) incubator (relative humidity 65-82%) for five consecutive days. Daily changes were assessed in activity level during and after heat exposure and in attitude / mood along with behaviour (both spontaneous and provoked) after heat exposure in experimental animals and compared with control animals. Results: There was increased restlessness during heat exposure and decreased level of activity after heat exposure in experimental animals. The mood of the experimental animals was depressed and the experimental animals kept them isolated and did not respond on provoking after heat stress. Conclusion: All the above observations confirmed that exposure to repetitive heat stress, even of moderate level, causes significant change in behaviour of male albino rats.