Search

Summary: Background: Dietary interventions and increased physical activity are the cornerstones for management of the paediatric non‐alcoholic fatty liver disease (NAFLD). Though, no specific diet has been proven superior, Indo‐Mediterranean diet (IMD) has shown promise in adult literature. Thus, we aimed to compare the effect of IMD and a standard calorie‐restricted diet (CRD) in Indian overweight children and adolescents with biopsy‐proven NAFLD. Methods: Thirty‐nine consecutive biopsy‐proven NAFLD children between the ages of 8 and 18 years were randomized into either IMD or CRD for 180 days, and various parameters were evaluated at baseline and then after 180 days (NCT05073588). Results: A total of 34 subjects (18 in IMD and 16 in CRD group) completed the study. There was a significantly higher decrease in controlled attenuation parameter (CAP) values (as a marker of hepatic steatosis; on transient elastography) (95% CI: 4.2–73.4, p = 0.042), weight (95% CI: 0.75–5.5, p = 0.046) and body mass index (BMI) (95% CI: 0.21–2.05, p = 0.014) (but not in Pediatric NAFLD Fibrosis Index or PNFI; as a marker of hepatic fibrosis) in IMD group compared to the CRD group. Liver stiffness measurement, serum cholesterol and low‐density lipoprotein levels and HOMA‐IR decreased only in the IMD group (p < 0.001). Our statistical model showed that delta‐Weight was the only independent variable associated with delta‐CAP. Conclusion: Both IMD and CRD can improve the various anthropometric, clinical, imaging and biochemical parameters but IMD was superior to CRD in terms of reducing CAP values and weight/BMI over 180 days in overweight/obese NAFLD children. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aims to investigate the clinicopathological profile of cervical lymphadenopathy in a tertiary referral centre. The findings will contribute to a deeper understanding of the disease spectrum, aid in accurate diagnosis, and help in improving patient treatment and outcomes. Methodology: This is a prospective study conducted in the Department of ENT, Head and Neck Surgery, Apollo Hospital, Chennai, between June 2022 and May 2023. The clinicopathological profile of all patients was analysed. The final histological diagnosis and the preoperative Fine Needle Aspiration Cytology (FNAC) were correlated. The primary tumour was identified in cases with metastatic secondary tumours in the neck. Results: Among the 80 patients in our study, 67% had a benign aetiology (most common was tuberculosis), and 33% had a malignant aetiology (most common was Hodgkin's Lymphoma). Gender distribution was equal, with those between the ages of 35 and 60 more frequently affected. The nasopharynx (30%) was the most likely location of the occult primary, followed by the thyroid (20%) and larynx (20%). In detecting TB, FNAC had a sensitivity of 75.5% and a specificity of 98%; in detecting lymphomas, it was 64% and 100%; in detecting metastatic secondaries, it was 80% and 100%; and in detecting reactive lymphadenitis, it was 79% and 86%. Conclusion: Cervical lymphadenopathy is a common entity requiring careful evaluation and treatment. PET scans prove invaluable in detecting occult primary tumours. FNAC is an initial, cost-effective diagnostic tool. However, biopsy is indicated in specific conditions to obtain accurate diagnosis to enable prompt treatment. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. Methods: New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. Results: Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. Conclusion: The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen. [ABSTRACT FROM AUTHOR]

Background: Patients with cirrhosis are susceptible to development of acute kidney injury (AKI), which leads to poor outcome. We conducted a study to evaluate the spectrum of AKI in patients with cirrhosis. Materials and Methods: This study was conducted in consecutive cirrhotic patients with AKI admitted in a tertiary care center of India from April 2020 to December 2022. Details including history, examination findings, and results of laboratory investigations were recorded. Results: A total of 243 patients were enrolled in this study. The majority (91.3%) of the patients were males. The most common etiology of cirrhosis was alcohol in 58.4% (n = 142) followed by hepatitis B in 10.3% (n = 25) of patients. Pre-renal form of AKI was present in 54.4% (n = 132) of patients and hepatorenal syndrome (HRS) in 21.8% (n = 53) of patients. IgA nephropathy was the commonest (n = 6) glomerular pathology in nonresponders with intrinsic renal disease. Majority of the patients belonged to stage II (46.9%) and stage I AKI (37%), while only 16.1% had stage III AKI. Various stages of AKI showed a significant correlation (P < 0.05) with Child-- Turcotte--Pugh (CTP) score and Model for End-stage Liver Disease (MELD)-Na score. The overall in-hospital mortality rate was found to be 18.5% (n = 45). Conclusion: Renal dysfunction is a frequent complication among cirrhotic patients. Pre-renal factors were the most common cause of AKI in cirrhotics. Stages of AKI showed significant correlation with liver prognostic scores. Renal biopsy should be considered in patients not responding to treatment, to guide further management. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the quality of free‐to‐access videos on oral biopsy procedures on the YouTube platform. Materials and Methods: We conducted a search on YouTube using the term "oral biopsy" and selected the first 100 videos in order of relevance. The following exclusion criteria were applied: language other than English, videos that did not cover oral biopsy techniques, videos on nonhuman specimens, postoperative instructions, personal experiences, exfoliative cytology, or "brush biopsy." Forty‐seven selected videos were classified based on their duration, country of origin, date of upload to the system, author, information source and number of views, and likes and dislikes. Video quality was analyzed using DISCERN, the Global Quality Scale (GQS), and the Video Information and Quality Index (VIQI). Results: The majority (78.7%) of analyzed videos were uploaded by dentists, originating from India (48.9%), with a mean duration of 11.8 min (SD, 20.4), with 104.5 likes (SD, 186.4) and 7.1 dislikes (SD, 10.55). The mean values for DISCERN, GQS, and VIQI were 1.3 (SD, 0.52), 2.1 (SD, 1.04), and 9.62 (SD, 1.69), respectively. Conclusion: The majority of videos on oral biopsy published on YouTube are of low quality. [ABSTRACT FROM AUTHOR]

Background: A renal biopsy is essential for the identification and management of renal disorders. Although considered an invasive operation, it is necessary for a definitive diagnosis and treatment of many renal diseases. The primary goal of this study was to assess the clinicopathological aspect of renal diseases undergoing biopsy in children receiving tertiary care. Patients and Methods: Children (≤18 years) hospitalized with nephrotic syndrome were the subjects of this cross-sectional study, and comprehensive assessments confirmed the need for a kidney biopsy. Included were 277 children who met the inclusion and exclusion criteria. Data on patient outcomes, biopsy indications, complications, histopathologic results, and demographic information were documented. Results: Of the 277 patients who underwent renal biopsy, 63.2% were male, and 36.8% were female. Average age of the patients was 15 ± 2.9 years, with age distribution ranging from 3 to 18 years. The most frequent indication for renal biopsy was atypical age of <1 and >10-years-old (91.7%), steroidresistant (5.1%), asymptomatic hematuria (21.3%), abnormal glomerular filtration rate (16.2%), and proteinuria (14.8%). The most common histopathological findings were focal segmental glomerulosclerosis (FSGS) (36.5%), followed by minimal change disease (MCD) (13.4%), membranoproliferative glomerulonephritis (MPGN) (10.5%), membranous glomerulonephritis (MGN) (7.94%), IgA nephropathy (IGAN) (7.58%), non-proliferative glomerulonephritis (NPGN) (7.58%), diffuse proliferative glomerulonephritis (DPGN) (6.9%), crescentic GN (5.8%), and systemic lupus erythematosus (SLE) (3.97%). The high frequency of positive samples was seen in SLE, followed by DPGN, MPGN, IGAN, and MGN. In contrast, MCD, crescentic GN, and NPGN showed negativity in all differential item functioning (DIF) parameters. Conclusion: Renal biopsy is a safe and effective procedure in the diagnosis and treatment of in children with nephrotic syndrome. FSGS had the highest frequency in examined biopsies. [ABSTRACT FROM AUTHOR]

Background: Adult soft tissue sarcomas (STS) are rare and diverse. Current management is based on limited literature from the West. Therefore, data from different geographical regions is required, including the low‐middle‐income countries. This is our experience managing adult sarcomas in the tertiary cancer center of North India. Materials and methods: This is a retrospective analysis of the structured sarcoma database of patients treated in the surgical oncology department between 1992 and 2020. The descriptive analysis includes demography, site distribution, diagnosis, histopathology variations, prior surgical interventions, and stage. Results: A total of 1106 soft tissue sarcoma patients were treated in three decades. Age distribution was 13%, 43%, 31%, and 11% in <20, 21–40, and 41–60 and >60 years, respectively. The male‐to‐female ratio was 1.73. The anatomical distribution was 17%, 42%, 23%, 7%, 7%, and 3% in upper extremity, lower extremity, trunk, retroperitoneum, head and neck, and viscera, respectively. Overall, 49% of patients had undergone prior suboptimal surgeries at community hospitals. Common histology subtypes were synovial sarcoma (18%), undifferentiated pleomorphic sarcoma (UPS) (13%), dermatofibrosarcoma protuberans (12%), and liposarcoma (9%). A pathological discordance of 13% was identified between the initial and the final histologies. Overall, 61% of tumors were high‐grade. Memorial Sloan Kettering Stages II and III were present in 33% and 35% of patients, respectively. Conclusions: This is one of the largest single institutional experiences of STS from the Asian population. Mostly young adults were affected with male preponderance. The lower extremity and trunk were common subsites. Frequent histologies were synovial sarcoma and UPS. A high rate of suboptimal surgical intervention at the community level and pathological discordance was noted. This study highlights the need to establish prospective structured databases for capturing quality information related to rare malignancies and providing insights for future research. [ABSTRACT FROM AUTHOR]

Introduction: Dapsone forms the backbone of multi-drug therapy (MDT) in leprosy and many other dermatological disorders. Haemolysis is its common side effect which often necessitates drug stoppage. Currently, wide variation in data of haemolysis with dapsone exists in literature ranging from 24.7% to 83% and none of the studies point towards the timing of onset of haemolysis/timing of maximal haemolysis which is important in therapeutic decision making regarding continuing or stopping the drug. This study aimed to answer such unanswered questions. Objectives: Primary: To estimate the fall in haemoglobin (Hb) levels after administering MDT for 3 months in patients with leprosy. Secondary: To determine factors associated with Hb change -- age, glucose-6-phosphate dehydrogenase (G6PD) status, pole of leprosy and duration of MDT taken (if any). Materials and Methods: All freshly diagnosed cases of Hansen's disease were studied for 3 months. At baseline, demographic data (age, sex), skin biopsy, slit skin smear and G6PD were taken. Haemoglobin (Hb), serum glutamate oxaloacetate transferase (SGOT), serum glutamate pyruvate transferase (SGPT), serum bilirubin, lactate dehydrogenase (LDH), reticulocyte count, peripheral blood smear (PBS) along with clinical photography was done at baseline, 1, 2 and 3 months. Results: Out of the 48 patients who completed the study: Mean Hb (g/dL) decreased from 13.37 at baseline to a minimum of 12.08 at 2 months, and then increased to 12.34 at 3 months. Of 42 patients (87.5%) with a fall in Hb, 13 (27.1%) had severe (fall >20%), 17 (35.4%) had moderate (fall 10--20%), 12 (25%) had mild fall (fall <10%) and in 6 (12.5%), there was no haemolysis. Reticulocyte count, LDH, SGOT and SGPT were significantly associated with haemolysis. Severe haemolysis occurred more frequently in the lepromatous spectrum. Conclusion: Dapsone causes maximal fall of hemoglobin by 1.29 g/dl at two months following which it increases. The fall of hemoglobin is reversible and hemoglobin starts to increase by 3 months of therapy making cessation of the drug unnecessary in most of the patients. [ABSTRACT FROM AUTHOR]

Background and Objective: Pediatric renal transplantation is a life‑saving procedure for children with end‑stage renal disease. This study aims to analyze the outcomes of pediatric renal transplants at our center, focusing on patient demographics, donor sources, surgical techniques, posttransplant complications, graft survival, and rejection rates. Methodology: A retrospective analysis was conducted on 43 pediatric kidney transplant recipients. Data on recipient age, gender, donor type, pretransplant dialysis, donor characteristics, surgical techniques, native kidney disease, induction therapy, maintenance immunosuppression, posttransplant infections, graft survival, and rejection episodes were collected and analyzed. Results: We performed 43 pediatric kidney transplants in total. The average age was 13.7 years (±3.81), with 8 (18.6%) being under the age of ten, 11 (25.6%) being between the ages of eleven and fourteen, and 24 (55.8%) being between the ages of fifteen and eighteen. There were 43 recipients: 27 males and 16 females. There were four (9.3%) deceased donor renal transplants and 39 (90.7%) live‑related kidney transplants. Right internal iliac artery and right external iliac vein anastomosis were found in 32 (74.4%) cases, right external iliac artery and right external iliac vein in 9 (20.9%), right common iliac artery and right common iliac vein in 1 (2.3%), and right common iliac and right internal iliac in 1 (2.3%). Induction was used in 27 recipients (62.8%). Graft survival was seen at 1 year in 42 (97.7%) patients and at 5 years in 34 (81%). Biopsy‑proven rejection occurred in 22 (51.2%) of the recipients, with antibody‑mediated rejection occurring in 8 (18.6%) and cellular rejection occurring in 22 (51.2%). Graft loss was caused by acute cellular rejection in three (23.1%) cases, graft pyelonephritis in 2 (15.4%), and an unknown cause in 2 (15.4%). There were no significant connections with antibody‑mediated rejection. Conclusion: Our study provides valuable insights into the outcomes of pediatric renal transplantation at our center. Despite the challenges of graft rejection and posttransplant infections, favorable graft survival rates were achieved. Cellular rejection emerged as a significant risk factor for graft survival, highlighting the importance of effective immunosuppressive management. Our findings emphasize the need for close follow‑up, infection control measures, and individualized immunosuppressive strategies to optimize long‑term outcomes in pediatric renal transplant recipients. Further research is warranted to refine protocols and address the specific needs of this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to evaluate the outcomes of live‑donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live‑related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One‑year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant. [ABSTRACT FROM AUTHOR]

Posttransplant thrombotic microangiopathy (PT-TMA) can be caused by calcineurin inhibitors (CNIs), ischemic injury, infections, or antibody-mediated rejection (ABMR). Delayed recognition can result in allograft loss. We describe the first reported case of successful reversal of refractory PT-TMA with eculizumab in India. It highlights the importance of prompt diagnosis and benefit from an early initiation of eculizumab therapy in refractory cases. [ABSTRACT FROM AUTHOR]

Background: Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. Methods: This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000--2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. Results: A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. Conclusion: In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary urethral cancer is a rare condition often manifesting in the sixth decade of life and is typically associated with urethral stricture disease. A 65-year-old male, a known case of stricture urethra, underwent perineal urethrostomy 10 years back. He presented with a growth at the urethrostomy site and the biopsy revealed squamous cell carcinoma. Magnetic resonance imaging of the pelvis revealed that the lesion extended into the penile and prostatic urethra with possible involvement of the corpus spongiosum, bulbospongiosus, and the bladder neck. Radical cystectomy, penectomy, scrotectomy, and bilateral orchiectomy with ileal conduit were performed. At 18-months of follow-up, the patient is recurrence-free. [ABSTRACT FROM AUTHOR]

Objective: Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. Material and Methods: All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. Results: This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Conclusion: Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Patients with cirrhosis and hepatocellular carcinoma (HCC) can develop both benign and malignant portal vein thrombosis (PVT). Characterising the nature of PVT is important for planning an optimal therapeutic strategy. In the absence of typical findings or contraindications to computed tomography (CT) or magnetic resonance imaging (MRI), contrast‐enhanced ultrasound (CEUS) could help in this differentiation. The present meta‐analysis aimed to evaluate the performance of CEUS for characterising PVT in patients with HCC. Methods: Electronic databases of PubMed, Embase and Scopus were searched from inception to 31 December 2022 for studies analysing the role of CEUS in the differentiation of benign and malignant PVT in HCC. Using the bivariate random effect model, pooled sensitivity and specificity were calculated, and the summary receiver operating characteristic (sROC) curve was plotted. Results: A total of 12 studies with data from 712 patients were included in the meta‐analysis. The pooled sensitivity and specificity of CEUS for the diagnosis of tumour in vein were 97.0% (95% CI: 93.0–98.7) and 96.8% (95% CI: 92.1–98.7), respectively, without significant heterogeneity. A sROC curve was plotted, and the area under the receiver operating characteristic was 0.99 (95% CI: 0.98–1.00). Despite the presence of publication bias, sensitivity analysis did not show any change in sensitivity and specificity. Discussion: Our meta‐analysis summarises the accuracy data from 12 studies, including >700 subjects. Contrast‐enhanced ultrasound had excellent diagnostic accuracy with pooled sensitivity and specificity of 97.5% (95% CI: 93.5–99.1) and 98.2% (95% CI: 91.5–99.6), respectively, without any significant heterogeneity. Additionally, the pooled positive LR, negative LR and DOR were 54.6 (95% CI: 11.1–25.6), 0.02 (0.01–0.07) and 2186.8 (318.3–15022.2), respectively. A positive result increases the pretest probability of malignant PVT from 50% to 98%, whereas a negative result decreases it from 50% to 2%. Most of the studies included in our meta‐analysis used identical techniques and 6–12‐month follow‐up scans to check for thrombus progression or regression. Our analysis showed no significant heterogeneity in the studies, and area under receiver operating characteristic curve (AUROC) with 95% CI was 1.00 (95% CI: 0.99–1.00). This critical meta‐analysis thus propels CEUS to the forefront for differentiating benign from tumoural PVT and suggests routinely using CEUS in patients presenting with HCC and evidence of thrombus on greyscale ultrasound. Conclusion: Contrast‐enhanced ultrasound is an effective diagnostic modality differentiation of benign and malignant PVT in patients with HCC and can be an alternative modality to CT or MRI. Further studies are required to study the role of CEUS as initial diagnostic modality for the characterisation of PVT in HCC. [ABSTRACT FROM AUTHOR]

Introduction: Dentists, the first medical professionals to be consulted for conditions involving the oral cavity, have the distinct advantage of being in a position to screen patients for oral cancer. To effectively manage patients, dentists must be familiar not only with where, when, how and why to perform biopsies, but also with when to refer them to specialised institutions. Aim: To assess the attitude and practice of dental practitioners towards the oral biopsy procedure. Materials and Methods: The present questionnaire-based cross-sectional study was conducted in the city of Jamnagar, Gujarat, India, from July 2023 to August 2023. Fifty dental practitioners with a minimum academic qualification of Bachelor of Dental Surgery (BDS) participated in the study, which was designed to collect information regarding the importance of oral biopsy, methods used to obtain biopsies, tissue preservation, diagnosis, referral to higher centers and the attitudes and practices of dental practitioners in examining oral mucosal lesions. The questionnaire was prepared using the Google Forms app. The received responses were compiled and statistical data (percentage) was calculated using Microsoft Excel 2020. Results: Out of total, 42 (84%) dentists encounter up to 10 oral mucosal lesions, such as potentially malignant disorders, in a month. Despite this, only 22% (n=11) of them performed biopsies themselves. Furthermore, 6 (12%) dentists did not know the proper medium for preserving biopsies. Of all, 24 (48%) dentists felt the need for proper training in biopsy techniques to be included in the undergraduate curriculum. Conclusion: Despite being aware of the importance of biopsy as a crucial diagnostic procedure, not many dentists perform it routinely due to reasons such as lack of training, patient non compliance and medicolegal implications. Hence, dentists should be educated in performing the oral biopsy procedure, including handling of specimens and referral to specialists. [ABSTRACT FROM AUTHOR]

Primary cutaneous carcinosarcoma (PCCS) is a rare cutaneous biphasic tumour with just 120 cases being reported till date. The epithelial component trichoblastic carcinoma/ malignant trichoblastoma (trichoblastic carcinosarcoma) is even rarer, so is the present case. An eighty years old male patient presented with a rapidly progressing ulceroproliferative nodular growth on the left temporal region. The incisional biopsy showed primary cutaneous carcinomasarcoma (PCCS). IHC showed epithelial and stromal component marked exclusively for pancytokeratin (AE1/AE3) CK5&6/ p40 and vimentin respectively. Both components were immunopositive for D2-40 and immunonegative for BerEP4/ S100/ Melan A/ MITF, thus final diagnosis given was Trichoblastic carcinosarcoma. Wide excision of the lesion with local rotation flap and skin grafting (thigh skin) was done. Patient remains disease free after four years also. Present case thus highlights the importance of HPE, IHC and early surgery for excellent prognosis of PCCS. [ABSTRACT FROM AUTHOR]

Introduction: Kidney allograft survival has increased significantly in the past few decades. However, the more potent immunosuppression has also resulted in a higher incidence of infections including BK virus nephropathy (BKVN). The profile of kidney transplant (KT) recipients including age, basic kidney disease, comorbidities, dialysis vintage, and type of kidney donor in India is different from that of high-income countries. There are very few studies on the incidence and outcomes of BKVN from India. We studied the incidence, clinical features, and the impact of a screening strategy on patients with BKVN at our center. Materials and Methods: This was a single-center retrospective record-based study. We screened the medical records of all KT recipients at our center from March 2012 to December 2020 for patients who were diagnosed with BKVN. We compared the incidence of BKVN before and after the implementation of a proactive screening strategy in 2017. Results: From March 2012 to December 2020, a total of 212 KTs were performed at our center. Twenty-eight patients were diagnosed to have BKVN at this time. The incidence of BKVN in our study was 13.2%. The incidence of BKVN before routine screening was initiated at our center was 11.3% whereas it was 13.6% after routine screening was initiated. Graft loss from BKVN was 7.14%. Conclusion: The incidence of BKVN at our center is higher than previously reported in India; however, the rate of graft loss is low. A proactive screening strategy using nucleic acid test may allow early detection of BKVN and may have a beneficial impact on graft outcomes. [ABSTRACT FROM AUTHOR]

Background: Dyschromias are the second most commonly diagnosed dermatological entity in patients with skin of color (SOC). People with SOC develop postinflammatory hyperpigmentation (PIH) with a higher frequency and greater severity attributed to the presence of reactive melanocytes. This can have severe repercussions on selfesteem and social/emotional functioning. While there are studies on the impact of post-acne PIH on quality of life (QOL), the assessment of impact of PIH on QOL as a heterogenous group of dermatoses has not been studied previously. Objectives: The aim of this study was to assess the impact of PIH on QOL in patients with SOC using Skindex-16. Materials and Methods: This was a cross-sectional study conducted from October 2019 to September 2021, involving 60 patients with SOC having biopsy-proven PIH. All patients underwent thorough clinical workup, followed by the administration of the Skindex-16 questionnaire. Data were tabulated and analyzed. Results: The mean age was 32.53±11.73 years: 35 (58%) patients were male, and 25 (42%) were females. Most patients presented with PIH secondary to papulosquamous disorders (n=23; 38.34%), followed by acne/acneiform eruptions (n=11; 18.33%). The mean scores for symptoms, emotions, functioning, and total scores were 0.37±0.51, 2.30±1.13, 2.26 ±1.40, and 1.64±0.85, respectively. PIH lesions with simultaneous evolution were associated with higher symptoms subscale scores. A previous tendency of PIH, involvement of exposed sites, higher intensity of PIH, epidermal PIH, and lesions accentuating on Wood's lamp had higher, statistically significant impact on emotions, functioning, and total scores. Conclusion: PIH had significant impact on Quality of Life in patients of Skin-of-Color. Our study was limited by the sample size, and larger, multicentric, population-based studies are recommended. [ABSTRACT FROM AUTHOR]

Mycobacterium indicus pranii (MIP) vaccine is widely used in dermatology as immunotherapy for warts as well as in patients with leprosy. During the COVID-19 pandemic, a positive role of MIP as an immunomodulator in SARS-CoV-2 disease was reported after pilot research, with minor adverse effects. We report a case of a 65-year-old male, presenting with skin lesions suggestive of noninfective granulomatous dermatitis for 4 months, at the sites of MIP intradermal injections, allegedly received during a hospital stay for severe COVID-19 disease. The patient presented with nonhealing nodulo-ulcerative lesions at the sites of injection, which persisted for 4 months associated with intermittent serous discharge and showed no signs of healing despite supportive treatment. The patient was started on a combination therapy of ofloxacin 400mg/day and clarithromycin 500mg 12 hourly for 2 months. At the end of 2 months, all the lesions showed complete healing with a resolution of discharge and nodularity, leaving behind postinflammatory hypopigmentation and atrophic scarring. The patient was followed up for 4 months after stopping treatment during which time he had no relapse of the lesions. This case has been reported to the India Pharmacopoeia. [ABSTRACT FROM AUTHOR]

Background: Juvenile myelomonocytic leukemia (JMML), previously known as juvenile chronic myeloid leukaemia, is a rare, unique, and aggressive myeloproliferative neoplasm of early childhood. Making a diagnosis of JMML is challenging because of the overlapping clinical and haematological features with other myeloproliferative neoplasms (MPN). However, some unique features like monocytosis, the absence of BCR-ABL translocation, and the presence of specific mutations (PTPN-11, K-RAS, N-RAS, CBL, or NF1) clinch the correct diagnosis. Methods: A prospective analysis of six JMML patients with variable clinical features treated with injection azacytidine as frontline therapy during the study period of 2 years. Results: The median age was 4.5 years with male:female ratio 2:4. Pallor and splenomegaly were the most common presenting signs. Four patients (66.67%) achieved complete remission (CR), two patients (33.33%) had partial remission (PR), and one patient (16.67%) had progressive disease (PD). The overall survival rate was 66.67% (four out of six), and the mortality rate was 33.33%. Conclusion: Azacitidine is an effective treatment option as upfront therapy for JMML, especially in resource poor developing countries. [ABSTRACT FROM AUTHOR]

IgG4-related lung disease is a diagnostic challenge as the presenting patterns can mimic other commonly seen pulmonary diseases like infections, interstitial pneumonia, malignancy, etc. The diagnosis of IgG4-related disease requires a correlation of clinical, radiological, biochemical, and histopathological features. Especially, an adequate tissue sample is necessary to diagnose this disease confidently. Conventionally surgical lung biopsy was needed for histopathology. But with the availability of the new less invasive technique-transbronchial cryo lung biopsy, adequate tissue can be obtained to clinch the diagnosis via bronchoscopy, thereby avoiding surgery. We report a case of IgG4-related interstitial lung disease diagnosed with the help of this technique in a tertiary care center in South India. Clinicoradiological features were inconclusive. Transbronchial cryo-lung biopsy helped to achieve the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: The management of male infertility has undergone rapid changes with advancements in assisted reproductive techniques such as testicular sperm aspiration and microdissection, testicular sperm extraction (MicroTESE). However, testicular biopsy remains an important tool for diagnosing and managing male infertility, as well as assessing spermatogenesis levels. Aim: To examine the histological patterns of testicular biopsies in male patients with infertility. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, ESIC Super Specialty Hospital, Hyderabad, Telangana, India from May 2012 to May 2023. A total of 141 Tru-Cut biopsies from patients with male infertility were included based on predefined inclusion and exclusion criteria. Histopathologists labeled and reported the slides, noting the pattern of histopathology and level of spermatogenesis according to Johnson’s criteria. The data was analysed for percentages and mean values. Results: The majority of patients 43 (30.5%) exhibited normal histopathology, followed by Sertoli cell-only syndrome in 37 (26.24%) patients, and complete spermatogenic arrest in 14 (9.93%) patients. The least common pattern observed was incomplete spermatogenic arrest. Testicular atrophy was observed in 13 (9.22%) patients. Conclusion: This study highlights the importance of understanding the histological patterns observed in testicular biopsies, as it provides valuable insights to clinicians regarding the likelihood of obtaining spermatozoa for testicular sperm extraction in infertile males. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 48-year-old woman with multiple whorled keloidal plaques on her limbs, which developed over 33 years and are attributed to repeated microtrauma from her work in tea gardens. Topics discussed include the unique morphology of keloidal lesions, the clinical and histopathological characteristics of keloids, and the potential role of occupational exposure in their development.

Solid organ transplant patients are at an increased risk of developing various types of malignancies. Herein, we have reported the case of a 32‑year‑old male patient, who presented with a nodular mass in the left shoulder 4 months after undergoing deceased donor renal transplantation. Local excision and biopsy were performed which revealed a malignant spindle cell tumor. Immunohistochemistry revealed S100 faint nuclear positivity in a few cells, CD34 positive, Ki67 1% low, and SMA negative suggestive of low‑grade fibroblastic origin spindle cell tumor. This is a rare low‑grade sarcoma with a high rate of local recurrence, rarely leading to amputation. Metastasis to the lungs and liver has been seldom reported. Our patient had local recurrence twice posttransplant for which he underwent wide local excision. [ABSTRACT FROM AUTHOR]

Background: Any treatment protocol that leads to complete elimination of surgery may lead to a better patient acceptance of breast cancer treatments. Objectives: We conducted this study to assess the feasibility of preoperative vacuum-assisted biopsies in identifying pathological complete response (pCR) and its accuracy in correlation to final histopathology report (HPR), in an Indian setting. Methods: This was a prospective study conducted between October 1, 2019, and March 31, 2021. Patients with early breast cancer, estrogen and progesterone receptors negative and either Her2 positive or negative, and who were fit to undergo marker placement at the centre of the tumour and to receive third-generation chemotherapy (4 cycles of 3 weekly doxorubicin and cyclophosphamide followed by 4 cycles of 3 weekly docetaxel) were included in the study. Following the enrolment, a tissue marker was placed at the centre of the tumour and appropriate chemotherapy was started. Patients who achieved clinical complete response were subjected to ultrasound-guided vacuum-assisted biopsy (VAB) from the tumour bed before surgery. Pathology results of the VAB and resected specimen were then compared. Descriptive statistics were used in the study. Results: Eighteen patients were enrolled in the study, with a mean age of 43.6 ± 9.8 years. However, only 10 were eligible for VAB procedure, and sensitivity and specificity were calculated based on the results of these 10 patients only. Vacuum-assisted biopsy showed sensitivity of 50% and specificity of 100% in identifying pCR. Combination of mammography, ultrasonography, and VAB showed sensitivity of 77.8% and specificity of 66.7% in identifying pCR. Conclusion: Vacuum-assisted biopsy of tumour bed may not be sensitive enough to eliminate surgery even in patients who have had exceptional response to neo-adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Pneumonia is the most common cause of mortality in under-five children worldwide. Largely, viral pneumonia is the most common cause of pneumonia in children across all age groups. We need to think outside the jukebox while dealing with cases of recurrent or persistent pneumonia. A few uncommon causes of persistent or recurrent pneumonia are primary or secondary immunodeficiencies, airway anomalies, infection with Mycobacterium tuberculosis complex, aspiration pneumonia, and severe gastroesophageal reflux. We present a few uncommon presentations of pneumonia in children, which can pose a significant diagnostic challenge in a resource-limited setting. [ABSTRACT FROM AUTHOR]

Introduction: Elevated serum prostate-specific antigen (PSA) is the most common trigger for a prostate biopsy. However, the range of normal PSA is poorly defined in many populations. Men with "elevated" PSA may not harbor cancer, and it is unclear if such men with a prior negative prostate biopsy should be biopsied again. We conducted a cohort study to assess the PSA trends and cancer detection rates in such men. Methods: In an Institutional Review Board-approved ambispective study, men who underwent prostate biopsy between January 2016 and December 2021 for PSA > 4 ng/mL were identified. Among them, those whose biopsy was negative for malignancy were contacted either telephonically or reviewed in person, and the most recent PSA and histopathology of any repeat prostate biopsy were determined. These were evaluated to assess the PSA trend, re-biopsy rate, and cancer detection rate. Results: During the study period, prostate biopsies were performed in a total of 1260 men; out of which 444 were negative for malignancy and 241 patients fulfilled the inclusion criteria. Their median prebiopsy PSA was 9.81 ng/mL (interquartile range [IQR]: 7.14--15.6), and the median follow-up PSA was 5.08 (IQR: 3.18--8.4). At a median follow-up of 53 months (range: 6--77 months), PSA had decreased in 177 (73.4%) patients, was static in 48 (19.9%) patients, and increased in only 16 (6.6%) patients. Repeat biopsy was performed on 20 patients; of whom seven had cancer (35%) with an overall positivity rate of 2.9% among the 241 patients. Although the positivity rate was higher in men with increased PSA, it was not statistically different from those with lower or similar PSA. No factors could be identified to predict a positive repeat biopsy. Conclusions: PSA, the sole trigger for a prostate biopsy, declined in nearly three-quarters of men with a negative first biopsy, and <3% of men were detected to have cancer on a repeat biopsy. This information could help appropriately counsel patients and allay anxiety after a negative biopsy. [ABSTRACT FROM AUTHOR]

Background: The most typical uterine tumour that develops from smooth muscle is a leiomyoma. It might be challenging to provide an accurate diagnosis when it exhibits abnormal gross features or artefacts. The fixation, grossing, taking sections, tissue processing, sectioning and staining are all aspects that might alter the histological spectrum, which varies from benign to malignant. Therefore, careful consideration must be given to all advantages and disadvantages in specimen handling, processing, evaluating gross examination and obtaining sections to arrive at a definitive diagnosis. Aims: To identify the pathological factors that affect the diagnostic accuracy in resection specimen of uterine mass, clinico-radiologically suggestive leiomyoma. Patients: All female patients (352) who underwent surgery for clinically suggestive uterine leiomyoma in a period of two years were included in the study. Materials and Methods: It was a retrospective observational study in a tertiary care centre that spanned 2 years, from January 2019 to January 2021. All patients who had undergone surgery for leiomyoma in this duration were included. All big specimens underwent customised pathology techniques. Results: A total of 352 cases, including 348 leiomyomas, three uterine smooth-muscle tumours of uncertain malignant potential (STUMP) and one case of leiomyosarcoma, were studied. A majority of patients were in the age group of 36–45 years (49.04%). Total hysterectomy was the most common type of surgery performed for leiomyoma (62.06% cases). The most common site of occurrence is intramural. The average size of leiomyoma was 4.72 cm. A majority (88.21%) of leiomyomas were of typical type without any degeneration or variation in histology. Hyalinised collagen (5.75%) is the most frequent finding encountered as a histopathological variant, followed by myxoid change (1.43%). Associated pathology with leiomyoma was adenomyoma (10.91%), followed by uterine malignancy. Adopting the pathology techniques, three cases of uterine smooth-muscle tumours of uncertain malignant potential (STUMP) and one case of leiomyosarcoma could be identified. Conclusion: A pathologist needs to be skilled in troubleshooting lacunae, whether they are caused by fixing the gross or by cutting sections and staining tissue processing. These variables affect the accuracy of the diagnostic process. [ABSTRACT FROM AUTHOR]

Donovanosis is a chronic granulomatous ulcerative sexually transmitted infection caused by Klebsiella (Calymmatobacterium) granulomatis. A 39‑year‑old female patient with underlying HIV infection presented to the department of dermatology outpatient department with a painless ulcer over the left labia majora for 3 months. Histopathological examination revealed histiocyte which contains granular material resembling coccobacilli and Giemsa staining was positive for Donovan bodies. She was treated with doxycycline 100 mg twice daily and azithromycin 1 g once weekly for 3 weeks and further azithromycin 1 g weekly for the next 9 weeks till complete healing of the lesion. Due to the rarity of this condition in our region, we present this case of donovanosis in an HIV‑positive female patient. [ABSTRACT FROM AUTHOR]

Human retro‑viral disease and the myriad opportunistic infections associated with it continue to pose a diagnostic challenge to clinicians. Disseminated Kaposi sarcoma (KS) and KS‑associated immune reconstitution inflammatory syndrome (IRIS) are entities that can be associated with adverse clinical outcomes unless recognized early by the treating physician. We present the case of a 36‑year‑old homosexual HIV‑positive male who presented with unusual symptoms of KS and KS IRIS with lower gastrointestinal bleeding and respiratory distress devoid of any cutaneous manifestations. [ABSTRACT FROM AUTHOR]

A structural flaw in the globin gene causes hemoglobinopathies, while a flaw in the globin chain's synthesis causes thalassemia. One of the most prevalent hemoglobinopathies worldwide is sickle cell disease. Any region of the body can be affected, but the spleen is one of the most often afflicted and the first organs to suffer damage in sickle cell anemia (SCA). Splenomegaly, splenic infarction, hypersplenism, and acute splenic sequestration are the most common manifestations. Usually enlarged in the first 10 years of life, it gradually atrophies and eventually requires an autosplenectomy. It is well established that splenic complications from SCA are linked to higher rates of morbidity and in some cases, even death. This case report discusses a unique presentation of a patient who has hypersplenism together with beta-thalassemia and sickle cell trait. This is a case report of the adult patient admitted in Dhiraj General Hospital, SBKS MIRC, Sumandeep Vidyapeeth, Waghodia, Piparia, Vadodara-391760. The high-performance liquid chromatography (HPLC) technique was used to diagnose thalassemia trait and sickle cell trait. The clinical, ultrasonographic and computed tomography scan methods have been used to identify splenomegaly. The patient had clinical symptoms suggestive of beta-thalassemia and sickle cell trait with hypersplenism. This was supported by his peripheral smear, ultrasonography, contrast-enhanced abdomen–pelvis, HPLC, and bone marrow biopsy. It is imperative that clinicians remain cognizant of this infrequent consequence. Hence, early diagnosis and genetic counseling are of great importance for improving the prognosis of these patients. [ABSTRACT FROM AUTHOR]

EBUS‑TBNA is a well‑established procedure for diagnosis of mediastinal lymphadenopathy replacing the need for mediastinoscopy. In certain diseases like lymphomas, the yield is reportedly 50%, sarcoidosis lymph nodes also give a yield of 80% with EBUS and at times, more material is needed for better characterization of malignancies. EBUS‑intranodal forceps biopsy may be useful in these situations. In our series of seven cases, we describe a unique and safe technique of obtaining forceps biopsy from mediastinal lymph nodes under real‑time endobronchial ultrasound guidance using a 19G EBUS‑TBNA needle tract and thin biopsy forceps. Lymph node biopsy was able to give a conclusive diagnosis in 42% patients negative with TBNA, and was able to suggest a diagnosis in one case. No complications were seen. Thus, surgical biopsy can be avoided in nearly 50% of failed EBUS‑FNAC cases. [ABSTRACT FROM AUTHOR]

Background: Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and non necrotizing granulomas. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications. Aim: The present study aims to evaluate clinical manifestation and diagnosis of Cardiac sarcoidosis -terials and methods: This retrospective study was carried out in the department of medicine, cardiology and CTVS in a tertiary care hospital, India. A total of 140 patients age ranged from 18 to 70 years, with a sarcoidosis diagnosis were screened, and 35 patients were diagnosed with CS based on JCS 2016 Guidelines. All medical records contain socio-demographic and clinical data was evaluated. Results: The majority of the patients 37.2% were 41-60 years age group, median age was 45.9 years. 60% was male, 54.3% residing at rural areas and 42.8% belonged to lower socioeconomic class. Common clinical manifestations of CS were dyspnoea (71.4%), palpitation (48.6%), fatigue (34.3%), dizziness (31.4%) and chest pain in 25.7% of patients. Syncope (20%) and cardiac arrest (11.4%) were the common complication of CS Conclusion: As systemic sarcoidosis, CS remains a challenging issue in the matter of diagnostics. The evolution of clinical manifestation and diagnostic techniques in recent years has led to a significant improvement in the detection and classification of the severity of the disease. [ABSTRACT FROM AUTHOR]

Mitochondrial disorders are a group of metabolic disorders with variable presentation and usually affect organs with high energy requirements like the brain, eye, and heart. Seventeen-month-old girl child presented with right hemiparesis and regression of milestones following chicken pox. Investigations showed elevated lactate, white matter signal changes in both periventricular and subcortical white matter with frontal predominance in the MRI of the brain, cardiomyopathy in the echocardiography, with complex I deficiency in respiratory enzyme assay in the muscle biopsy. A homozygous missense variant c.304C>T (p. Arg102Cys) in exon 5 of NDUFS8 gene (chr11:67800682C>T; NM_002496.4) was detected on whole exome sequencing with positive parental Sanger for the same gene. The child was started on a mitochondrial cocktail, ramipril, and frusemide. Mitochondrial complex deficiency should be considered in cases with stroke-like episodes, and predominant white matter involvement on imaging mimicking classical genetic leukodystrophy like Alexander disease. [ABSTRACT FROM AUTHOR]

Introduction: Primary fallopian tube neoplasms are usually rare, and they are the rarest of all female genital tract neoplasms. According to the WHO classification, papillomas, adenofibroma, cystadenoma, cystadenofibroma, and metaplastic papillary tumors belong to the group of benign tumor masses that arise from the fallopian tubes. Methods: In our case, during an abdominal hysterectomy in a 45-yearold woman suspicious of endometrial adenocarcinoma, a right tubal mass was incidentally found. Results: Microscopic findings revealed features of serous papillary adenofibroma. Serous papillary adenofibroma is a very rare tumor. Till date, only a few cases have been reported worldwide, more so in the presence of endometrial malignancy. Conclusion: Serous papillary adenofibroma is often an incidental finding; thus, it is important to gross the specimen minutely to look for any such finding in the adnexa to avoid missing out on such rare neoplasm. [ABSTRACT FROM AUTHOR]

Background: Eradication of Helicobacter pylori provides the most effective treatment for gastroduodenal diseases caused by H. pylori infection. Clarithromycin, a member of the macrolide family, still remains the most important antibiotic used in H. pylori eradication treatment. But the increasing prevalence of clarithromycin resistant H. pylori strains due to point mutations in the V region of the 23S rRNA, poses a great threat in treating the ailing patients. So, we aimed for PCR-mediated rapid detection of the point mutation at 2143 position of 23S rRNA gene in H. pylori that is relevant to clarithromycin resistance from culture and simultaneously from biopsy specimens to avoid the empirical treatment. Results: Newly developed PCR assay using DNA of pure culture detected point mutation in 23S rRNA gene in 21 (8.04%) of 261 clinical strains tested. The agar dilution method showed that all these 21 strains were resistant to clarithromycin indicating the perfect match of the PCR based results. Additionally, the sequencing study also identified the A to G mutation at 2143 position in 23S rRNA gene of the resistant strains only. Consequently, the newly developed Nested-ASP-PCR dealing directly with 50 biopsy specimens demonstrated 100% sensitivity and specificity with the findings of agar dilution method taken as Gold standard. Bioinformatics based analysis such as accessibility analysis and dot plot clearly stated that the base pairing probability has increased due to mutation. Computational studies revealed that the point mutation confers more stability in secondary structure due to conversion of loop to stem. Furthermore, interaction studies showed binding affinity of the CLR to the mutant type is weaker than that to the wild type. Conclusion: This assay outlines a rapid, sensitive and simple approach to identify point mutation that confers clarithromycin resistance as well as clarithromycin sensitive strains, providing rapid initiation of effective antibiotic treatment. Additionally, it is simple to adopt for hospital based diagnostic laboratories to evaluate the degree of regional clarithromycin resistance from biopsy specimens itself. Furthermore, in silico studies provide evidence or a signal that the prevalence of clarithromycin resistance may rise in the near future as a result of this point mutation. [ABSTRACT FROM AUTHOR]

Background We identified pathogens found in internal organs and placentas of deceased preterm infants cared for in hospitals in India and Pakistan. Methods Prospective, observational study conducted in delivery units and neonatal intensive care units. Tissue samples from deceased neonates obtained by minimally invasive tissue sampling and placentas were examined for 73 different pathogens using multiplex polymerase chain reaction (PCR). Results Tissue for pathogen PCR was obtained from liver, lung, brain, blood, cerebrospinal fluid, and placentas from 377 deceased preterm infants. Between 17.6% and 34.1% of each type of tissue had at least 1 organism identified. Organism detection was highest in blood (34.1%), followed by lung (31.1%), liver (23.3%), cerebrospinal fluid (22.3%), and brain (17.6%). A total of 49.7% of the deceased infants had at least 1 organism. Acinetobacter baumannii was in 28.4% of the neonates compared with 14.6% for Klebsiella pneumoniae , 11.9% for Escherichia coli/Shigella , and 11.1% for Haemophilus influenzae. Group B streptococcus was identified in only 1.3% of the neonatal deaths. A. baumannii was rarely found in the placenta and was found more commonly in the internal organs of neonates who died later in the neonatal period. The most common organism found in placentas was Ureaplasma urealyticum in 34% of the samples, with no other organism found in >4% of samples. Conclusions In organ samples from deceased infants in India and Pakistan, evaluated with multiplex pathogen PCR, A. baumannii was the most commonly identified organism. Group B streptococcus was rarely found. A. baumannii was rarely found in the placentas of these deceased neonates. [ABSTRACT FROM AUTHOR]

Background: Glomerular diseases vary with age, and it is important to investigate the spectrum of glomerular diseases in pediatric patients to help in a more precise clinical diagnosis and optimize the management of patients. We aimed to study the clinicopathologic pattern of pediatric glomerular diseases in North India. Methods: This is a 5-year retrospective, single-center cohort study. The database was searched to identify all pediatric patients with glomerular diseases in their native kidney biopsies. Results: About 2890 native renal biopsies were studied, of which 409 were pediatric glomerular diseases. The median age was 15 years with a male preponderance. Nephrotic syndrome was the most common presentation (60.8%), followed by non-nephrotic proteinuria with hematuria (18.5%), rapidly proliferative glomerulonephritis (7%), isolated hematuria (5.3%), acute nephritic syndrome (3.4%), non-nephrotic proteinuria (1.9%), and advanced renal failure (0.7%). Minimal change disease (MCD) was the most common histological diagnosis, followed by focal segmental glomerulosclerosis (17.4%), IgA nephropathy (IgAN; 10%), membranous nephropathy (6.6%), lupus nephritis (5.9%), crescentic glomerulonephritis (2.9%), and C3 glomerulopathy (2.9%). Diffuse proliferative glomerulonephritis (DPGN) was the most common histological diagnosis in patients with hematuria and non-nephrotic as well as nephrotic range proteinuria. The most common histological diagnoses for isolated hematuria and acute nephritic syndrome were IgAN and postinfectious glomerulonephritis (PIGN), respectively. Conclusions: MCD and lupus nephritis are the most common pediatric primary and secondary histopathologic diagnoses, respectively. The adolescent-onset glomerular diseases have a higher frequency of IgAN, membranous nephropathy, and DPGN. PIGN is still an important differential in our pediatric patients presenting with acute nephritic syndrome. [ABSTRACT FROM AUTHOR]

Mutations in ROMK1 potassium channel gene (KCNJ1) causes antenatal/neonatal Bartter's syndrome type II, which presents with renal salt wasting, hypokalemic metabolic alkalosis, secondary hyperaldosteronism, hypercalciuria, and nephrocalcinosis. We herein describe a case of late-onset Bartter's syndrome type II with progressive renal failure requiring renal replacement therapy secondary to a novel homozygous missense mutation in Exon 2 of KCNJ1 gene (c.500G>A). With this case, we aim to highlight the need for a high index of suspicion and the role of genetic evaluation to diagnose clinically unclassified cases of nephrocalcinosis with renal electrolyte abnormalities more so in late and atypical presentations. [ABSTRACT FROM AUTHOR]

Introduction: Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide, but there is a marked geographic difference in its prevalence and prognosis. IgAN is known to have an aggressive course in Asians. However, its exact prevalence and clinicopathologic spectrum in North India are not well documented. Materials and Methods: The study included all patients aged above 12 years with primary IgAN on kidney biopsy from January 2007 to December 2018. Clinical and pathological parameters were noted. Two histopathologists independently reviewed all kidney biopsies, and MEST-C score was assigned as per the Oxford classification. Results: IgAN was diagnosed in 681 (11.85%) out of 5751 native kidney biopsies. The mean age was 32 ± 12.3 years, and the male to female ratio was 2.5:1. At presentation, 69.8% had hypertension, 68% had an estimated glomerular filtration rate (eGFR) of less than 60 ml/min, 63.2% had microscopic hematuria, and 4.6% had gross hematuria. The mean proteinuria was 3.61 ± 2.26 g/day, with 46.8% showing nephrotic range proteinuria and 15.2% showing nephrotic syndrome manifestation. Histopathologically, 34.4% of patients had diffuse global glomerulosclerosis. Oxford MEST-C scoring revealed M1 in 67%, E1 in 23.9%, S1 in 46.9%, T1/T2 in 33%, and crescents in 19.6% of biopsies. The mean serum creatinine was significantly higher in cases with E1, T1/2, and C1/2 scores (P < 0.05). Hematuria and proteinuria were significantly higher (P < 0.05) with E1 and C1/2 scores. Coexisting C3 was associated with higher serum creatinine at presentation (P < 0.05). Conclusion: IgAN patients with late presentation and advanced disease became less amenable to immunomodulation in our cohort. The implementation of point-of-care screening strategies, early diagnosis, and retarding disease progression should be prioritized in the Indian strategy. [ABSTRACT FROM AUTHOR]

Objective: To study unusual presentations of coronavirus-associated mucormycosis that are rarely seen in sinonasal mucormycosis cases. Method: The data of 400 rhino-orbito-cerebral mucormycosis patients admitted to Sawai Man Singh Hospital, Jaipur, from May 2021 to June 2021, were retrospectively collected. The diagnosis of mucormycosis was made by histological examination of biopsy samples. Results: Out of 400 patients, 62 had symptoms other than common symptoms of rhino-orbito-cerebral mucormycosis. Thirty-four patients had facial palsy, 19 complained of gum ulcers, 6 developed a cheek abscess, 2 complained of maggots in the nose along with common rhino-orbito-cerebral mucormycosis symptoms, and 1 had a cerebellar infarct. Conclusion: Mucormycosis is a disease with various presentations, and coronavirus-associated mucormycosis has added unusual presentations to the existing list of manifestations of rhino-orbito-cerebral mucormycosis. In this coronavirus disease era, mucormycosis should always be considered as a diagnosis in patients with these unusual presentations. [ABSTRACT FROM AUTHOR]

Hypersensitivity pneumonitis (HP) is an umbrella term for a spectrum of disorders caused by the inhalation of organic dust or low molecular weight chemicals. Bagassosis, a rare form of HP, is an allergic reaction caused by inhalation of bagasse dust, which is used in manufacturing several products. Very few cases of bagassosis have been reported in India, owing to the growing industrialization adapting organized sectors for preventing occupational health disorders. Nevertheless, a small population is being exposed to bagasse dust, shadowed by inadequate protective equipment, leading to the occurrence of this occupational disease. Here, we report a case of bagassosis in a 25-year-old male, brick-kiln worker, who presented with respiratory complaints. He underwent a transbronchial lung biopsy that aided in confirmation of the disease, but developed pneumothorax as a complication, which was managed with an Intercostal drain. He was started on corticosteroids, following which his symptoms improved significantly. [ABSTRACT FROM AUTHOR]