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Pulmonary mucormycosis is a relatively rare pulmonary fungal disease, which is difficult to diagnose early and lacks effective treatment. It is seen in patients with hematological malignancies, diabetes mellitus, and immunocompromised states. The diagnosis depends primarily on the detection of fungi in lung tissue. Here, we present a case of a 52-year-old male who has type 2 diabetes mellitus and a past history of treated pulmonary tuberculosis. Clinical diagnosis is difficult in pulmonary mucormycosis, and early diagnosis is needed for this life-threatening infection. Histopathological examination of a resected cavity confirmed the diagnosis of pulmonary mucormycosis. This report highlights the difficulty of diagnosis and the importance of histological examination in detecting mucormycosis which will help for early management.

Aim The present study proposed a new classification system based on computed tomography (CT) scan appraisal; this enables the surgeon to identify the extent of the defect and helps to execute the proper treatment plan. Background Various terminologies and classifications were proposed to understand developmental defects. But none of the existing classifications/nomenclatures used the preoperative radiographic evaluation (i.e., computed tomography scan-CT scan) in the management and prognosis. Various treatments were advocated and practiced successfully for the surgical correction of lip and palate. Materials and methods The available CT scans from archives of the Department of Radiology and Oral and Dental Surgery were evaluated (retrospectively) for cleft alveolus and its morphology as per the proposal. The English language literature was searched in the MEDLINE database without date restriction to revise existing literature on numerous classification systems/nomenclatures using MeSH keywords related to cleft lip, palate, alveolus, developmental disturbance, facial clefts, and classification. Existing classification systems were revisited with a note on the drawbacks. After careful examination of morphological patterns of all clefts, the new CT scan-based alveolar cleft classification is proposed depending on the extent of cleft. Results The literature revealed a total of twenty-nine classifications of cleft lip and palate starting from the year 1922 to the year 2015, but none exclusively classified the cleft alveolus based on CT scan observations. The observation of three thousand CT scans showed five types of cleft alveolus, depending on the extent of involvement. Conclusion The CT scan-based classification is essential to the surgeon for successful surgical planning of cleft alveolus. The proposed classification is clinically relevant in this digital era for relating surgical outcomes. The three-dimensional viewing of a defect is essential for the surgeon for virtual planning. This paper provides a CT scan-based classification for universal acceptance in this era of digital technology, and CT scan aids in achieving these goals. Clinical significance The new proposal is based on preoperative evaluation of cleft using a CT scan. CT scan imaging provides a clear picture of the cleft in three dimensions for the operating surgeon. Advanced technology-enhanced surgical management modalities like CAD/CAM guided templates to support graft for successful management. The classification system will help the medical and surgical fraternity in various aspects. The three-dimensional modeling of defect and printing of a defect model using additive manufacturing technology helps the surgeon for presurgical visualization and virtual planning in a better way. This strategy of defect classification using a CT scan will help obtain better clinical outcomes and patient satisfaction.

The National Premarital Screening Program, which includes sickle cell disease and thalassemia, was made mandatory in 2004 by the Kingdom of Saudi Arabia (KSA), and the earlier studies have shown a poor knowledge and negative attitude toward this program in the different study groups. This study was conducted to assess the knowledge and attitudes toward premarital screening (PMS) in a randomly selected national sample of the Saudi population, 18 years and above. This was a cross-sectional study conducted in the Saudi population in the western region between July and December 2021. Valid and reliable questionnaire and data were collected from 893 participants aged ≥18 years. The χ2 test was used to ascertain if there is an association between categorical variables. Multivariate logistic regression was used to determine factors predicting satisfactory knowledge. All 893 study participants had heard about PMS with 625 (70.0%), 244 (27.3%) and 24 (2.7%) having satisfactory, fair and poor knowledge, respectively. Participants aged 26–35 years (p =0 .038), females (p < 0.001), those with higher education (p = 0.003) and employed (p = 0.004), had a better knowledge compared to other groups. Most of the participants had a positive attitude toward PMS. There is a changing trend in the knowledge and attitude toward PMS with a greater number of people wanting to go for PMS. There is also an improvement in the number of participants opting out of marriage in case of incompatibility with their future partner. However, the health education programs need to be improved regarding the hemoglobinopathies.

Background:- Inhibitors to infused factor VIII are the most significant complication of hemophilia treatment. These inhibitors are usually IgG antibodies, that react with FVIII in a time and temperature dependent manner. Coagulation factor VIII inhibitors can be detected by Chromogenic, clot based and immunological assays. However, there is lack of consensus as to what constitutes a positive inhibitor, including the appropriate cut-off for inhibitor measurement The main objective of this study is to compare the sensitivity and specificity of chromogenic Nijmegen Bethesda assay (CNBA) with Centre for disease control modified Nijmegen Bethesda (CDC-NBA) assay against the Reference control method (RCM). Materials and Methods: The Coagulometer used for inhibitor titre quantification is Sysmex CS-5100. APTT reagent used isPathromtin SL supplied by seimensSeimens. All data were expressed as Mean ± SD. Statistical formulae were used for sensitivity and specificity calculations. Unpaired students t test was used whereever necessary and a P value of 2 NBU) CNBA has 88% and 80% and CDC-NBA has 85 and 70 % sensitivity and specificity respectively. Conclusion :- These results shows that CNBA is more sensitive and specific than CDC-NBA at both low and high inhibitor titre. Moreover chromogenic assays can differentiate factor specific inhibitor from nonspecific inhibitors like lupus anticoagulant and unfractionated heparin therapy.

Background. Timely detection of the progression of the highly contagious coronavirus disease (COVID-19) is of utmost importance for management and intervention for patients in intensive care (ICU). Aim. This study aims to better understand this new infection and report the changes in the various laboratory tests identified in critically ill patients and associated with poor prognosis among COVID-19 patients admitted to the ICU. Methods. This was a retrospective study that included 160 confirmed SARS-CoV-2-positive patients. Results. Elevated serum ferritin, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and nonconjugated bilirubin levels were present in 139 (96%), 131 (96%), 107 (68%), 52 (34%), and 89 (70%) patients, respectively. Renal parameters were abnormal in a significant number of cases with elevated creatinine and blood urea nitrogen in 93 (62%) and 102 (68%) cases, respectively. Hematological profiles revealed lower red blood cell count, hemoglobin, eosinophils, basophils, monocytes, and lymphocytes in 90 (57%), 103 (65%), 89 (62%), 105 (73%), 35 (24%), and 119 (83%) cases, respectively. The neutrophil count was found to increase in 71.3% of the cases. There was significantly higher mortality (83%) among patients older than 60 years p = 0.001 and in female patients (75%) p = 0.012 . Patients with lung diseases had a poor outcome compared to patients with other comorbidities p = 0.002 . There was a significant association between elevated D-dimer levels and increased mortality p = 0.003 . Elevated levels of AST, creatinine, blood urea nitrogen, and bilirubin were significantly associated with unfavorable outcomes. Conclusion. Different parameters can be used to predict disease prognosis, especially the risk of poor prognosis. Accurate diagnosis and monitoring of disease progression from the early stages will help in reducing mortality and unfavorable outcomes.

Middle East respiratory syndrome is a zoonotic viral disease caused by a novel Coronavirus named Middle East Respiratory Syndrome-Coronavirus (MERS-CoV). More than 1806 cases have been reported in human beings till the end of 2016 with a fatality rate of more than 30%. Majority of the cases have been reported from Saudi Arabia. Many healthcare associated outbreaks have been reported with the largest such outbreak being reported from Republic of Korea in 2015, where 186 cases including 36 deaths occurred. MERS is a viral pneumonia with rapidly progressive respiratory failure leading to ARDS. It presents with a wide range of clinical manifestations and associated with significant mortality rates in hospital admitted patients with comorbidities. Multiple surveillance and phylogenetic studies suggest a bat origin for this virus.A diagnostic real time reverse transcription polymerase chain reaction (RT- PCR) is done to detect MERS-CoV .Supportive treatment is the mainstay of management as no specific drug treatment exists for MERS. Resveratrol has shown to inhibit MERS-CoV infection and prolong cellular survival after virus infection. It is also inhibited by interferon type I in cultured cells. Adequate infection control measures are the mainstay in the management of MERS-CoV. Surveillance should be conducted on a large scale among humans and different animal species to determine the exact rate of spread of MERS-CoV.

Adenomatous colorectal polyps are known to be precursor lesions for colorectal cancer. Colorectal adenomas are usually classified into two categories:tubular and villous. A mixed (tubulovillous) phenotype is also recognized. The aim of the study was to study the prevalence and pathological features of adenomatous polyps. We studied five cases of adenomas. Three were diagnosed as tubular adenomas and two were diagnosed as villous adenomas. Most of the significant polyps were identified in patients aged 50 years or older. In case of villas adenoma, the incidence of dysplasia rose with an increase in size. Conclusion: It is advisable that all polypoidal lesions should be removed for definitive histological examination.

BACKGROUND : Of all the tissues in the human body, perhaps the salivary glands have the most histologically heterogenous group of tumors and the greatest diversity of morphologic features among their cells and tissues. This diversity combined with the fact that most surgical pathologists have limited opportunity for experience with salivary glands is the primary reason behind the difficulty caused by these diseases for many pathologists. Therefore, present study was undertaken to study the relative incidence and spectrum of histomorphological features of various salivary gland neoplasms. AIMS : The aim of this study was to evaluate the relative frequencies, types, site distribution and the histomorphology of salivary gland neoplasms. MATERIAL AND METHODS : The material for this study comprised of incisional biopsies and resected specimens of salivary gland neoplasms received in the department of pathology, J.J.M.Medical College, Davangere. In cases of parotid gland lesions, superficial parotidectomy and total parotidectomy without neck dissection was done and specimens were sent for histopathological examination. Gross examination and subsequent microscopic examination was done after staining with hematoxylin and eosin. 53 cases diagnosed histopathologically as salivary gland neoplasms were included in this two year prospective study. RESULTS : During the two years of study period 53 salivary gland neoplasms were seen. 38 cases were benign neoplasms and 15 cases were malignant. Among all neoplasms, pleomorphic adenoma was the commonest. Mucoepidermoid carcinoma was the most common malignant neoplasm. The mean age of presentation of all neoplasms was 42.74 years. The male to female ratio was 1:1.2. Most common site of occurrence was parotid gland. No intraparotid lymph nodes were observed. In all the neoplasms studied, typical histomorphological features were seen. Surgical margins were free in all the cases. CONCLUSION : It is concluded that some of our results are in harmony with those of other authors.. On the other hand, some of our results are different from published literature. Further nationwide population based survey is needed to define the epidemiology of salivary gland neoplasms.

Introduction: Petroclival meningiomas are based on or arising from the petro-clival junction in upper two-thirds of clivus, medial to the fifth cranial nerve. This study focuses on the surgical experience in resecting large-giant tumors >3.5 in size predominantly utilizing middle fossa approaches. Material and Methods: 33 patients with a large or a giant petroclival meningioma (size >3.5 cm) were included. Clinical features, preoperative radiological details, operative findings, and postoperative clinical course at the follow-up visit were reviewed. Group A tumors (n = 17,51.5%) were sized 3.5cm-5cm, and Group B (n = 16,48.48%) tumors were of size >5 cm. Extent of resection was described as ‘gross total' (no residual tumor), ‘near total' ( 10% residual tumor). Glasgow outcome scale (GOS) quantitatively scored postoperative neurological outcome (mean follow up: 35.77months; range 1-106 months). Results: 25 (75.8%) patients had tumour extension into both supratentorial and infratentorial compartments. Extension into Meckel's cave (n = 25,75.8%), cavernous sinus (n = 17,48.4%], sphenoid sinus (n = 12,38.7%] and suprasellar area [12,38.7%] was often seen. In 31 (93.9%) patients, the tumor crossed the midline in the premedullary, prepontine, and interpeduncular cisterns. In 20 (60.6%) patients, the tumour extended below and posterior to the internal auditory meatus (IAM), while in 13 (39.4%) patients, the tumor was located above and anterior to the IAM. Kawase's approach was the most commonly used approach in 16 (48.48%) patients and resulted in maximum tumor resection. Other approaches included half-and-half (trans-Sylvian with subtemporal) [n = 6, 18.18%]; frontotemporal craniotomy with orbitozygomatic osteotomy [n = 1, 3%] and retromastoid suboccipital craniectomy (RMSO) [n = 7, 21.21%]. In 2 (6.06%) patients, staged anterior petrosectomy with RMSO; and, in 1, staged presigmoid with half-and-half approach was used. Gross total excision was achieved in 12 (36.36%), near-total excision in 15 (45.45%) and subtotal excision in 6 (18.18%) patients. 20 (60.6%) patients had a good functional outcome; 6 patients succumbed due to meningitis, pneumonitis, perforator injury or a large tumor recurrence. Conclusions: Half-and-half approach was used in tumors with middle and posterior cranial fossae components often extending to the suprasellar region. Kawase's anterior petrosectomy was utilized in resecting tumors with predominant posterior fossa component (along with a small middle fossa component) that was crossing the midline anterior to the brain stem, and mainly situated superomedial to the IAM. Tumors confined to the posterior fossa, that extended laterally and below the IAM were resected utilizing the RMSO approach. Occasionally, a combination of these approaches was used. Middle fossa approaches help in significantly avoiding morbidity by an early devascularisation and decompression of the tumor. In tumors lacking a plane of cleavage, a thin rim of capsule of tumor may be left to avoid brain stem signs.

Angiomyofibroblastoma is a rare,usually small benign mesenchymal tumor that occurs mainly but not exclusively in the vulval region of premenopausal women. Patients often present with non specific symptoms. It is a well circumscribed lesion that clinically is often thought to represent a Bartholin's gland cyst. Diagnostic confusion often arise between angiomyofibroblastoma and other tumors arising in the vulval region like aggressive angiomyxoma and cellular angiofibroma because of overlapping histological features. Differentiating between angiomyofibroblastoma and cellular angiofibroma is not of clinical significance.Aggressive angiomyxoma is a more infiltrative lesion that has a high propensity for local recurrence. Immunohistochemistry is not of much help in distinguishing these entities. Sincere efforts should be made to differentiate angiomyofibroblastoma from aggressive angiomyxoma, which has a potential to metastasize or recur.

Adenosquamous carcinoma of the pancreas is a rare subtype of pancreatic cancer. A 55-year-old female patient was admitted in our hospital for evaluation of her epigastric pain of 2 months duration. On physical examination, there was no jaundice. Diffuse tenderness was present over the right upper quadrant and epigastrium. There was a mass located in the epigastrium. Computed tomography scan of the abdomen showed an 8 × 9 cm solid mass with partly cystic areas in the region of body and tail of the pancreas. Other investigations including liver function tests, complete blood count, and urea and electrolytes were normal. A clinical diagnosis of pancreatic tumor was made. Distal pancreatectomy with gastric reconstruction and small bowel anastomosis with splenectomy was done. Histologically, the tumor was diagnosed as adenosquamous carcinoma of the pancreas with infiltration into the wall of duodenum. Adenosquamous carcinoma of the pancreas is an uncommon variant of exocrine pancreatic cancer which demonstrates characteristic immunoprofile and distinct clinical and pathologic features with a worse prognosis than ductal adenocarcinoma.