Online teaching of undergraduates in pathology during COVID-19 pandemic: An opportunity to grab or dismiss?

Introduction: Covid 19 pandemic has brought human life one on one with the pace of growth. The indispensable lockdown and social distancing norms have posed challenges to continue education in various fields. Distance learning via online teaching has emerged as a savior in the pandemic. In the current scenario, it is very important to keep learners in the loop and obtain feedback from students at the end of online teaching, for understanding its strength and weaknesses which will eventually assist in developing strategies to improve its quality. We intend to share our experience with the online teaching. Materials and Methods: The study was conducted from March 2020 to Feb 2021, which includes 8 months of online teaching classes and practicals, one online examination (mid term exam), and 1 offline examination (final professional exam). The marks obtained by the students who attended online classes (batch II) in 2020-21 session was compared with previous batch i.e 2019-20 (batch I). Also the marks obtained by batch I during online exam (mid-term exam) were compared with their marks during offline exam (final professional exam). Results: Batch II scored higher marks than batch I in theory and practical (p-value < 0.05). However, the marks of viva for both batches were equitable. Conclusions: We feel that the online teaching is a reasonable alternative to conventional teaching in the current scenario.

Expression of tumor necrosis factor-α and nuclear factor-kappaB/RelA and the pathogenesis of psoriasis.

Context: Tumor necrosis factor-α (TNF-α) is an important mediator in the pathogenesis of psoriasis. Nuclear factor-kappaB (NF-κB) is a transcription factor that regulates the activity of the proinfl ammatory genes. Psoriasis is an infl ammatory disease and the role of TNF-α and NF-κB, should be considerable. Aims: We studied the role of TNF-α and NF-κB in psoriasis. Materials and Methods: A total of 61 cases of psoriatic skin biopsies were studies and the grade of TNF-α and NF-κB, staining was correlated with the histopathological indices of severity. Statistical Analysis Used: Pearson’s correlation coeffi cient and Chi-square test. Statistical Package for Social Sciences version 13 was used. Results: The TNF-α immunostain in the cytoplasm of the epidermal cells and basal cells showed a strong inverse correlation with the grade of epidermal hyperplasia (P –0.019 and P –0.009, respectively). The epidermal cytoplasmic positivity and lymphocyte positivity for TNF-α did not correlate with the grade of NF-κB immunostaining in the epidermal cell nuclei, basal cells or lymphocytes. The basal cell cytoplasmic positivity for TNF-α correlated with the grade of NF-κB immunostaining in the nucleus of basal cells at a P – 0.005. There was a strong correlation between the epidermal cytoplasmic TNF-α immunostaining with the lymphocyte immunostaining (P –0.08); however, there was no correlation between the TNF-α expression in the other two locations. Conclusions: The study outlines the relationship between NF-κB and TNF-α and their combined role in the development of the characteristic histopathological changes in psoriasis. We hypothesize that NF-κB is involved in stimulating the release of TNF-α which would account for the characteristic histopathological changes of psoriasis. However, it is likely that NF-κB can act independently of TNF-α also in the pathogenesis of psoriasis.

Clonality assessment of lymphoproliferative lesions using the polymerase chain reaction: An analysis of two methods.

Background: Lymphoid malignancies are a heterogeneous group of disorders which may be difficult to differentiate from reactive proliferations even after immunohistochemistry. Polymerase chain reaction (PCR) is believed to be a good adjunct tool for diagnosis. Materials and Methods: We examined 24 cases of neoplastic and non-neoplastic lymphoproliferative lesions in this study and evaluated the PCR as an additional tool in the confirmation of the diagnosis. Two different PCR methodologies were evaluated. Results: In the evaluation of the T-cell PCR, it was seen that the correlation using both the commercial kits and the custom-synthesized primers was highly significant at a P value of <0.05. In the evaluation of the B-cell PCR, it was seen that the correlation using both the commercial kits and the custom-synthesized primers was not significant using either method (P > 0.05). Conclusions: Both the methods showed an excellent concordance for T-cell γ gene rearrangements, However, the same was not seen in the B-cell receptor rearrangements. This may be because of the small sample size or the inability of consensus V primers to recognize complementary DNA sequences in all of the V segments.

Pulmonary carcinosarcoma masquerading as a cryptic disseminated malignancy.

Pulmonary carcinosarcoma is an aggressive rare malignant tumor comprising a mixture of carcinoma and sarcoma components containing differentiated mesenchymal elements, such as malignant cartilage, bone, and skeletal muscle. We report a case which presented with unusual clinical features and proved cryptic until death. At autopsy, it was a stage IV lung malignancy and histopathology revealed a carcinosarcoma comprising an adenocarcinoma and an osteosarcoma with metastasis to the heart, lymph nodes, and both adrenals. To our knowledge, this is the first case of this subtype with metastasis to the heart. The present case had an unusual clinical presentation and its elusive nature towards diagnosis despite dissemination is noteworthy and unique in the literature.

Spectrum of renal lesions in HIV patients.

BACKGROUND: A variety of renal lesions have been reported in HIV positive patients from western world however there is paucity of Indian data. METHODS: Over a four year period, all hospitalised HIV positive patients were screened for renal involvement. Screening was done with urinalysis. Those with abnormality in urine examination underwent further assessment with clinical, biochemical, immunological profile and renal biopsy. Renal histology was studied by light and electron microscopy. RESULTS: Twenty-five (17.6%) of the 142 patients screened, had proteinuria/abnormal urinary sediment however none of the patient had proteinuria in nephrotic range. Fourteen of these 25 patients were asymptomatic while others had AIDS. Renal biopsy was studied by light microscopy in all and by electron microscopy in 11 cases. On histology mesangioproliferative GN was encountered in eight, focal segmental glomerulosclerosis in four and collapsing GN in one patient. In two cases cryptococcal infiltration and in one lymphomatous deposits were seen in glomerulus and interstitium. In one patient interstitium showed granulomas and in other three mononuclear cell infiltration. Histology was normal in 8 (32%) patients. On EM visceral cell hyperplasia and vacuolisation was seen in all, two had collapse of glomerular basement membrane and in three cases tubuloreticular structures were seen. There was no co-relation of renal histology with duration or severity of the disease (p > 0.05). No deterioration of renal function was seen over a short follow up period of 4.2 months (1-20 months). CONCLUSION: This study highlights that HIV patients exhibiting abnormal urinary sediment usually have underlying renal lesion and at times unexpected opportunistic infections may be present.

Isolation & preliminary characterization of two HIV-2 strains from Pune, India.

Two HIV-2 strains were isolated from peripheral blood mononuclear cells of two HIV-2 seropositive patients with pulmonary tuberculosis by co-cultivating the cells with phytohaemagglutinin-P stimulated heterologous normal lymphocytes. Biological characterization of the isolates indicated that both isolates were syncytium inducing and induced cytopathic effect in the form of giant cells and syncytia formation in four T lymphoid cell lines. The isolates differed in their replication pattern. The isolates were confirmed as HIV-2 by nested PCR using HIV-1 and HIV-2 specific oligonucleotide primers from the env region and by supplementary tests like indirect immunofluorescence assay, syncytium inhibition assay using reference and HIV-2 reactive patients' sera, western blot and electron microscopy. Neutralization of one isolate (TB1) with two Senegal reference sera also indicated that the isolate may be related to the Senegal strain. To our knowledge, this is the first report of isolation of HIV-2 in India.