Primary follicular lymphoma of the prostate co-existing with grade group 5 prostatic adenocarcinoma and presenting as a PI-RADS lesion 4 on mpMRI.

Primary prostatic lymphoma is an exceedingly rare entity comprising less than 0.09% of all prostatic cancers with follicular lymphoma making up only 12% as a subset. To our knowledge, primary follicular lymphoma co-existing with high grade prostatic adenocarcinoma presenting as a PI-RADS lesion 4 on mpMRI has not been previously described. We report the case of a 73-year-old male who presented with mildly elevated PSA and lower urinary tract symptoms. Prostate needle biopsy revealed low grade follicular lymphoma juxtaposed with high grade prostatic adenocarcinoma. The patient has been treated with radiation therapy for adenocarcinoma and is under observation for lymphoma progression.

Hybrid backscatter communication for IoT devices in remote areas.

The IoT devices placed in remote locations require a battery replacement very often, which is not a convenient option. Backscatter communication can resolve this problem, as backscatter communication is a data transmission in which an RF signal incident from the gateway is used for energy harvesting, and this energy will be employed for data transmission. In this paper, a hybrid contention-based TDMA scheme is proposed, which provides slots to devices by dividing them into groups, and then contention is employed in groups to acquire a slot; if a device is not able to transmit during harvest, then transmit (HTT) period, then it can transmit in variable sub frame and the devices which are not able to completely transmit during HTT period can reserve subframes. The proposed hybrid scheme is compared with the TDMA scheme for average transmission delay.The proposed scheme provides scalability. The difference between the average transmission delay of TDMA and the proposed hybrid scheme is from 6 to 20 s, depending on the number of devices added and when traffic is generated.

An Elusive Diagnosis: Diffuse Large B-Cell Lymphoma Masquerading as Acute Liver Failure with Persistent Lactic Acidosis.

BACKGROUND Acute liver failure (ALF) associated with malignant lymphoma is a rare condition with non-specific clinical and radiological features. Here, we describe an unusual case of ALF due to DLBCL with an image negative on presentation posing diagnostic difficulty. CASE REPORT A 74-year-old man was admitted to our hospital with abdominal pain. Radiological and laboratory investigations revealed lymphadenopathy with mildly elevated transaminitis and alkaline phosphates levels. A right upper-quadrant ultrasound showed heterogeneous hepatic parenchyma. Eight days later, he had worsening abdominal pain. He was found to have altered mental status and asterixis. His liver function was worsened with ALT 101, AST 328, lactic acid 4.2, total bilirubin 2.5, INR 6.35, and ammonia level 117 µmol/L. He continued to deteriorate with worsening lactic acidosis, coagulopathy, severe anemia, elevated liver enzymes, and thrombocytopenia. Unfortunately, the patient died of multi-organ failure on the 14th day of hospitalization. The autopsy findings revealed DLBCL involving multiple organs, including the liver, lung, bone marrow, and multiple lymph nodes. Despite an extensive diagnostic workup, an underlying diagnosis was unable to be established antemortem. CONCLUSIONS We describe a case of ALF linked to DLBCL discovered at autopsy. The non-specific clinical and radiological features of this condition make diagnosis challenging, and the prognosis is often poor. Further research and awareness are needed to improve the early detection and management of ALF associated with malignant lymphoma. By expanding the literature on this topic, we aim to improve outcomes and optimize patient care in similar clinical scenarios.

Impact of early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors in patients with acute coronary syndrome: A systematic review meta-analysis.

OBJECTIVE: Scant data is available on the efficacy and safety of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) for early and rapid reduction of low-density lipoprotein cholesterol (LDL-C) within 4-8 weeks of an acute event in patients with acute coronary syndrome (ACS). We undertook this meta-analysis to address this knowledge-gap. METHODS: Electronic databases were searched for RCTs involving patients with ACS receiving PCSK9i in intervention arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in 1-month LDL-C post ACS. Secondary outcomes were to evaluate alterations in other lipid parameters and adverse events. RESULTS: From initially screened 194 articles, data from 3 studies was analyzed. After 4-weeks therapy, patients receiving PCSK9i had lower LDL-C [MD -0.95 mmol/L (95%CI:-1.51 to -0.40); P = 0.0007; I2 = 96%, total cholesterol (TC) [MD-1.05 mmol/L (95%CI:-1.83 to -0.27); P = 0.009; I2 = 94%] and triglycerides (TG) [MD-0.27 mmol/L (95%CI:-0.44 to -0.10); P = 0.002; I2 = 0%] compared to controls. After 4-8 weeks therapy, patients receiving PCSK9i has lower apolipoprotein B [MD-27.74% (95%CI:-42.59 to -12.89); P = 0.0003; I2 = 89%] as compared to controls. High density lipoprotein cholesterol (HDL-C) [MD 0.05 mmol/L (95%CI:-0.00-0.11); P = 0.05; I2 = 0%], lipoprotein(a) [MD-20.63 mmol/L (95%CI:-41.86- 0.59); P = 0.06; I2 = 54%] and apolipoprotein A1 [MD 0.02 g/L (95%CI:-0.02-0.07); P = 0.32; I2 = 0%] were comparable between groups. Hospital readmission for ACS was significantly lower in group receiving PCSK9i compared to controls [OR0.25 (95%CI:0.07-0.85); P = 0.03; I2 = 0%]. Occurrence of cardiac death [OR3.75 (95%CI:0.41-34.22); P = 0.24; I2 = 0%], serious adverse events [OR0.71 (95% CI:0.13-3.83); P = 0.69; I2 = 70%] and total adverse events [OR1.01 (95%CI: 0.19-5.30); P = 0.99; I2 = 92%] was comparable between groups. CONCLUSION: PCSK9i are highly effective in early reduction of LDL-C along with reduction of early hospital readmissions post-ACS.

Environmental damages due to war in Ukraine: A perspective.

The ongoing Russia-Ukraine war is the most prominent conflict in Europe since the Second World War and has several geopolitical, economic, infrastructure, and health implications. The war has serious negative consequences on people and the planet. The damage to industrial and commercial infrastructure can contaminate water sources, which can be hazardous for human and ecosystem health. Water shortages and deteriorating sanitary conditions are already evident since water supply and sanitary infrastructure have been hit. Air quality is adversely affected due to troop movement and constant bombarding. Chances of radiation leakage from nuclear sites also remain. The physical, chemical and biological characteristics of soil have been impacted due to shelling and explosions, as a result of which, agriculture has been severely affected. Military actions have caused large-scale deforestation and even wildfires. There is also fear of biodiversity loss and species extinction in the long term. The war of such nature may directly hamper efforts to deal with aspects such as climate change, sustainable development goals (SDGs), conservation and protection of biodiversity, and pollution control at local and global levels. Besides this, the repercussions of this war on essential services such as healthcare, education, social security, and public amenities will be felt for a long. As a result of important interruptions in the supply of energy and raw materials throughout the world, prices for commodities, oil, and food have risen dramatically. To avert such damages in the future and make the offenders accountable, in the long term, reforms in the mandate of the International Criminal Court are required to include environmental crimes. New international norms to safeguard the environment during conflict are urgently needed. The environment should not be considered an unavoidable war casualty. Environmental and human security are inextricably linked. The international community's reaction to the crisis must include addressing this as a priority.

Leveraging Experimental Strategies to Capture Different Dimensions of Microbial Interactions.

Microorganisms are a fundamental part of virtually every ecosystem on earth. Understanding how collectively they interact, assemble, and function as communities has become a prevalent topic both in fundamental and applied research. Owing to multiple advances in technology, answering questions at the microbial system or network level is now within our grasp. To map and characterize microbial interaction networks, numerous computational approaches have been developed; however, experimentally validating microbial interactions is no trivial task. Microbial interactions are context-dependent, and their complex nature can result in an array of outcomes, not only in terms of fitness or growth, but also in other relevant functions and phenotypes. Thus, approaches to experimentally capture microbial interactions involve a combination of culture methods and phenotypic or functional characterization methods. Here, through our perspective of food microbiologists, we highlight the breadth of innovative and promising experimental strategies for their potential to capture the different dimensions of microbial interactions and their high-throughput application to answer the question; are microbial interaction patterns or network architecture similar along different contextual scales? We further discuss the experimental approaches used to build various types of networks and study their architecture in the context of cell biology and how they translate at the level of microbial ecosystem.

Parasitic leiomyoma causing small bowel perforation: A case report.

BACKGROUND: Parasitic leiomyomas are rare extra-uterine tumors that can be seen in patients after myomectomy or morcellation of leiomyomas. CASE: A 63-year-old woman with a history of abdominal myomectomy 20 years prior presented with worsening abdominal distension and pain for the past eight months. The patient delayed care due to fear of the COVID-19 pandemic and was found to have a 42 cm parasitic leiomyoma attached to the small bowel causing obstruction and perforation. CONCLUSION: Parasitic leiomyomas can cause small bowel obstruction and perforation.

Undifferentiated Pancreatic Carcinoma With Osteoclast-Like Giant Cells and Associated Ductal Adenocarcinoma With Focal Signet-Ring Features.

Undifferentiated pancreatic carcinoma with osteoclast-like giant cells (UPC-OGC) is a unique and rare tumor characterized by the presence of highly atypical carcinoma cells and non-neoplastic osteoclast-like giant cells. The histogenesis of this tumor is unclear and data on its prognosis remain controversial. Some data show poor clinical outcomes in affected patients while other more recent studies report a better outcome especially for cases with pure UPC-OGC. There are currently no established reliable management guidelines for UPC-OGC partly because of its rarity and presence of conflicting data in the literature. Hence the need for continued reporting and further research on this neoplasm. We report an incidental finding of UPC-OGC with associated ductal adenocarcinoma and focal signet ring features in an elderly male patient who presented with symptoms of urinary tract infection (UTI).

Morphologic Changes in Circulating Blood Cells of COVID-19 Patients.

Objective Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many studies have described the quantitative peripheral blood findings seen in COVID-19 patients. However, morphologic changes have been described by only a few studies. We report morphologic and quantitative changes in peripheral blood of COVID-19 patients. Design We reviewed electronic medical records, complete blood counts, and peripheral blood smears of 20 patients who were COVID-19 positive by reverse transcriptase-polymerase chain reaction (RT-PCR), from March 1, 2020, through May 31, 2020. The peripheral blood smears of all 20 patients were retrieved and morphological features of white blood cells, red blood cells, and platelets were reviewed and documented. Appropriate pictures were taken. Results Of the 20 patients reviewed, 13 were males and seven were females. The average age of the patients was 65.1 years. The most common quantitative hematologic abnormalities noted on complete blood count (CBC) were anemia followed by neutrophilia, neutrophilic left shift, and lymphopenia. The most significant morphologic changes noted were neutrophils with clumped chromatin, multiple abnormal nuclear shapes, pseudo-Pelger-Huet deformity, and smudged neutrophils. Lymphocytes showed abundant blue cytoplasm and/or lymphoplasmacytoid morphology and monocytes were activated with abnormal shapes and vacuolization. Platelets were adequate in number in the majority of patients and platelet clumping was the most significant finding noted. The red blood cells were normocytic and normochromic with few nucleated red blood cells and coarse basophilic stippling. Conclusion Our study identifies and describes significant morphologic changes in the peripheral blood cells of COVID-19 patients. An understanding of these morphologic changes in addition to established hematologic parameters can aid in the diagnosis of COVID-19 and serial CBC and peripheral smear review may help with management decisions in COVID-19 patients.

A Cross-Sectional Study of Clinico-etiological Profile and Associated Comorbidities in Indian Patients of Pigmented Purpuric Dermatoses.

BACKGROUND: Pigmented purpuric dermatoses (PPDs) are a group of chronic benign vascular disorders with varied clinical presentation. The etiopathogenesis of the condition largely remains unknown with a paucity of clinico-epidemiological and/or clinico-etiological studies. OBJECTIVE: To study the clinico-epidemiological pattern, etiological factors and associations of PPD and correlate them with its severity in a set of Indian patients. MATERIALS AND METHODS: In a cross-sectional study, all clinically diagnosed and histopathologically confirmed cases of PPD attending the outpatient department of dermatology from November 2015 to October 2016 were included in the study. Patients were evaluated based on a detailed history of the illness, comorbid conditions, drug usage, general physical, systemic, and cutaneous examinations, severity of disease (mild, moderate, or severe), laboratory parameters, and Doppler ultrasonography of the lower extremities. RESULTS: There were a total of 60 patients with a female-to-male ratio of 1.14:1. The mean age of patients was 47 ± 12.10 (range: 15-70) years. Majority (70%) of the patients were housewives, bankers, and businessmen. The possible etiological and/or aggravating factors included prolonged standing (28.3%), drug intake (13.3%), alcohol ingestion (10%), strenuous exercise (5%), and varicose vein (3.3%). Schamberg's disease (90%) was the most common type observed. The most common systemic comorbidity identified was hypertension (58.3%) followed by diabetes mellitus (31.6%) and dyslipidemia (28.3%). A positive correlation was found between severity of the disease and presence of comorbidities (Mantel-Haenszel method, P < 0.0001). CONCLUSION: PPD was found to be associated with a variety of disorders and comorbidities. The number of the comorbidities increased with increasing severity of the disease. Besides exposing the patient to various risk factors, this may contribute to the vessel wall damage seen in the condition. All patients with PPD should, therefore, undergo an initial screen for these comorbidities.

Cardiovascular and Metabolic Risk Assessment in Patients with Lichen Planus: A Tertiary Care Hospital-based Study from Northern India.

BACKGROUND: The association between lichen planus (LP) and cardiovascular disease (CVD) risk factors has been demonstrated in previous reports. However, the evidence of CVD risk factors in Indian patients with LP is limited. OBJECTIVE: To compare CVD risk factors in LP patients and healthy controls. METHODS: We performed a cross-sectional study on 122 subjects, 61 LP patients, and 61 controls who visited the outpatient clinic of the dermatology department of a tertiary care hospital. Patients with skin diseases known to be associated with CV risk, pregnant, and lactating women were excluded from the study. CVD risk factors were compared between LP cases and controls using anthropometric measures, hemodynamic and metabolic parameters, and inflammatory marker (ESR). RESULTS: The proportion of metabolic syndrome (MS) was significantly higher in LP patients than the controls (29.5% vs. 9.8%, odds ratio [OR] 3.83; 95% confidence interval [CI] 1.40-10.50; P = 0.006). The proportion of dyslipidemia was also significantly higher in LP patients (70.5% vs. 42.6%; P = 0.002). LP patients had a high proportion of obesity (P = 0.004), hypertension (P = 0.004), impaired fasting glucose (P = 0.025), and raised ESR (P = 0.006) as compared to controls. A multivariate regression model demonstrated that dyslipidemia and obesity were significantly associated with LP even after controlling for confounders such as age, gender, sedentarism, dietary habits, alcohol, and impaired fasting glucose. There was no significant association between the extent of LP and the proportion of MS or dyslipidemia. CONCLUSION: The present study found a significant association of LP with individual CVD risk factors as well as MS.

Resilient Customized Hollow Vaginal Stent for the Treatment of Vaginal Agenesis in Mayer-Rokitansky-Kuster-Hauser Syndrome.

Vaginal agenesis is a common congenital anomaly in females and is most commonly associated with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. These patients can be treated with both surgical and nonsurgical procedures. Prefabricated as well as customized vaginal stents are used for the reconstruction and maintenance of neovagina. This case report explains the fabrication of customized tissue conditioner-reinforced acrylic vaginal stent for the treatment of a 20-year-old female having vaginal agenesis associated with MRKH syndrome. This vaginal stent with resilient surface provides a relatively easy, simple, and cost-effective alternative for the treatment of vaginal agenesis. It is also associated with increased compliance and comfort to the patient.

Rhodoccoccus erythropolis Is Different from Other Members of Actinobacteria: Monoploidy, Overlapping Replication Cycle, and Unique Segregation Pattern.

Among actinomycetes, chromosome organization and segregation studies have been limited to Streptomyces coelicolor, Corynebacterium glutamicum, and Mycobacterium spp. There are differences with respect to ploidy and chromosome organization pattern in these bacteria. Here, we report on chromosome replication, organization, and segregation in Rhodococcus erythropolis PR4, which has a circular genome of 6.5 Mbp. The origin of replication of R. erythropolis PR4 was identified, and the DNA content in the cell under different growth conditions was determined. Our results suggest that the number of origins increases as the growth medium becomes rich, suggesting an overlapping replication cell cycle in this bacterium. Subcellular localization of the origin region revealed polar positioning in minimal and rich media. The terminus, which is the last region to be replicated and segregated, was found to be localized at the cell center in large cells. The middle markers corresponding to the 1.5-Mb and 4.7-Mb loci did not overlap, suggesting discontinuity in the segregation of the two arms of the chromosome. Chromosome segregation was not affected by inhibiting cell division. Deletion of parA or parB affected chromosome segregation. Unlike in C. glutamicum and Streptomyces spp., diploidy or polyploidy was not observed in R. erythropolis PR4. Our results suggest that R. erythropolis is different from other members of Actinobacteria; it is monoploid and has a unique chromosome segregation pattern. This is the first report on chromosome organization, replication, and segregation in R. erythropolis PR4.IMPORTANCE Rhodococci are highly versatile Gram-positive bacteria with high bioremediation potential. Some rhodococci are pathogenic and have been suggested as emerging threats. No studies on the replication, segregation, and cell cycle of these bacteria have been reported. Here, we demonstrate that the genus Rhodococcus is different from other actinomycetes, such as members of the genera Corynebacterium, Mycobacterium, and Streptomyces, with respect to ploidy and chromosome organization and segregation. Such studies will be useful not only in designing better therapeutics pathogenic strains in the future but also for studying genome maintenance in strains used for bioremediation.

Multiple Cutaneous and Uterine Leiomyomatosis with Renal Involvement: Report of a Rare Association.

Cutaneous leiomyomas (CLs) are uncommon benign smooth muscle tumours characterised by solitary or multiple painful nodules. Based on origin, three types are recognised, namely piloleiomyoma, dartoic leiomyoma, and angioleiomyoma, with piloleiomyomas being the commonest one. Reed's syndrome also known as multiple cutaneous and uterine leiomyomatosis (MCULs) is characterised by CLs in men and CLs and uterine fibroids in women. Association of Reed's syndrome with renal cell carcinoma is labelled as hereditary leiomyomatosis and renal cell carcinoma (HLRCC). Both MCUL and HLRCC are caused by a heterozygous mutation in the fumarate hydratase gene. Besides renal cell carcinoma, there were extremely rare reports of association of MCUL with benign renal lesions. We report a case of a 55-year-old female with segmental tender papulonodular lesions suggestive of leiomyoma associated with uterine leiomyomas and unilateral renal cyst. The case is reported here for its rarity and uncommon association with asymptomatic benign renal cyst.

Synchronous Diagnosis of De Novo Acute Myeloid Leukemia with inv(16)(p13q22) and Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature.

The occurrence of de novo acute myeloid leukemia (AML) with chronic lymphocytic leukemia (CLL) is rare. Most cases of hematologic malignancies such as AML occurring in patients with pre-existing CLL are therapy-related. In this report, we describe a 65-year-old male with no past history of a hematolymphoid malignancy, who presented with abdominal pain. He was evaluated for acute diverticulitis, and incidentally found to have 14% circulating blasts upon peripheral blood smear review for anemia and thrombocytopenia. Bone marrow biopsy revealed 30-40% blasts and lymphoid aggregates. In conjunction with cytogenetics studies, a diagnosis of de novo AML with inv(16)(p13q22) CBFB-MYH11, trisomy 8, monosomy 18, and concurrent CLL with trisomy 12 was made. Serial FISH studies were used to demonstrate that the nuclei with (CBFB-MYH11) fusion did not have trisomy 12 and it was concluded that AML and CLL cells arose from separate clones. He died 3 weeks following presentation from complications of diverticulitis. To our knowledge, this is the second reported case of de novo AML with inv(16) and CLL.

B Lymphoblastic Leukemia/Lymphoma With Burkitt-like Morphology and IGH/MYC Rearrangement: Report of 3 Cases in Adult Patients.

Isolated MYC rearrangement without other recurrent genetic abnormalities is rare in B lymphoblastic leukemia/lymphoma (B-ALL/LBL), with most cases reported in pediatric patients. We report 3 adult cases with lymphoblasts showing a precursor B cell immunophenotype, and isolated MYC/IGH translocation. All 3 cases occurred in male patients with initial presentation of diffuse lymphadenopathy. Cases 1 and 2 had B-ALL with significantly increased lymphoblasts in peripheral blood and bone marrow. Case 3, a patient with human immunodeficiency virus infection, had the diagnosis of B-LBL made on a retroperitoneal lymph node biopsy and had no peripheral blood or bone marrow involvement. The leukemic and lymphoma cells in all 3 cases demonstrated Burkitt lymphoma-like morphology with deeply basophilic cytoplasm and numerous cytoplasmic vacuoles. However, all 3 had immature immunophenotypes including expression of terminal deoxynucleotidyl transferase (TdT), absence of BCL6, and dim-to-negative CD45. CD20 was largely negative in 2 of 3 cases. All 3 had confirmed MYC/IGH translocation, but lacked rearrangements of BCL2 or BCL6. EBV was negative by Epstein-Barr virus encoded small RNA in situ hybridization. Treatment protocols varied, including both high-risk ALL-type (protocol 8707) and high-grade lymphoma regimens (hyper-CVAD [cyclophosphamide, vincristine, adriamycin, and dexamethasone]), but no patient achieved continuous complete remission. These cases seem to represent a distinct biological phenomenon, in which a MYC translocation may be acquired at an immature stage of differentiation, thus manifesting features of both B-ALL/LBL and Burkitt lymphoma.

Establishing the Cephalometric Values for Tetragon Analysis in Patients with Class I Occlusion: A Cephalometric Study.

OBJECTIVES: Proper application of the cephalometric norms for tetragon analysis for better understanding, diagnosis, and management of dentofacial deformities in the ethnic population. MATERIALS AND METHODS: A total of 204 subjects, inclusive of males (102) and females (102), were selected randomly from the outpatient department of Saveetha Dental College and Hospitals, in the age group ranging from 18 to 25 years, fulfilling the inclusion criteria. Assessment of each lateral cephalogram was done using tetragon analysis to evaluate the cephalometric values for individuals with class I occlusion using the FACAD(®) 3.4.0.3 A software. RESULTS: Statistically significant differences were found for all parameters between the ethnic population and the Caucasian norms. Four out of 14 parameters were found to be significantly different between male and female in the ethnic population. CONCLUSION: This study indicates that the local ethnic population have more prognathic maxillary and mandibular jaws, converging tendency of the jaw bases (resulting in reduced lower anterior facial height and horizontal growth pattern) as indicated by the analysis done in the tetragon and the trigon, and increased proclination of the upper and lower incisors.