Endocardial fibroelastosis causing sudden death in an infant: Autopsy case report of an unusual lesion.

ABSTRACT: Endocardial fibroelastosis is characterized by proliferation of both elastic and collagenous fibers within the endocardium, causing diffuse or localized thickening. A four-and-a-half-month-old baby was admitted to a local hospital, with a history of seizures for one day. Baby developed features of heart failure and died within one week after admission. At the post-mortem examination, heart was found to be enlarged with dilated ventricles. The endocardium of left ventricle was markedly thickened with a whitish appearance. Histopathology showed a thick layer of collagenous fibrous tissue in the endocardium, which was confirmed by Masson trichrome stain. The cause of death was offered as dilated cardiomyopathy due to endocardial fibroelastosis. The underlying mechanisms of myocardial fibrosis remain unclear. It is hypothesized that genetic, infectious, inflammatory, and nutritional processes are involved in this condition. This case highlights the importance of gross specimen examination and special staining methods to support histopathology after postmortem examination, for ascertaining the cause of death.

Is de novo membranous nephropathy suggestive of alloimmunity in renal transplantation? A case report.

BACKGROUND: Post-transplant nephrotic syndrome (PTNS) in a renal allograft carries a 48% to 77% risk of graft failure at 5 years if proteinuria persists. PTNS can be due to either recurrence of native renal disease or de novo glomerular disease. Its prognosis depends upon the underlying pathophysiology. We describe a case of post-transplant membranous nephropathy (MN) that developed 3 mo after kidney transplant. The patient was properly evaluated for pathophysiology, which helped in the management of the case. CASE SUMMARY: This 22-year-old patient had chronic pyelonephritis. He received a living donor kidney, and human leukocyte antigen-DR (HLA-DR) mismatching was zero. PTNS was discovered at the follow-up visit 3 mo after the transplant. Graft histopathology was suggestive of MN. In the past antibody-mediated rejection (ABMR) might have been misinterpreted as de novo MN due to the lack of technologies available to make an accurate diagnosis. Some researchers have observed that HLA-DR is present on podocytes causing an anti-DR antibody deposition and development of de novo MN. They also reported poor prognosis in their series. Here, we excluded the secondary causes of MN. Immunohistochemistry was suggestive of IgG1 deposits that favoured the diagnosis of de novo MN. The patient responded well to an increase in the dose of tacrolimus and angiotensin converting enzyme inhibitor. CONCLUSION: Exposure of hidden antigens on the podocytes in allografts may have led to subepithelial antibody deposition causing de novo MN.

Enterochromaffin Cells and Mast Cells in Acute Appendicitis.

Background and Objective Serotonin levels are increased in acute appendicitis. We investigated the possible source of this increase. The aim of this study was to compare the distribution and density of epithelial and nonepithelial enterochromaffin (EC) cells as well as numbers of degranulated and nondegranulated mast cells in different layers of normal appendices and acute appendicitis. Methods Sections from 15 cases of acute appendicitis and 10 cases where the appendix was morphologically normal were stained with Hematoxylin & Eosin, Toluidine blue, and immunohistochemically for chromogranin and CD-117. EC cells stained by chromogranin were counted per crypt and extraepithelial EC cells counted and expressed as cells per unit area (mm 2 ). Mast cells stained by Toluidine blue and CD-117 were counted in lamina propria, submucosa, and muscle layers. The difference between Toluidine blue and CD117 stained mast cells was taken to be an estimate of degranulated cells. The cell counts were expressed per unit area (mm 2 ) as well as per cross-sectional area of the appendix. Results There was no statistically significant difference in epithelial and extraepithelial EC cells between acute appendicitis and normal appendix. Estimated mast cell degranulation as indicated by mast cell counts per cross-sectional area is greatly increased in acute appendicitis when compared with normal. Conclusion Degranulated mast cells rather than EC cells may be the main source of raised serotonin in acute appendicitis.

Insights into a novel class of azobenzenes incorporating 4,6-O-protected sugars as photo-responsive organogelators.

A novel class of 4,6-O-butylidene/ethylidene/benzylidene ß-d-glucopyranose gelator functionalized with photo-responsive azobenzene moieties were designed and synthesized and also characterized using different spectral techniques. These azobenzene-based organogelators can gel even at lower concentrations (critical gelation concentration - 0.5% and 1%). A morphological study of the gels shows one-dimensional aggregated bundles and helical fibres. The main driving force for the self-assembly is through cooperative interactions exhibited by the different groups viz., sugar hydroxyl (hydrogen bonding interaction), azobenzene (aromatic π-π interaction) and alkyl chain of the protecting group (van der Waals interaction).

Nitrogen uptake potential under different temperature-salinity conditions: Implications for nitrogen cycling under climate change scenarios.

As projected by climate change models, increase in sea surface temperature and precipitation in the future may alter nutrient cycling in the coastal regions due to potential changes in phytoplankton community structure and their ability to assimilate nitrogen (N) and carbon (C). An experiment simulating different temperature and salinity conditions (28°C-35 ambient conditions, 28ºC-31, 31ºC-35 and 31ºC-31) in mesocosms containing 1000 L of coastal water from the Arabian Sea was performed and N uptake rates were measured using 15N tracer technique on 2nd, 5th, 7th and 10th day of the experiment. The results show that, under all conditions, the total N (NO3- + NH4+) uptake rates were lower in the beginning and on the final day of the tracer experiment, while it peaked during middle, consistent with chlorophyll a concentrations. Total N uptake rate was significantly lower (p = 0.003) under ambient temperature-lower salinity condition (28ºC-31) than the others. This indicates that lowering of salinity in coastal regions due to excessive rainfall in the future may affect the N uptake potential of the phytoplankton, which may change the regional C and N budget.

Effect of viscosity and dielectric constant variation on fractional fluorescence quenching analysis of coumarin dye in binary solvent mixtures.

Photo physical properties of fluorescent organic compounds give an immense improved knowledge on characteristics of excited state that is beneficial to devise innovate molecules and understand their performance in particular applications. Coumarin derivatives have been extensively investigated in this regard. This article narrates steady state fluorescence quenching measurements of a coumarin derivative namely 3-hydroxy-3-[2-oxo-2-(3-oxo-3H-benzo[f]chromen-2-yl)-ethyl]-1,3-dihydro-indol-2-one (3HBCD) in a binary mixture of acetonitrile and 1,4-dioxane. Aniline is used as quencher. Fluorescence intensity is large in acetonitrile and decreases as the percentage of 1,4-dioxane in the solvent mixture increases. With modest quencher concentration a deviation towards the x axis is noticed in the Stern-Volmer (S-V) plots. This downward curvature is interpreted as due to the presence of 3HBCD in different conformers in the lowest energy level. Ground state intramolecular hydrogen bonding formation is observed due to the conformational changes in the solute. Figured estimations of various quenching parameters recommend that, while dynamic quenching prompts linearity in S-V plot at lower quencher concentration, increasing quenching efficiency with increasing medium viscosity suggests that reaction is not entirely controlled by material diffusion. Stern-Volmer constant increases with decreasing medium dielectric constant.

Sinonasal Teratocarcinosarcoma- A Rare Tumour not so Rarely Misdiagnosed.

Sinonasal teratocarcinosarcoma (STCS) is a rare, morphologically heterogeneous and highly aggressive tumour of ambiguous origin. It is characterized by the presence of benign and malignant epithelial, mesenchymal and neuroectodermal components. Because of their rarity and heterogeneity, these lesions are often misdiagnosed, leading to management difficulties. Adequate sampling with a high index of suspicion is needed to diagnose this rare tumour. We reported here a 48-year old man with right nasoethmoidal mass eroding the cribriform plate with intracranial extension. An initial incisional biopsy was performed and a diagnosis of craniopharyngioma was made. Subtotal endoscopic excision of the mass revealed features of STCS. Immunohistochemistry confirmed the same. The patient was subsequently treated with radiotherapy. The histogenesis, histopathological features, immunohistochemistry findings, clinical features and treatment were discussed here. Till date, there are less than 100 cases reported in English literature.

Sarcomatoid Carcinoma of Renal Pelvis Involving Ureter and Renal Parenchyma with Heterologous Osteosarcomatous Differentiation: A Case Report and Review of Literature.

Sarcomatoid carcinoma is a highgrade rare malignant tumor with both epithelial and mesenchymal components. Sarcomatoid carcinoma in the upper urinary tract is very rare. We reported here a case of sarcomatoid carcinoma of renal pelvis with osteosarcomatous differentiation, with involvement of the ureter and renal parenchyma in a 68-year-old female. Histologically, predominant pleomorphic spindle cell sarcoma component with osteoid production and urothelial carcinoma component with in situ areas were identified. Immunohistochemical analysis showed vimentin positivity in sarcomatous component and cytokeratin positivity in carcinomatous component.

The Role of Bolus Injection of Saline with Arm Elevation on Rocuronium onset Time: A Randomized Control Study.

BACKGROUND: The onset time of neuromuscular blockade is a crucial time associated with the risk of hypoxia and pulmonary aspiration. Various strategies have been undertaken to shorten this onset time. Therefore, we investigated the effects of bolus of 20 ml saline followed by limb elevation after administration of rocuronium in a dose of 0.6 mg/kg to study the onset time. METHODOLOGY: Thirty patients were randomly allocated to the bolus saline group or control group. General anesthesia was induced and maintained with fentanyl and propofol. Rocuronium 0.6 mg/kg intravenous (IV) was administered followed by 20 ml saline bolus and limb elevation in the study group compared to administration of 0.6 mg/kg in a running drip only in the control. Onset of neuromuscular block was assessed by acceleromyography at the adductor pollicis muscle with train-of-four stimulation. RESULTS: The lag time was shorter in bolus group (34 s median) than in control group (45 s median), P < 0.017. The onset time was shorter in bolus group (55 s median) than in control group (110 s median), P < 0.001. The T1 recovery to 25% was longer in bolus group (42 min median) than in control group (39 min median) which was statistically not significant. CONCLUSION: Rocuronium 0.6 mg/kg IV followed by bolus 20 ml saline and concomitant limb elevation resulted in shorter lag time, faster onset of neuromuscular blockade, good intubating conditions without prolonging clinical duration of action when compared to the control.