Role of 18 F-FDG PET-CT in Urethral Malignant Melanoma and Analysis of the UK Guidelines on Ano-uro-genital Melanomas.

Urethral melanomas are a rare subtype of noncutaneous melanomas. The disease has a tendency to have skip lesions and early metastases as compared with cutaneous melanomas. The role of fluorine-18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography computed tomography (PET-CT) is well established in cases of cutaneous melanomas and is recommended by the National Comprehensive Cancer Network (NCCN) for stage IIB to IV cancer. There are no established guidelines on the management of noncutaneous melanomas; however, a recently published United Kingdom national guideline aims to streamline the management of ano-uro-genital melanomas. The guideline describes a very limited role in the use of 18 F-FDG PET-CT in this case scenario. The tendency to skip lesions, early metastases, involvement of brain parenchyma, and finally the usage of anti-PD-1 medications are key areas where 18 F-FDG PET-CT has shown superiority over CT scan. With this case report, we aim to highlight the strength of 18 F-FDG PET-CT in the management of urethral melanomas, which can be extrapolated to other ano-uro-genital melanomas.

Exacerbation of Fatality Rates Induced by Poor Air Quality Due to Open-Air Mass Funeral Pyre Cremation during the Second Wave of COVID-19.

This study investigates the air pollution-induced mortality rate during the second wave of COVID-19, which claimed several thousand lives in the capital city of India, New Delhi, even during a lockdown period. Delhi is a hotspot of unhealthy air quality. During the second wave of COVID-19 in 2021, surface ozone levels were observed to be higher, which had a direct impact on lung function, thereby making people more susceptible to COVID-19. The correlation coefficient between surface ozone concentration and mortality has been observed to be 0.74 at a 95% confidence level. This work focuses on the plausible impact and feedback of poor air quality induced by the burning of open-air funeral pyres due to the increased COVID-19 mortality rate in New Delhi, estimated by using an epidemiological model (AirQ+) of the World Health Organization. The mortality rate estimated quantitatively with the aid of AirQ+ is 1.27 excess deaths per 100,000 population due to surface ozone from pyre burning. The findings suggest transformational system goals before the resurgence of a subsequent wave.

Air quality improvement during triple-lockdown in the coastal city of Kannur, Kerala to combat Covid-19 transmission.

The novel SARS-CoV-2 coronavirus that emerged in the city of Wuhan, China, last year has since become the COVID-19 pandemic across all continents. To restrict the spread of the virus pandemic, the Government of India imposed a lockdown from 25 March 2020. In India, Kannur district was identified as the first "hotspot" of virus transmission and a "triple-lockdown" was implemented for a span of twenty days from 20 April 2020. This article highlights the variations of surface O3, NO, NO2, CO, SO2, NH3, VOC's, PM10, PM2.5 and meteorological parameters at the time of pre-lockdown, lockdown and triple-lockdown days at Kannur town in south India using ground-based analyzers. From pre-lockdown days to triple-lockdown days, surface O3 concentration was found to increase by 22% in this VOC limited environment. NO and NO2 concentrations were decreased by 61% and 71% respectively. The concentration of PM10 and PM2.5 were observed to decline significantly by 61% and 53% respectively. Reduction in PM10 during lockdown and triple-lockdown days enhanced the intensity of solar radiation reaching the lower troposphere, and increased air temperature and reduced the relative humidity. Owing to this, surface O3 production over Kannur was found to have increased during triple-lockdown days. The concentration of CO (67%), VOCs (61%), SO2 (62%) and NH3 (16%) were found to decrease significantly from pre-lockdown days to triple-lockdown days. The air quality index revealed that the air quality at the observational site was clean during the lockdown.

Potential link between compromised air quality and transmission of the novel corona virus (SARS-CoV-2) in affected areas.

The emergence of a novel human corona virus disease (COVID-19) has been declared as a pandemic by the World Health Organization. One of the mechanisms of airborne transmission of the severe acute respiratory syndrome - corona virus (SARS-CoV-2) amid humans is through direct ejection of droplets via sneezing, coughing and vocalizing. Nevertheless, there are ample evidences of the persistence of infectious viruses on inanimate surfaces for several hours to a few days. Through a critical review of the current literature and a preliminary analysis of the link between SARS-CoV-2 transmission and air pollution in the affected regions, we offer a perspective that polluted environment could enhance the transmission rate of such deadly viruses under moderate-to-high humidity conditions. The aqueous atmospheric aerosols offer a conducive surface for adsorption/absorption of organic molecules and viruses onto them, facilitating a pathway for higher rate of transmission under favourable environmental conditions. This mechanism partially explains the role of polluted air besides the exacerbation of chronic respiratory diseases in the rapid transmission of the virus amongst the public. Hence, it is stressed that more ambitious policies towards a cleaner environment are required globally to nip in the bud what could be the seeds of a fatal outbreak such as COVID-19.

A rare case of adult T cell leukemia/lymphoma: clinicopathological correlation with autopsy confirmation.

Adult T cell leukaemia/lymphoma (ATLL) is a rare T lymphoproliferative disorder which is etiologically linked with human T cell lymphotropic virus type-1 (HTLV-1). HTLV-1 is endemic in Japan, Caribbean and Africa. The highest incidence of ATLL is in Japan although sporadic cases have been reported elsewhere in the world. We describe a case of ATLL with an unusual presentation with clinic-pathological correlation and autopsy confirmation. A 56 year old male was referred to Command Hospital (Southern Command) for an incidental finding of lymphocytosis on a routine Hemogram. Clinical examination did not reveal hepatosplenomegaly, lymphadenopathy, jaundice or skin lesions. Laboratory investigations showed lymphocytosis with predominance of atypical lymphomonocytoid cells. Immunophenotyping of the bone marrow mononuclear cells showed positivity for CD45, CD2, CD3, CD4, CD5 and negative for CD7, CD8, CD13, CD33, CD19, which is characteristic of ATLL phenotype. Clonality was confirmed by PCR for TCR gene rearrangement on post mortem tissue. He succumbed to his illness after 40 days of initial presentation and 16 days of being diagnosed as ATLL. Here, we discuss the pathogenesis and characteristics of ATLL with clinico-pathological correlation and autopsy confirmation.