A rare case of multisystemic Langerhans cell histiocytosis in an adult affecting the thyroid gland, skeletal system, and pituitary gland: A case report.

ABSTRACT: Langerhans cell histiocytosis (LCH) is a rare disorder affecting usually children and rarely adults. The most common site affected is bone. The involvement of the thyroid gland in LCH is extremely rare and it is usually observed in an adult as a multisystemic disease. Adult males presented with anterior neck swelling, and fine needle aspiration cytology (FNAC) diagnosed it as suspicious for malignancy. On frozen sectioning, differential diagnosis was given as non-Hodgkin lymphoma and poorly differentiated malignancy. On immunohistochemistry (IHC), tumor cells were positive for CD1a and S100p. Thus, the final diagnosis offered was LCH-thyroid. The pathogenesis is unclear and believed to be related to immune dysfunction, cytokine mediators, viral infection, smoking, and genetic factors. Due to its rarity, thyroid LCH is often misinterpreted as other common disorders of the thyroid and results in delayed diagnosis. This case highlights the importance of histomorphology and the use of ancillary techniques such as IHC to arrive at a diagnosis in time and hence the treatment.

Assessing Mismatch Repair Expression by Immunohistochemistry in Colorectal Adenocarcinoma -Insight from a Tertiary Care Centre.

BACKGROUND: Microsatellite instability (MSI) is a pattern of hyper mutation that occurs at microsatellite level in the genome and result due to error in the mismatch repair system. MSI is caused by defective mismatch repair (MMR) genes associated with either hyper methylation of MMR genes or BRAF mutations. Anti-MLH-1, anti-MSH-2, anti-MSH-6 and anti-PMS2 monoclonal antibodies are used for Immunohistochemical analysis. METHODS: The immunohistochemical expression of MSI proteins were assessed in 72 cases of colorectal carcinoma. These were classified based on the expression of MLH1, MSH2, MSH6 and PMS2 proteins. RESULTS: There were 57 percent of cases showing loss of at least one antibodies, and 43 percent cases showing intact expression of all antibodies (MLH1, MSH2, MSH6 and PMS2). CONCLUSION: In conclusion, our study provides valuable insights into the expression of mismatch repair in colorectal adenocarcinoma through immunohistochemistry analysis conducted at our tertiary care centre. These findings hold significant clinical implications, suggesting further testing for BRAF and MLH1 Promoter Hypermethylation to confirm possibility of Lynch syndrome. KEY WORDS: IHC, MMR, CRC.

Practice Trends of Neuromodulation Therapies for Pain and Spasticity in India.

BACKGROUND: Neuromodulation has been successfully used globally to address severe refractory chronic pain for over five decades. Compared to the wide acceptance that it enjoys in United States and Europe, it is fairly underutilized in Asia, including India. OBJECTIVES: We conducted the first systematic nationwide survey to provide an overview of neuromodulation in the past 20 years to investigate the practice trends for severe refractory chronic pain and barriers for the uptake of neuromodulation therapies for pain in India. DESIGN: A 20-point detailed questionnaire survey was sent out for online completion in August 2020 to practitioners in India involved in interventions for pain. The survey was completed by 112 practitioners (10% return rate). The response data collected were analyzed, tabulated, and presented as percentages. RESULTS: The average duration of pain practice in India for the majority of respondents was less than a decade. About 70% of practitioners expressed that they manage severe refractory pain without neuromodulation. This survey confirms that neuromodulation is grossly underutilized for pain, comprising only 10% of total neuromodulation implants performed per annum in India. The most common indications were neuropathic pain (45%) and failed back surgery syndrome (42%). The respondents expressed the main barriers to be related to the cost (85%), lack of awareness (68%), and lack of good training (59%). More than 50% of respondents also expressed difficulty of access to neuromodulation therapies for pain and acceptance by patients. CONCLUSION: The younger generation of pain practitioners in India is becoming more aware and convinced about the role of neuromodulation to alleviate severe pain and suffering. An all-round approach combining improved training, awareness at various levels, more flexible options of newer technology and reimbursement approval can positively influence its use. This can be achieved with the collective efforts of physicians, insurers, industry, and focused academic activities of clinical societies.

Urine Biochemical Parameters in Predicting Severity of SARS-CoV-2 Infection: an Experience in Tertiary Care Centre in Western India.

BACKGROUND & OBJECTIVE: Coronavirus is an enveloped RNA virus that mainly causes respiratory infection. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal and oropharyngeal swab is the confirmatory diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection. The relationship between SARS-COV-2 and body fluid parameters is still not known. There have been few studies regarding the correlation between urine biochemical parameters and SARS-COV-2 infection. The aim of the study is to determine the importance of urinary biochemical parameters in SARS-COV-2 infection and whether these parameters can be used to predict the severity of the infection. METHODS: This was a retrospective observational study consisting of total of 285 patients diagnosed with SARS-COV-2 infection. The patients were divided into three groups according to the severity of infection as mild (120 cases), moderate (110 cases) and severe (55 cases). During the study period 72 healthy persons were enrolled as controls. Analysis was done to find any relationship between various urine biochemical parameters and the severity of SARS-COV-2 infection. RESULTS: Urinary occult blood (U. Blood) and Urinary protein (U. Pro) have higher positive rates in SARS-COV-2 patients as compared with healthy controls. Among the severities of SARS-COV-2 infection (mild, moderate and severe), both these parameters were significantly higher. Glucose (Glu) and Ketone (Ket) positivity rate was more in moderate cases of SARS-COV-2 than mild cases. CONCLUSION: Urinary biochemical parameters are very useful in identification of SARS-COV-2 infection and also have the advantage in evaluating the progression in patients infected with SARS-COV-2. Among the different parameters, Urinary Occult Blood and Urinary protein are significant in the differentiation of SARS-COV-2 severity.

Dual tumor - Clear cell sarcoma of kidney with differentiating neuroblastoma: A rare case with review of literature.

Occurrence of two distinct synchronous primary tumors is a rare event in children as well as in adults. Here, we report an extremely rare case of an infant found to have two synchronous Tumours namely clear cell sarcoma of kidney(CCSK) and differentiating neuroblastoma of preaortic region. To our knowledge, this may be the first case of synchronous CCSK and differentiating neuroblastoma being reported.

Comparison of lea gratings with cardiff acuity cards for vision testing of preverbal children.

AIMS: To create a normative data for lea grating (LG) in the Indian population and to compare LG with Cardiff Acuity Card (CAC). SETTINGS AND DESIGN: Normative Data was acquired from normal children between 6 months-3 years coming to the 'Immunisation Clinic' and 'Well-Baby Clinic' at a Civil Hospital. To compare LG with CAC, normal and amblyopic children between 6 months-3 years were evaluated, MATERIALS AND METHODS: Monocular and binocular visual acuity (VA) was measured using LG and then CAC. VA and time taken to perform the test were compared. STATISTICAL ANALYSIS USED: Pearson's Correlation Coefficient to compare VA and Student paired t-test (significance P<0.005) to compare time. RESULTS: Two standard deviations of VA of 100 normal children overlapped with that published by Lea. Of the 30 amblyopic children aged 18.32 ± 10.5 months (2-36), 18 were females. VA was 0.95 ± 0.3 logMAR (0.7-1.2) and 1.0 ± 0.6 logMAR (0.5-2.1) binocularly and 1.32 ± 0.08 logMAR (0.2-0.6) and 1.15 ± 0.15 logMAR (0.88-1.48) monocularly on CAC and LG respectively. Pearson's correlation coefficient was 0.98 and 0.63 for binocular and monocular assessment respectively. Time taken to perform LG monocularly and binocularly was significantly less (P<0.001) than CAC. CONCLUSION: Normative data acquired in Indian pre-verbal children is similar to that published by Lea. Though VA by CAC is better than LG, the two tests are comparable.