Changes in cerebrovascular disease-related deaths and their location during the COVID-19 pandemic in Japan.

OBJECTIVE: The COVID-19 pandemic placed an enormous strain on healthcare systems and raised concerns for delays in the management of patients with acute cerebrovascular events. In this study, we investigated cerebrovascular excess deaths in Japan. STUDY DESIGN: Vital mortality statistics from January 2012 to May 2022 were obtained from the Japanese Ministry of Health, Labour and Welfare. METHODS: Using quasi-Poisson regression models, we estimated the expected weekly number of cerebrovascular deaths in Japan from January 2020 through May 2022 by place of death. Estimates were calculated for deaths in all locations, as well as for deaths in hospitals, in geriatric health service facilities, and at home. The age subgroups of ≥75 and <75 years were also considered. Weeks with a statistically significant excess of cerebrovascular deaths were determined when the weekly number of observed deaths exceeded the upper bound of 97.5% prediction interval. RESULTS: Excess deaths were noted in June 2021 and became more pronounced from February 2022 onward. The trend was notable among those aged ≥75 years and for those who died in hospitals. With respect to the location of deaths, the excess was significant in geriatric health services facilities from April 2020 to June 2021, whereas no evidence of excess hospital deaths was observed during the same period. CONCLUSIONS: Beginning in the late 2021, excess cerebrovascular deaths coincided with the spread of the Omicron variant and may be associated with increased healthcare burden. In 2020, COVID-19 altered the geography of cerebrovascular deaths, with fewer people dying in hospitals and more dying in geriatric health service facilities and at home.

Cystoscopic bladder biopsies: a histopathological study.

Urothelial carcinoma is the most common tumor of the bladder and is a major cause of morbidity and mortality. Cystitis constitutes an important source of clinical signs and symptoms. In this study 31 cystoscopic biopsies subjected for histopathological examination were taken. The study was conducted in the department of Pathology of Nepal Medial College Teaching Hospital over a period of two years (October 2012 to September 2014). The mean age of the patient undergoing cystoscopic biopsy was 61.3 years, most of the patients being elderly male. 51.6% cases were clinically malignant. The most common histopathological diagnoses were cystitis (29%) and non invasive papillary urothelial carcinoma, low grade (29%). 58% are neoplastic lesions. 51.6% of the case was malignant lesions on histopathology. Among the malignant lesion of urinary bladder 93.7% were urothelial tumor and 6.3% were glandular neoplasm (adenocarcinoma, signet ring cell). There was no detrusor muscle in 33.3% cases of urothelial tumor to assess the muscle invasion. 26.7% cases of urothelial tumor shows muscle invasion. Histopathological study of cystoscopic biopsy helps in early detection of tumor and its management.

Inguinal hernia in a continuous ambulatory peritoneal dialysis patient practising "Kapal Bhati" therapy.

A 72 years elderly man, diagnosed case of end stage renal disease with hypertension stage II and anemia of chronic disease on continuous ambulatory peritoneal dialysis along with the supportive medicines and yoga therapy mainly Kapal Bhati, presented with slowly increasing swelling in left inguinal region for two months which used to subside in supine position and bulge during coughing, later involved ipsilateral side of scrotum also. Then he was diagnosed having left side direct inguinal hernia. And then switched to hemodialysis followed by hernioplasty. CAPD was started again after two weeks. Though inguinal hernia is common in elderly male with predisposing factors but its development has not been reported in association with Kapal Bhati therapy which has become recently popular therapy for many diseases.

A histopathological study of ophthalmic lesions.

Ophthalmic lesions include a wide spectrum of conditions ranging from benign lesions to precancerous lesions and malignant lesions. The diagnosis of these lesions is based on the clinical as well as histopathological features. This was a prospective study of ophthalmic lesions conducted in the department of pathology of Nepal Medial College teaching hospital over a period of one year (September 2012 - August 2013). In this study period, we received total 11 ophthalmic biopsies. Out of these, 54.5% cases were conjunctival lesions and 45.5% cases were eye lid lesions. The age range was from 8 years to 40 years with the mean age of 25.5 years. All the cases were benign lesions, papilloma being the most common clinical and histopathological diagnosis. Other lesions like inclusion cyst, dermoid cyst, seborrheic keratosis, pilomatrixoma, nevus and molluscum contagiosum are also included in our study.

Signet ring cell carcinoma of the gallbladder: a case report.

Carcinoma of the gall bladder is the most common biliary tract tumor with higher incidence in females and increasing age. The risk is significantly higher in cholelithiasis. Signet ring cell carcinoma is a rare form of mucinous adenocarcinoma and has a worse prognosis. Early diagnosis is rare. We report a case of signet ring cell carcinoma of the gall bladder in a 70 years old female patient. The gross finding was yellowish white mass measuring 4 x 3.5 cm on cut surface of the gall bladder along with thickened wall. Histopathological examination of the specimen shows the sheets of signet ring cells with lateral spread through the lamina propria and large amount of extracellular mucin. There was metastasis in the retroperitoneum and mesenteric lymph node. The tumor was stage IV (according to TNM staging). Patient died 20th post operative day. Since very few cases have been reported, information regarding the behavior and prognosis of gall bladder carcinoma is limited. However it has been seen that stage III and IV carcinoma usually have worse prognosis.

Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimens.

Cholecystectomized specimens are one of the frequently encountered specimens in daily routine histopathological work in the pathology department. With the expectation that most of the gallbladder specimens harbor benign disease, it is at times surprising to find occult malignancy. This study aims to find out the frequency of primary gallbladder carcinoma and incidental primary carcinoma, detected during routine histological examination of gallbladder specimen that were submitted in pathology department of Nepal Medical College Teaching Hospital (NMCTH) as well as to assess the need of histopathological examination of cholecystectomy specimens. Retrospective study was done in total 668 cases of cholecystectomies specimens submitted in NMCTH histopathology department during 5 yrs of duration from Jan 2003 to Dec 2007. There were total 22 cases of primary gallbladder carcinoma and 2 cases of metastatic cholangiocarcinoma in gallbladder. The incidence rate of primary malignancy was 3.3% and was commonly found in female at 7th decade of their life. Adenocarcinomas were the most common histological type with poor differentiation and diagnosed frequently at stage IIA. The rate of incidental primary carcinoma of gallbladder was 1.4%, detected commonly at stage I. Combined preoperative and intraoperatively, only 55.0% of histologically proven gallbladder malignancies were correctly identified. Intraoperative findings of incidental carcinomas included thickened GB (3 cases), distended GB (2 cases), GB polyp (1 case) and no obvious abnormality were mentioned in 3 cases. Therefore, every cholecystectomy specimen should be examined histopathologically to detect possible incidental carcinomas.

Histopathologic diagnosis of lymph node biopsies.

This is a retrospective study of biopsies of lymph nodes received in the department of pathology, Nepal Medical College (NMC), from January 2004 to December 2005. Total number of lymph node biopsies during the two year period was 55, out of which 56.0% cases were females and 44.0% were males with M:F 1:1.29. Most common cause of lymphadenopathy was tuberculosis and most common group of lymph node was cervical lymph nodes. Metastatic deposits were seen in only six cases. So, like other developing countries, in our country also, tuberculosis is the leading cause for lymphadenopathy.