Evaluation of comorbidities in the SARS-CoV-2-related mortalities: A retrospective observation from a dedicated COVID-19 care hospital.

Since its discovery in Wuhan, China, in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world with being declared a pandemic in March 2020 by the World Health Organization (WHO). Comorbidities are one of the most concerning clinical considerations for mortality. Materials and Methods: This was a retrospective observational study conducted at the All India Institute of Medical Sciences in Patna, Bihar, from June 2020 to December 2020. It included adult patients who succumbed to coronavirus disease 2019 (COVID-19) during this period, and their relevant information, such as demographic information hospital stay duration, haematological parameters and comorbidities, was gathered. Results: The mean age of the study group was 63.5 (11.8) years. Of 150 cases, 126 men (about 84 per cent) and 24 women were involved (16 per cent). In our study, hypertension (HTN) was shown to be the most frequent comorbidity at 68.7% (103/150), followed by diabetes mellitus (DM) at 61.3% (92/150). The most prevalent haematological disorder identified in our investigation was anaemia and leucocytosis. Conclusion: The categorisation of patients who would need extra measures including early hospitalisation, heightened monitoring and intense therapy would be made easier by identifying patient traits and conditions.

From co-delivery to synergistic anti-inflammatory effect: Studies on chitosan-stabilized Janus emulsions having chloroquine phosphate and flavopiridol in Complete Freund's Adjuvant induced arthritis rat model.

For the first time, the co-delivery of chloroquine phosphate and flavopiridol by intra-articular route was achieved to provide local joint targeting in Complete Freund's Adjuvant-induced arthritis rat model. The presence of paired-bean structure onto the dispersed oil droplets of o/w nanosized emulsions allows efficient entrapment of two drugs (85.86-96.22 %). The dual drug-loaded emulsions displayed a differential in vitro drug release behavior, near normal cell viability in MTT assay, better cell uptake (internalization) and better reducing effect of mean immunofluorescence intensity of inflammatory proteins such as NF-κB and iNOS at in vitro RAW264.7 macrophage cell line. The radiographical study, ELISA test, RT-PCR study and H & E staining also indicated a reduction in joint tissue swelling, IL-6 and TNF-α levels diminution, fold change diminution in the mRNA expressions for NF-κB, IL-1ß, IL-6 and PGE2 and maintenance of near normal histology at bone cartilage interface respectively. The results of metabolomic pathway analysis performed by LC-MS/MS method using the rat blood (plasma) collected from disease control and dual drug-loaded emulsions treatment groups revealed a new follow-up study to understand not only the disease progression but also the formulation therapeutic efficacy assessment.

Small Intestinal Volvulus Caused by Lipomatosis in a Middle-Aged Female.

Lipomas are benign tumors composed of adipose tissue that can occur in various locations throughout the body, including the gastrointestinal (GI) tract. Lipoma of the small bowel is a rare clinical condition. It infrequently results in small bowel obstruction and volvulus. In most of the patients, it is an incidental diagnosis. However, it may present with abdominal pain, nausea, vomiting, GI bleeding, and constipation. It is commonly diagnosed using imaging studies, such as computerized tomography scan or magnetic resonance imaging. The management of small bowel lipomas depends on the presence of symptoms and the risk of complications. Asymptomatic lipomas can be safely monitored with imaging studies, as the risk of complications is low. However, in symptomatic cases, surgical or endoscopic treatment may be necessary to relieve obstruction and prevent complications. We report a case of volvulus of small bowel in a middle-aged female presenting to our hospital with acute GI symptoms.

Cytohistological correlation and risk stratification of salivary gland lesions using the Milan System for Reporting Salivary Gland Cytopathology: A tertiary care centre experience.

INTRODUCTION: Salivary gland neoplasms account for approximately 5% of head and neck tumours. The cytomorphology of fine needle aspiration material helps determine the preoperative assessment and risk stratification. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was developed to improve communication between the laboratory and treatment provider. AIMS AND OBJECTIVE: In the present study, we stratified all salivary gland lesions according to the MSRSGC and evaluated each category's concordance and risk of malignancy (ROM). MATERIALS AND METHODS: This was a 5 year retrospective study. First, all cases were assigned to one of the six MSRSGC categories. Then, following cytohistological correlation, the concordance rates and ROM were calculated based on the final histopathology report. RESULTS: A total of 354 cases were identified, with ages ranging from 2 to 88 years and the commonest age group was the 3rd to 4th decades. Categories I, II, III, IVA, IVB, V, and VI comprised 5.37% (19/354), 26.84% (95/354), 1.13% (04/354), 51.41% (182/354), 1.98% (07/354), 1.13% (04/354), and 12.15% (43/354) of the cases, respectively. The overall concordance rate between the cytological and histopathological diagnoses was 81.25% (65 out of 80 cases), with the sensitivity, specificity, positive predictive value, and negative predictive value at 43.48%, 96.49%, 83.33%, and 80.88%, respectively. CONCLUSION: The MSRSGC provides a better objective and structured way to communicate with the health care provider. In our study, the overall concordance rate was observed in 62/80 cases, with maximum concordance seen in categories III, IVB, and V of the MSRSGC.

Significance of immune-inflammatory markers in predicting clinical outcome of COVID-19 patients.

Background: The epidemic of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale affecting many countries and territories. There is rapid onset of generalized inflammation resulting in acute respiratory distress syndrome. We, thus, aimed to explore the potential of immune-inflammatory parameters in predicting the severity of COVID-19. Materials and Methods: Age, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Lactate Dehydrogenase (LDH), C-reaction protein (CRP), and procalcitonin (PCT) of 611 patients with laboratory-confirmed COVID-19 were investigated and compared. Patients were divided on the basis of severity and survival into two groups. Data were expressed as mean or median values and percentages. The receiver operating characteristic curve was applied to determine the optimal cut-off values of these biomarkers. Results: The median age was 50 years and the male to female ratio was 3.7:1. The mean NLR, LMR, PLR, LDH, CRP, and Procalcitonin for the non-severe group were 4.16, 10.8, 133.7, 666.1, 49.9, and 0.15, respectively. In the severe group mean values of the above-mentioned immune-inflammatory markers were 17.8, 4.69, 268.2, 1277, 158.6, and 3.05, respectively. Elevated levels were significantly associated with disease severity. In ROC curve analysis, NLR had the largest area under the curve at 0.923 with the highest specificity (0.83) and sensitivity (0.88). Conclusion: This study shows that NLR, PLR, LDH, CRP, and Procalcitonin may be a rapid, widely available, useful predictive factor for determining the severity of COVID-19 patients.

Evaluation of C4b as an adjunct marker in symptomatic RT-PCR negative Covid-19 cases.

Introduction: Detecting low viral load has been a challenge in this pandemic, which has led to its escalated transmission. Complement activation has been implicated in pathogenesis of Covid-19 infection. Thus, evaluation of complement activation in suspected Covid-19 infection may help to detect infection and limit false negative cases thus limiting transmission of infection. We speculate that measuring C4b, produced from an activated complement system due to the presence of Covid-19 may help in its detection, even when the viral titers are low. Methods: Plasma C4b levels of symptomatic RT-PCR positive patients (cases, n = 40); symptomatic RT-PCR negative patients (n = 35) and asymptomatic RT-PCR negative controls (n = 40) were evaluated. Plasma C5b-9, IL-6, D-dimer and C1-Inhibitor (C1-INH) were also measured in cases and controls. ELISA kits were used for all measurements. Statistical analyses were carried out using Stata, version 12 (Stata Corp., Texas, USA). Results: C4b levels were found to be significantly increased in RT-PCR positive patients as compared to asymptomatic RT-PCR negative controls. RT-PCR negative but symptomatic patients still showed increased C4b levels. The significantly higher levels of C4b in cases with a cut-off value of ≥ 116 ng/ml with optimum sensitivity and specificity of 80% and 52% respectively is indicative of its possible use as an adjunct marker. Increased levels of D-dimer, IL6, along with decreased levels of C1-INH were found in cases compared to controls. Whereas, C5b-9 levels were not significantly raised in cases. Conclusions: The results of our study suggests that plasma C4b may help to detect infection in false negative cases of RT-PCR that escape detection owing to low viral load. However, to confirm it a large-scale study is needed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01033-z.

Sudden Death Due to Cardiac Tamponade Secondary to Myocardial Infarction Ventricular Wall Rupture.

Sudden deaths due to natural causes are commonly seen in forensic practice, most of which are attributed to cardiovascular diseases. Cardiac tamponade (CT) is one of the causes of sudden cardiac death, with a fatal outcome usually detected at autopsy. While both trauma and non-traumatic causes are responsible for CT, it is a known complication of acute myocardial infarction leading to cardiac rupture that involves the ventricular wall, septum, and papillary muscles. We report the case of a 50-year-old male who collapsed suddenly and was declared dead in the Trauma and Emergency Unit of the hospital before admission. Autopsy findings revealed 250 mL of blood and a 206 g blood clot in the pericardial cavity with a vertical tear on the posterolateral surface of the left ventricle with focal hemorrhagic myocardium consistent with acute myocardial infarction. The cause of death was CT as a result of myocardial rupture due to acute myocardial infarction. The gross and histopathological findings were diagnostic and revealed thrombosis of the left circumflex artery, transmural myocardial infarction, and ruptured myocardium of the left ventricle.

Epidermal Inclusion Cyst of the Clitoris: A Case Report.

Epidermal inclusion cysts are cysts occurring in intradermal or subcutaneous regions with the cyst wall consisting of the true epidermis. They are slow-growing tumors that occur most commonly on the scalp, neck, face, and trunk. They are common in infancy and childhood or after female external genitalia mutilation. Herein, we report a case of a spontaneously occurring epidermal inclusion cyst of the clitoris, a rare location in a 43-year-old woman which was removed by local excision.

Bone Within Bone as a Calcified Subdural Hematoma.

Calcified subdural hematoma (CSDH) is a very rare presentation but a known and reported entity in literature. Most of the case reports have been described in children and the elderly. Surgical treatment for CSDH is still considered controversial. We report here a case of calcified subdural hematoma in a middle-aged male that was successfully operated on. A 45-year-old male presented with complaints of right-sided weakness and seizures with a history of head trauma three years ago. Non-contrast computerized tomography (NCCT) head showed calcified subdural hematoma associated with mass effect and midline shift. A frontotemporoparietal craniotomy was done to remove the CSDH. Intra-operatively the brain was pulsating well. He was discharged on the 12th postoperative day and doing well on a follow-up visit.

The Business of T Cell Subsets and Cytokines in the Immunopathogenesis of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder and one of the most common inflammatory diseases of gastrointestinal (GI) tract in young adults. It is now equally prevalent in western countries as well as in Asian countries. Recently, there has been an increasing IBD burden in low- to middle-income countries as opposed to the earlier notion of this being a disease of the affluents. It occurs due to a variety of factors, namely, local immune alteration, disruption and inflammation of the mucosa, environmental factors, microbial commensals, and pathogen-induced genetic predisposition or genetic alteration in protective factors, etc. So far, an exact etiopathogenesis of IBD is yet to be completely elucidated. Several recent types of research have emphasized the role of altered innate and humoral immunity in its causation, many of them based on animal models of IBD. Due to the poor understanding of its etiopathogenesis, IBD is still a challenge for the treating clinicians leading to persistent and recurrent disease in many cases. Immune dysregulation in the GI tract incited by various pathogenic stimuli has gained great attention from researchers in the field of IBD. This review focuses on highlighting the role of various T cell subsets, their interplay, and associated cytokines involved in the pathogenesis of IBD along with a short description of genetic as well as other immunological factors. A better understanding of the pathogenic factors and subsequent randomized controlled trials targeting these factors is prudent for better therapeutic approaches for IBD.

Cytomorphology of sebaceous carcinoma of the eyelid: A short series of three cases with literature review.

BACKGROUND: Ocular sebaceous carcinoma (OSC) is a malignant and potentially lethal sebaceous gland tumor. Clinically, it masquerades as other benign and less malignant lesions, resulting in a delay in diagnosis. METHODS: In the present study, we sought to evaluate the cytomorphology of this aggressive neoplasm diagnosed by fine-needle aspiration cytology (FNAC) last year at our institute. RESULTS/FINDINGS: We report three cases of OSC diagnosed on aspiration cytology showed a cellular smear composed of sheets, 3D clusters, papillaroid, and singly scattered polygonal tumor cells having centrally located hyperchromatic pleomorphic nuclei and multiple microvacuolations in the cytoplasm. Necrosis and crushing artifact were also identified. Special stains such as Oil Red O stain on air-dried smears showed positivity, confirming the presence of lipid globules. Subsequently, the Cytological impression of sebaceous carcinoma was confirmed on histopathology. CONCLUSIONS: The article highlights the role of FNAC in the early and correct diagnosis of aggressive tumors and subsequent appropriate management to prevent recurrence and metastasis.

Invasive investigation in cases of visceral AVM may be fatal: A rare case report.

INTRODUCTION AND IMPORTANCE: Visceral arteriovenous malformations (AVMs) are extremely rare with only a few cases described in the literature. We have encountered a mesenteric AVM in a 23-year-old girl. Considering the rarity of this entity and diagnostic dilemma, we herein describe a case of mesenteric AVM along with the review of literature. CASE PRESENTATION: A 23-year-old female presented with pain and lump in lower abdomen. During her workup to conclude a final diagnosis, Fine needle aspiration cytology (FNAC) was done. Post FNAC patient went into shock and immediately emergency laparotomy was done. The bleeding mass was resected along with involved gut and anastomosis was done. Histopathology suggested AVM. She was doing well at 2 months of follow up. CLINICAL DISCUSSION: AVM is the rare cause of ischaemic colitis. It can create a diagnostic dilemma with its unusual presentation and its rarity even for both radiologists and surgeons. Usually such malformation reported after trauma or any surgical intervention, but in our case there was no such history of trauma which makes this case more interesting. Invasive investigation is recommended in such condition but needs to be very cautious. As in this index case invasive procedure lead to severe bleeding. Although definitive treatment are embolization and surgery. CONCLUSION: Invasive procedure should be avoided in case of AVM. If angiography is not available its mandatory to keep operating room ready before any invasive procedure.

Massive Abdominal Distension in a Five-Year-Old Child: Management of a Giant Mesenteric Cyst.

Mesenteric cyst is a rare entity with a very low incidence. The majority of the cases are incidental. Despite several theories, its etiology remains unknown. Some cases present with non-specific symptoms such as pain abdomen, swelling, and abdominal mass. It may rarely get complicated due to hemorrhage, torsion, or rupture of the cyst. Large mesenteric cysts are quite uncommon. However, these cysts seldom grow to produce clinical symptoms arising from compression of adjoining structures, such as vomiting, constipation due to intestinal obstruction, or dyspnoea due to compression of the diaphragm. Despite several theories, its etiology remains unknown. Diagnosis can be achieved with the help of radiological examinations such as ultrasonography (USG), contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and confirmed by histopathological examination. We report a case of a giant mesenteric cyst in a five-year-old girl.

The International Academy of Cytology standardized reporting of breast fine-needle aspiration biopsy cytology: A 2 year's retrospective study with application of categories and their assessment for risk of malignancy.

OBJECTIVES: Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category. MATERIAL AND METHODS: A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology. RESULTS: The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively. CONCLUSION: FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.

Astounding Fibro Lipoma of Spermatic Cord: A Diagnostic Dilemma.

BACKGROUND: Fibro lipoma of the spermatic cord is a very rare tumor with few cases reported in literature. Atypical presentation and site of swelling mystifies the diagnosis and creates bewildering situation intraoperatively. Case Summary. A 30-year-old farmer presented with an elastic firm nonreducible, nontender swelling at inguinoscrotal region with positive cough impulse and history of laparoscopic inguinal hernia repair 3 years ago. Ultrasonography of the swelling revealed a heteroechoic lesion of size 7 × 6 centimeter with probable features of lipoma or desmoid. Fine needle aspiration drawn in consideration of the diagnostic dilemma reported a benign lipomatous swelling which on final histopathology turned out to be a fibro lipoma of size 7 × 6 × 5 cm. CONCLUSION: Considering the age and presentation of the patient, it was astonishing. It provided an insight to the occurrence of fibro lipoma even in younger age group which in fact is the first case of its kind as per best of our knowledge. Malignancy should be ruled out in such cases, and complete excision is the treatment of choice.

Association of Ki-67 With Clinicopathological Factors in Breast Cancer.

Background Carcinoma of the breast is one of the most common cancer in females, with preponderance among urban females. The patient's age, tumor size, lymph node status, histological type, histological grade, lymphovascular invasion, hormonal receptor status, human epidermal growth factor receptor 2 (Her2neu) expression, and Ki-67 labeling index for proliferation rate can help determine the appropriate management strategy in these patients. The authors conducted this descriptive retrospective study to assess the association of Ki-67 with clinicopathological parameters in a newly established institute. This may help guide treatment planning in developing countries. Methodology Patients diagnosed with primary breast cancer in our institute between January 2017 and March 2020 were included in this study. The clinicopathological prognostic factors were retrieved from the records. Results A total of 129 cases of core needle biopsy and mastectomy specimens were included in this study. The patient's mean age and median age were 47.41 and 47 years, respectively. Only 56 specimens of mastectomy were received. T2 (26/56) was the most common tumor size. Grading was done in 46 cases, and grade 2 (23/46) was the most common. Estrogen, progesterone, and Her2neu were positive in 65, 61, and 59 cases, respectively. Only estrogen receptor (ER) expression (p = 0.035) and Her2neu (p = 0.035) overexpression were significantly correlated with Ki-67. Conclusions Ki-67 expression was correlated with clinicopathological factors. Only ER expression and Her2neu overexpression were significantly associated with Ki-67. Hence, patients with high Ki-67 expression may have better responses to hormonal therapy and chemotherapy.

Association of Peripheral Blood Parameters With Outcomes of COVID-19 Infection in a Tertiary Care Setting of Eastern India: An Institute-Based Study.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the Coronavirus DISEASE 2019 (COVID-19) pandemic. Blood investigations play a vital role in providing information regarding the inflammatory process. Previous studies have shown that complete blood count parameters have clinical importance in predicting disease outcomes. However, there is a scarcity of literature published from our region in India. Aims The present study was conducted to describe the epidemiological, clinical, and hematological characteristics and outcomes of COVID-19 confirmed cases. Material and methods All real-time reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 cases admitted in our institute over three months, from July to September 2020, were included in the study population. The blood samples of SARS-CoV-2 positive cases were analyzed for complete blood counts and coagulation profile on admission and at the time of discharge (most recent in case of mortality). Results A total of 252 RT-PCR confirmed SARS-CoV-2 cases were included in the study. The most common age group affected was 46 to 60 years, and the male-to-female ratio was 2.45:1. The most common clinical symptom was dyspnea, and the commonest comorbidity was hypertension. The statistical analysis showed a significant association of age, absolute neutrophil count (ANC) D-dimer, neutrophil-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) with intensive care unit (ICU) admission and death. Gender, dyspnea, and absolute eosinophil count (AEC) showed significant association with ICU patients only, while liver disease and absolute lymphocyte count (ALC) had a significant association with death. Conclusion There are many notable clinical and hematological manifestations of COVID-19. Age, gender, dyspnea, comorbid liver disease, ANC, ALC AEC, NLR, PLR, and D- dimer may help clinicians predict the disease progression and reduce mortality risk.