Unusual case of a leiomyoma in the space of Retzius mimicking broad ligament fibroid.

This case report will discuss an interesting case of a patient who presented with pain in the lower abdomen of 2-month duration. Clinical examination and imaging findings were suggestive of a broad ligament fibroid. However, intraoperatively, the mass was found to be present in the space of Retzius, which is an extremely rare location for such a pathology. The access to the tumour was very challenging. Successful surgical excision was done with the help of a multidisciplinary team involving a gynaecologist, a urologist and an anaesthetist. Histopathology reported it to be benign leiomyoma. Postoperatively, the patient made an uneventful recovery.

A novel anti-HIV-1 bispecific bNAb-lectin fusion protein engineered in a plant-based transient expression system.

The discovery of broadly neutralizing antibodies (bNAbs) has been a major step towards better prophylactic and therapeutic agents against human immunodeficiency virus type 1 (HIV-1). However, effective therapy will likely require a combination of anti-HIV agents to avoid viral evasion. One possible solution to this problem is the creation of bispecific molecules that can concurrently target two vulnerable sites providing synergistic inhibitory effects. Here, we describe the production in plants and anti-HIV activity of a novel bispecific fusion protein consisting of the antigen-binding fragment (Fab) of the CD4 binding site-specific bNAb VRC01 and the antiviral lectin Avaren, which targets the glycan shield of the HIV-1 envelope (VRC01Fab -Avaren). This combination was justified by a preliminary experiment demonstrating the synergistic HIV-1 neutralization activity of VRC01 and Fc-fused Avaren dimer (Avaren-Fc). Using the GENEWARE® tobacco mosaic virus vector, VRC01Fab -Avaren was expressed in Nicotiana benthamiana and purified using a three-step chromatography procedure. Surface plasmon resonance and ELISA demonstrated that both the Avaren and VRC01Fab moieties retain their individual binding specificities. VRC01Fab -Avaren demonstrated enhanced neutralizing activity against representative HIV-1 strains from A, B and C clades, compared to equimolar combinations of VRC01Fab and Avaren. Notably, VRC01Fab -Avaren showed significantly stronger neutralizing effects than the bivalent parent molecules VRC01 IgG and Avaren-Fc, with IC50 values ranging from 48 to 310 pm. These results support the continued development of bispecific anti-HIV proteins based on Avaren and bNAbs, to which plant-based transient overexpression systems will provide an efficient protein engineering and production platform.

Clinicopathologic spectrum of cutaneous tuberculosis: a retrospective analysis of 165 Indians.

BACKGROUND: Although cutaneous tuberculosis (CTB) is well described, it is wise to periodically revisit the prevailing clinical and epidemiological features, of this somewhat uncommon entity in developed nations that is also usually neglected in national tuberculosis control programs in countries where tuberculosis is a major health problem, to maintain heightened awareness as the HIV pandemic runs its course. METHODS: Medical records of 165 cases of CTB, diagnosed from 2007 to 2010, were studied. The diagnosis in each was made on the basis of well-conceived and described criteria. All patients had earlier been immunized with Bacillus Calmette-Guérin soon after birth. Patients were evaluated by routine hematology, Mantoux test, screening for HIV status in addition to fine-needle aspiration cytology, and/or histopathology of the lesion. RESULTS: Of the 165 cases (94 males and 71 females, male:female ratio of 1.32:1; age range, 1-64), 85 were lupus vulgaris, 11 tuberculosis verrucosa cutis (paucibacillary), and 39 scrofuloderma (multibacillary). The remaining 17 were tuberculids comprising 24 lichen scrofulosorum, 3 papulonecrotic tuberculid, 2 erythema induratum, and 1 erythema nodosum, afflicting children and young adults (age range, 0-10; 21-30). Fine-needle aspiration cytology was diagnostic in 39 cases, histopathology in 117, and their combination in 9. Clinicopathologic correlation and response to antituberculosis treatment were additional diagnostic adjuncts. CONCLUSIONS: CTB has a varied clinical and morphological spectrum. Cytology and histopathology play a key role in its diagnosis. An additional adjunct is the clinical response to antituberculosis treatment.

Tumid lupus erythematosus: an intriguing dermatopathological connotation treated successfully with topical tacrolimus and hydroxyxhloroquine combination.

Tumid lupus erythematosus (LE) is a rare variant of lupus erythematosus, which often follows a favorable course. A case of a young woman is illustrated, who presented with an asymptomatic erythematous, solitary plaque over her face. Histopathological and direct immunofluorescence examination established a diagnosis of tumid lupus erythematosus. She responded slowly and near-completely to hydroxychloroquine sulfate; however, a flare up occurred a month later. Addition of topical tacrolimus 0.1% resulted in complete regression without leaving any residual changes. No recurrence was seen subsequently.

Role of histopathological examination in nontraumatic perforation of colon.

AIM: Nontraumatic perforation of colon is an uncommon cause of peritonitis requiring early surgical intervention. This study was carried out to determine the prevalence patterns of the different etiologies of nontraumatic perforation of colon. METHODS AND RESULTS: A total of 35 patients with segments of colon or perforation margins removed for perforation were included. Most of the perforations occurred in the caecum, of which two were seen at the ileocaecal junction. The commonest cause was infection (amoebiasis: 13 cases and tuberculosis: 5 cases) followed by ulcers of non specific ulcers (12 cases). There were three cases of adenocarcinoma causing secondary perforation and one case of idiopathic intestinal gangrene and volvulus each. CONCLUSION: In tropics, non traumatic perforations of colon most often involves caecal and ileocaecal segment and the most common etiology is amoebiasis.

Usefulness of histopathological examination in uterine prolapse specimens.

BACKGROUND: Uterovaginal prolapse frequently occurs in postmenopausal women. Hysterectomy with pelvic floor repair is one of the frequently performed surgeries in treating women who have completed their family and are not particular about preserving menstrual function. These hysterectomy specimens are submitted for histopathological examination to confirm the diagnosis. AIMS: This study was conducted with the aim to evaluate the frequency of incidental histopathological findings in uteri removed for prolapse and assessing their clinical relevance. METHODS: A total 253 cases of hysterectomy with or without salpingoophorectomy were reviewed. RESULTS: Incidental findings were found in 77 cases (30.4%). Clinically significant incidental findings including tubercular endometritis (one case) and cervical intra-epithelial neoplasia (two cases) were found. CONCLUSION: Microscopic examination, although an integral part of pathological examination as some of these women may require subsequent treatment, reveals significant pathology in very few cases.

Usefulness of histopathological examination in nontraumatic perforation of small intestine.

INTRODUCTION: Nontraumatic perforation of small intestine (NTPSI) is a fairly common cause of peritonitis in developing world requiring early surgical intervention. Various etiological factors have been proposed for the cause of small bowel perforation. This retrospective study was conceded with an aim to determine the prevalence patterns of the different etiologies of NTPSI. MATERIALS AND METHODS: A total of 164 patients were included in the study who had segments of small intestine removed for perforation during emergency procedures. Preoperative definitive diagnoses were not known in these cases. On gross examination, most of the small intestine perforations, n = 110 (67%), were found in the terminal ileum. On microscopy, the most frequent category was that of ulcers of nonspecific etiology, n = 61 (37.2%), which showed general features like inflammatory granulation tissue, serositis, and foreign body giant cell reaction. RESULTS: In cases where a definite opinion could be established, infection was the commonest cause, n = 71 (43.3%), wherein tuberculosis (49, 29.9%) and typhoid (22, 13.4%) constituted the greatest number of cases. There were two cases of lymphoma and one case of metastatic adenocarcinoma involving the small intestine. Thus, histopathological examination of operated specimen is a useful guide for the surgeon to decide further management of the patient especially in the case of infections.

Iron profile in children with behavioural disorders: a prospective study in a tertiary care hospital in north India.

Iron deficiency anemia is the most frequent micronutrient deficiency in the developing countries like India especially affecting pregnant women and young children. Iron is an essential element involved in myelin formation, neurotransmitter synthesis and neuro-metabolism. Several behavioural disturbances have been reported in iron deficient children. In the present study, we determined the prevalence of iron deficiency anemia in children with behavioural disorders and assessed the improvement in terms of symptoms (by child behaviour check list), haematological parameters and iron status after treatment with oral iron. In this prospective study, 44 children in the age group of 3-12 years who were diagnosed with behavioural disorders were evaluated. Complete blood counts using automated hematology analyzer and iron parameters (serum iron, total iron binding capacity, % transferrin saturation and serum ferritin) were measured in all the patients to assess the prevalence of iron deficiency in these children. Thirty age matched controls were also studied. Iron deficiency was found in 32 (73%) children, as assessed by transferrin saturation <16% and/or serum ferritin <16 µg/l. Following treatment with iron for 100 ± 10 days, there was a statistically (P ≤ 0.05) significant improvement in the clinical features, haematological profile and iron status. The presence of iron deficiency in children with behavioural disorders and subsequent improvement in clinical features, haematological profile and iron status suggests a possible causal relationship between iron deficiency and behavioural disorders.

Agricultural waste material as potential adsorbent for sequestering heavy metal ions from aqueous solutions - a review.

Heavy metal remediation of aqueous streams is of special concern due to recalcitrant and persistency of heavy metals in environment. Conventional treatment technologies for the removal of these toxic heavy metals are not economical and further generate huge quantity of toxic chemical sludge. Biosorption is emerging as a potential alternative to the existing conventional technologies for the removal and/or recovery of metal ions from aqueous solutions. The major advantages of biosorption over conventional treatment methods include: low cost, high efficiency, minimization of chemical or biological sludge, regeneration of biosorbents and possibility of metal recovery. Cellulosic agricultural waste materials are an abundant source for significant metal biosorption. The functional groups present in agricultural waste biomass viz. acetamido, alcoholic, carbonyl, phenolic, amido, amino, sulphydryl groups etc. have affinity for heavy metal ions to form metal complexes or chelates. The mechanism of biosorption process includes chemisorption, complexation, adsorption on surface, diffusion through pores and ion exchange etc. The purpose of this review article is to provide the scattered available information on various aspects of utilization of the agricultural waste materials for heavy metal removal. Agricultural waste material being highly efficient, low cost and renewable source of biomass can be exploited for heavy metal remediation. Further these biosorbents can be modified for better efficiency and multiple reuses to enhance their applicability at industrial scale.