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Introduction: A bulla is defined as an intraparenchymal air-filled space of more than 2 cm in diameter in distended state within the lung which has developed because of emphysematous destruction of the lung parenchyma and loss of alveolar structural tissue. Indications for surgical resection of bullae include incapacitating dyspnea, a large bulla that fills >30% of the hemithorax, as seen in this case. Patients with Lung emphysematous bulla are at increased perioperative risk of rupture & barotrauma resulting in tension pneumothorax & compromised respiratory status. After a meticulous clinical and radiological assessment, patients with bullae can be taken up for surgeries like local excision/bullectomy, lobectomy, segmental resection, and minimal access surgeries. Case Report: We present an atypical case of a 26-year-old female with a large bulla measuring 16 x 21 x17cm arising from left lower lobe with centrilobular emphysema with passive collapse of left upper lobe and gross mediastinal shift to the right, managed successfully using lung isolation technique and peri-operative pain management. Conclusion: Anaesthetic management of a patient with lung bulla is challenging. Anesthesiologist should deliberate over an extensive preoperative assessment to identify the high-risk factors, reversibility of underlying lung pathology, need and dependency on mechanical ventilation, and establish a successful perioperative management plan for a smooth, pain free post-operative recovery in such patients. In this case, we describe the anaesthetic considerations of a patient with multiple large lung bullae underwent elective bullectomy under general anaesthesia. No serious complications occurred during intraoperative and postoperative course. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coronavirus disease 2019 (COVID-19) globally known as COVID-19 is a heterogeneous disease caused by the severe acute respiratory syndrome coronavirus 2. COVID-19 patients having severe disease and are critically ill are more prone to have abnormal coagulation prolife. It may lead to thromboinflammation in severe conditions. AIM: The aim is to evaluate the utility of coagulation parameters and inflammatory biomarkers in COVID-19 patients in the study conducted for 6 months duration. MATERIALS AND METHODS: It was a retrospective observational study conducted from April 2021 to September 2021 in a rural tertiary care referral Institute. Available data of the baseline values of coagulation parameters (platelet count [PLC], prothrombin time [PT], international normalized ratio [INR], partial thromboplastin time [PTT] and D-dimer) and inflammatory markers (C-reactive protein [CRP], serum lactate dehydrogenase [LDH], and serum ferritin) were evaluated with respect to the clinical severity of the disease and also the survival status of COVID-19 patients. RESULTS: One hundred and fifty-five cases of COVID-19-positive patients were analyzed. PT, INR, PTT, D-dimer, CRP, LDH, and ferritin had higher mean in severe cases than the nonsevere cases. PLC had higher mean in the severe cases than the nonsevere cases. PT, INR, PTT, D-dimer, CRP, LDH and ferritin had higher mean in nonsurvivors than the survivors. PLC had lower mean in nonsurvivors than the survivors. CONCLUSION: Baseline values of PT, INR, PTT, D-dimer, LDH, and ferritin may be considered reliable indicators of severity of COVID-19 disease. Baseline values of D-dimer, LDH, and ferritin may be considered a reliable indicator of survival of patients suffering from COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background & Objective: Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate the utility of the indigenously designed square grid method for the evaluation of tumor-stroma ratio and stromal tumor-infiltrating lymphocytes in invasive breast carcinoma by assessing the inter-observer variability. Methods: This was a retrospective study conducted at a rural tertiary care referral institute from July 2018 to June 2020. In each case, microphotographs were taken from 10 representative fields in H&E-stained sections for evaluating TSR in low-power and sTIL in high-power. Both the parameters were evaluated employing an indigenously designed square grid applied onto microphotographs in the power-point slides by making use of principles of the Pythagorean theorem. Both parameters were separately evaluated by two pathologists. Cohen kappa statistics was the statistical tool used to analyze inter-observer variability. Results: Thirty cases were analyzed. Invasive breast carcinoma of no special type (IBC-NST) was the most common histopathological type (26 cases (86.67%)). For TRS evaluation, a Kappa value of 0.78 suggested substantial agreement with an agreement of 91.67%. For sTIL evaluation, a Kappa value of 0.51 suggested moderate agreement with an agreement of 88.33%. The P-values were statistically highly significant (P<0.001). Conclusion: Square grid method is a novel technique for evaluating TSR and sTIL in invasive breast carcinoma. It can be considered an example of the application of Pythagoras' theorem in Pathology. [ABSTRACT FROM AUTHOR]

Myelodysplastic syndrome (MDS) represents one of the most challenging health-related problems in the elderly, characterized by dysplastic morphology in the bone marrow in association with ineffective hematopoiesis. Hypoplastic MDS (h-MDS) accounts for 12-17% of all patients with MDS and has yet to be shown to alter the disease course or prognosis. The concept that T-cell-mediated autoimmunity contributes to bone marrow failure in MDS has been widely accepted due to hematologic improvement after immunosuppressive therapy. T-cell expansion is known to occur in these patients, but development of chronic T-cell disorders, especially T-prolymphocytic leukemia (PLL) in a hypocellular MDS is extremely rare, which has an aggressive course. The possible explanation for the association between the two disorders is that T-PLL might arise from a clonally arranged MDS stem cell. We report a unique case of h-MDS with non-progressive pancytopenia and severe hypocellular marrow for 2 years, followed by T-PLL within few months.

Polycythemia vera (PV) is a stem cell disorder, characterized as a panhyperplastic, malignant, and neoplastic marrow disorder. Several reasons suggest that a mutation on the Janus kinase-2 gene (JAK2) is the most probable candidate gene involved in PV pathogenesis, as JAK2 is directly involved in intracellular signaling, following its exposure to cytokines, to which PV progenitor cells display hypersensitivity. A recurrent unique acquired clonal mutation in JAK2 was found in most patients with PV and other myeloproliferative diseases (MPDs). A female patient of age 50 years, presented with hemiplegia, diplopia, and had a consistent rise in hemoglobin and hematocrit. Serum Erythropoietin (Epo) was decreased. JAK2 mutation analysis was found to be negative. A diagnosis of polycythemia vera was made on the basis of the British Committee for Standards in Hematology (BCSH) guidelines.

The low incidence and the non-specific clinical symptoms led us to conclude that the diagnosis of a sebaceous carcinoma of the eyelid often occurs very late. Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior, can have pagetoid spread and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, and has relatively high morbidity and mortality. Scrape cytology was done in a 70-year-old female with a tumor in left upper lid. Cytological smears were suggestive of sebaceous carcinoma. Subsequently, histopathology confirmed the diagnosis of sebaceous gland carcinoma. The article highlights the role of scrape cytology in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma, to prevent recurrence and metastasis.

Syringocystadenocarcinoma Papilliferum (SCACP) is a rare adnexal malignant neoplasm. Most of the cases present with a long standing mass with a sudden progression in size. A 60-year-old female presented with history of swelling over the anterolateral aspect of left thigh since three years. The lesion was associated with history of pain and ulceration. Grossly, the external surface showed three ulcerated areas. The largest ulcer measured 4×5.5 cm. On cut section, the tumour showed variegated appearance consisting of grey-white to pink areas, multiple cysts, focal necrosis and hemorrhagic areas. Microscopically, tumour cells were arranged in papillary configuration, solid sheets, tubular and acinar pattern. Individual tumour cells showed pleomorphic vesicular nucleus and mitotic figures. The intervening connective tissue showed dense chronic inflammatory cell infiltrate composed of lymphocytes, plasma cells and eosinophils. Also seen were areas of necrosis and Gamna-Gandy body. Based on histological features, a diagnosis of malignant appendageal tumour of the skin with apocrine differentiation, favouring SCACP was offered. By Immunohistochemistry (IHC), tumour cells showed focal positivity for CEA and negative for GCDFP-15. IHC may be helpful, but a pathologist has to primarily depend on the histopathological characteristics of the lesion for diagnosing the condition. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia matters in type 2 diabetes and appreciation of the lipid abnormalities in diabetes has changed with time. There are few data on Apo B levels in these patients and consequently there is little information on the frequencies of the various dyslipidemic phenotypes. Methods: Plasma lipids and Apo B were measured by standardized methods. The patients were categorized by two different methods. The first was based on triglyceride (<150mg/dl) and LDL cholesterol (<100mg/dl), and the second was based on triglyceride (<150mg/dl) and Apo B (<137mg/dl). Results: As overall, plasma triglycerides were elevated, total and LDL cholesterol were normal and HDL was decreased. Results of the phenotyping analysis were, using the conventional approach; only 20% has elevated LDL cholesterol. Using the new approach, 63% has an elevated Apo B and therefore an elevated LDL particle number. The mean LDLc for hypertriglceridemic-hyperapo B group was 120.4mg/dl, whereas the mean Apo B for the same was 239mg/dl, indicating its significance over LDL cholesterol. Conclusion: Diagnosis based on triglycerides and Apo B revealed more number of patients with atherogenic, dyslipidemic status rather than by diagnosing on triglycerides and LDL cholesterol levels. Apo B is a better cardiovascular risk marker and can replace LDL cholesterol in maintaining statin therapy in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]