Concurrent Xanthogranulomatous Pyelonephritis and Upper Urinary Tract Transitional Cell Carcinoma.

A 37-year-old male with a history of chronic nephrolithiasis presented to the ED with gross hematuria, clot retention, and right flank pain. The patient had radiological findings of perinephric stranding, marked hydronephrosis, and marked thinning of the right renal parenchyma on computed tomography (CT), all suggestive of xanthogranulomatous pyelonephritis (XGP). The specimen following radical nephrectomy revealed urothelial carcinoma (UC) in a background of XGP but with no evidence of spread to regional lymph nodes. Follow-up imaging revealed hypodense lesions in the liver which demonstrated UC on biopsy. This is the first reported case of a young patient presenting with such an advanced stage of UC in the setting of XGP. It illustrates the link between inflammatory processes of the kidney and malignancy of the upper urinary tract.

Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses.

Cutaneous involvement can be an important sign of both COVID-19 and rickettsioses. Rickettsial infections may be first evident as an exanthem with eschars as a key finding. In contrast, eschars and necrotic lesions can be seen in critically ill COVID-19 patients. Both illnesses share a similar mechanism of infecting endothelial cells resulting in vasculopathy. Rickettsia parkeri and Rickettsia 364D are both characterized by eschars unlike Rickettsia rickettsii. Other eschar causing rickettsioses such as Rickettsia conorii, Rickettsia africae, and Orientia tsutsugamushi are commonly diagnosed in people from or having traveled through endemic areas. While there is no consensus on treatment for COVID-19, rickettsioses are treatable. Due to possibly serious consequences of delayed treatment, doxycycline should be administered given an eschar-presenting patient's travel history and sufficient suspicion of vector exposure. The proliferation of COVID-19 cases has rendered it critical to differentiate between the two, both of which may have overlapping vasculopathic cutaneous findings. We review these diseases, emphasizing the importance of cutaneous involvement, while also discussing possible therapeutic interventions.

Assessment of contamination of soil due to heavy metals around coal fired thermal power plants at Singrauli region of India.

In the present study, an attempt was made to measure contamination of soil around four large coal-based Thermal Power Plants. The concentration of Cadmium, Lead, Arsenic and Nickel was estimated in all four directions from Thermal Power Plants. The soil in the study area was found to be contaminated to varying degrees from coal combustion byproducts. The soil drawn from various selected sites in each direction was largely contaminated by metals, predominantly higher within 2-4 km distance from Thermal Power Plant. Within 2-4 km, the mean maximum concentration of Cadmium, Lead, Arsenic and Nickel was 0.69, 13.69, 17.76, and 3.51 mg/kg, respectively. It was also observed that concentration was maximum in the prevalent wind direction. The concentration of Cadmium, Lead, Arsenic and Nickel was highest 0.69, 13.23, 17.29 and 3.56 mg/kg, respectively in west direction where wind was prevalent.