Geographic information system-aided evaluation of epidemiological trends of dengue serotypes in West Bengal, India.

BACKGROUND OBJECTIVES: West Bengal is a dengue-endemic State in India, with all four dengue serotypes in co-circulation. The present study was conceived to determine the changing trends of circulating dengue virus (DENV) serotypes in five consecutive years (2015-2019) using a geographic information system (GIS) during the dengue season in West Bengal, India. METHODS: Molecular serotyping of dengue NS1 sero-reactive serum samples from individuals with ≤5 days of fever was performed using conventional nested reverse transcriptase-PCR. GIS techniques such as Getis-Ord Gi* hotspot analysis and heatmap were used to elucidate dengue transmission based on the received NS1-positive cases and vector data analysis was used to point out risk-prone areas. RESULTS: A total of 3915 dengue NS1 sero-positive samples were processed from most parts of West Bengal and among these, 3249 showed RNA positivity. The major circulating serotypes were DENV 3 (63.54%) in 2015, DENV 1 (52.79%) in 2016 and DENV 2 (73.47, 76.04 and 47.15%) in 2017, 2018 and 2019, respectively. Based on the NS1 positivity, dengue infections were higher in males than females and young adults of 21-30 yr were mostly infected. Getis-Ord Gi* hotspot cluster analysis and heatmap indicate that Kolkata has become a hotspot for dengue outbreaks and serotype plotting on maps confirms a changing trend of predominant serotypes during 2015-2019 in West Bengal. INTERPRETATION CONCLUSIONS: Co-circulation of all the four dengue serotypes was observed in this study, but only one serotype became prevalent during an outbreak. Representation of NS1-positive cases and serotype distribution in GIS mapping clearly showed serotypic shift in co-circulation. The findings of this study suggest the need for stringent surveillance in dengue-endemic areas to limit the impact of dengue and implement better vector-control strategies.

Synthesis and Characterization of 1H-Imidazole-4,5-dicarboxylic Acid-Functionalized Silver Nanoparticles: Dual Colorimetric Sensors of Zn2+ and Homocysteine.

A colorimetric assay has been developed for Zn2+ and homocysteine (Hcy) detection using functionalized silver nanoparticles (AgNPs). AgNPs have been synthesized using silver nitrate, where sodium citrate is used as a stabilizing agent and NaBH4 as a reducing agent. Then, the nanoparticles (citrate@AgNPs) were functionalized with 1H-imidazole-4,5-dicarboxylic acid (IDCA). UV-visible and FTIR spectra suggested that IDCA was functionalized on the surface of citrate@AgNPs through the N atom of the imidazole ring. The IDCA-functionalized silver nanoparticles (IDCA@AgNPs) simultaneously detected Zn2+ and Hcy from aqueous solution and showed different responses to the two analytes (Zn2+ and Hcy) based on the aggregation-induced color change of IDCA@AgNPs. They showed the color change from yellow to red, which was easily discriminated by visual inspection as well as UV-visible spectroscopy. The surface plasmon resonance absorbance values of Zn2+ and Hcy are 485 and 512 nm, respectively, when Zn2+ and Hcy react with IDCA@AgNPs. IDCA@AgNPs showed linearity with Zn2+ and Hcy concentrations, with the detection limit of 2.38 µM and 0.54 nM, respectively (S/N = 3). The IDCA@AgNPs showed excellent selectivity toward Zn2+ and Hcy compared to the different metal ions and amino acids, respectively. Optimal detection was achieved toward Zn2+ and Hcy in the pH range 3-10. In addition, IDCA@AgNPs were used to detect Zn2+ and Hcy from lake water, showing low interference.

Assessment of effectiveness of Japanese encephalitis vaccination in West Bengal, India using sample positivity rate as an alternate measure.

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE), is a vaccine preventable mosquito borne arboviral disease. The State Health Department of West Bengal, India started a vaccination programme using live attenuated, single dose JE vaccine (SA-14-14-2) in children aged 1-below15 years since 2006 in five districts. The objectives were to compare Sample Positivity Rates (SPR) of Acute Encephalitis Syndrome (AES) cases for JE between vaccinated & unvaccinated districts and observe trend of SPR & Cumulative Incidence in vaccinated districts for three years. METHODS: The study was based on the analysis of surveillance data from all tested AES cases including confirmed JE (IgM ELISA) from all JE testing facilities existent in the state during the study period (2011-13). Calculation of Cumulative Incidence, Odds Ratio (OR) with 95% CI, Preventive Fraction and Chi Square for trend (for SPR) was done. Trend of incidence was assessed by linear regression. RESULTS: In three years, 5 vaccinated districts contributed 945 AES and 88 JE cases (SPR - 9.3%) compared to 1807 and 254 (SPR - 14.1%) JE cases in 14 unvaccinated districts. Effectiveness of vaccination was evident by gradual decline of Odds Ratio in favour of vaccinated districts. Vaccination effectiveness of 68% overall and 80% [OR = 0.20 (0.10 - 0.41)] in below 15 years were observed. Trend of SPR was found significantly declining in most of the vaccinated districts. INTERPRETATION & CONCLUSION: Significant reduction in sample positivity rate over three years in most of the vaccinated districts indicated that the vaccination programme had been gradually effective.

Fine Needle Aspiration Cytology of Basal Cell Adenoma of Parotid Simulating Adenoid Cystic Carcinoma.

Basal cell adenoma is a rare type of monomorphic salivary adenoma most commonly involving the parotid gland. Cytology of basal cell adenoma closely mimics many other benign and malignant basaloid neoplasms. Cytological features of membranous basal cell adenoma simulate adenoid cystic carcinoma in fine needle aspiration cytology (FNAC) smears. Here, we are presenting a rare case of cytodiagnosis of membranous basal cell adenoma of parotid gland in an elderly lady, which mimicked adenoid cystic carcinoma on FNAC. We discuss the cytomorphology of this rare case with an emphasis on cytological difference between membranous basal cell carcinoma and adenoid cystic carcinoma as well as other basaloid neoplasms.

Fine needle aspiration cytology of primary cutaneous mucinous carcinoma of axilla-report of a rare case.

Primary mucinous eccrine carcinoma is a rare malignant adnexal tumor of older patients. The histopathological features of this tumor are well-established but the cytomorphology of this neoplasm has only been documented in a few cases. The cytology and histology of this tumor may mimic metastatic mucinous carcinoma and may cause a diagnostic dilemma, especially when the tumor is located at axilla. A correct diagnosis is important because the prognosis is better than that of a metastatic mucinous carcinoma. Here we report the cytological and histological features of a case of primary cutaneous mucinous carcinoma of axilla in an elderly male patient.

Severely calcified leiomyoma of broad ligament in a postmenopausal woman: Report of a rare case.

Calcified broad ligament leiomyoma is a rare benign lesion in postmenopausal age group. It causes diagnostic confusion with solid calcified adnexal mass and large bladder calculi at the pelvic region. Clinical and radiological diagnoses were confirmed by histopathology of the hysterectomy specimen. We hereby present a case of heavily calcified broad ligament fibroid in a postmenopausal woman.

Spectroscopic, computational and electrochemical studies on the formation of the copper complex of 1-amino-4-hydroxy-9,10-anthraquinone and effect of it on superoxide formation by NADH dehydrogenase.

A 1 : 2 copper(II) complex of 1-amino-4-hydroxy-9,10-anthraquinone (QH) having the molecular formula CuQ2 was prepared and characterized by elemental analysis, NMR, FTIR, UV-vis and mass spectroscopy. The powder diffraction of the solid complex, magnetic susceptibility and ESR spectra were also recorded. The presence of the planar anthraquinone moiety in the complex makes it extremely difficult to obtain a single crystal suitable for X-ray diffraction studies. To overcome this problem, density functional theory (DFT) was used to evaluate an optimized structure of CuQ2. In the optimized structure, it was found that there is a tilt of the two planar aromatic anthraquinone rings of the complex with respect to each other in the two planes containing the O-Cu(II)-O plane. The present study is an important addition to the understanding of the structural aspects of metal-anthracyclines because there are only a few reports on the actual structures of metal-anthracyclines. The theoretical vibrational spectrum of the complex was assigned with the help of vibrational energy distribution analysis (VEDA) using potential energy distribution (PED) and compared with experimental results. Being important in producing the biochemical action of this class of molecules, the electrochemical behavior of the complex was studied in aqueous and non-aqueous solvents to find certain electrochemical parameters. In aqueous media, reduction involves a kinetic effect during electron transfer at an electrode surface, which was characterized very carefully using cyclic voltammetry. Electrochemical studies showed a significant modification in the electrochemical properties of 1-amino-4-hydroxy-9,10-anthraquinone (QH) when bound to Cu(II) in the complex compared to those observed for free QH. This suggests that the copper complex might be a good choice as a biologically active molecule, which was reflected in the lack of stimulated superoxide generation by the complex.

1-Amino-4-hydroxy-9,10-anthraquinone - An analogue of anthracycline anticancer drugs, interacts with DNA and induces apoptosis in human MDA-MB-231 breast adinocarcinoma cells: Evaluation of structure-activity relationship using computational, spectroscopic and biochemical studies.

The X-ray diffraction and spectroscopic properties of 1-amino-4-hydroxy-9,10-anthraquinone (1-AHAQ), a simple analogue of anthracycline chemotherapeutic drugs were studied by adopting experimental and computational methods. The optimized geometrical parameters obtained from computational methods were compared with the results of X-ray diffraction analysis and the two were found to be in reasonably good agreement. X-ray diffraction study, Density Functional Theory (DFT) and natural bond orbital (NBO) analysis indicated two types of hydrogen bonds in the molecule. The IR spectra of 1-AHAQ were studied by Vibrational Energy Distribution Analysis (VEDA) using potential energy distribution (PED) analysis. The electronic spectra were studied by TDDFT computation and compared with the experimental results. Experimental and theoretical results corroborated each other to a fair extent. To understand the biological efficacy of 1-AHAQ, it was allowed to interact with calf thymus DNA and human breast adino-carcinoma cell MDA-MB-231. It was found that the molecule induces apoptosis in this adinocarcinoma cell, with little, if any, cytotoxic effect in HBL-100 normal breast epithelial cell.

Cytodiagnosis of epithelioid malignant melanoma (amelanotic) and diagnostic dilemmas.

Melanoma is an aggressive neoplasm, and early diagnosis can reduce mortality in such patients. Diagnosis may be delayed in amelanotic tumors. We present one such case, a 35-year-old lady with a rapidly growing mass over the right angle of mandible. Fine-needle aspiration cytology was done, and smears showed discretely arranged large epithelioid cells with high N:C ratio, prominent single to multiple nucleoli. Occasional binucleated and multinucleated tumor giant cells were also noted. Poorly differentiated carcinoma, high-grade non-Hodgkin lymphoma, amelanotic melanoma, and pleomorphic sarcoma were included as differential diagnoses. Immunocytochemistry (ICC) revealed Melan-A/MART-1 positivity in some cells and S-100 positivity in most tumor cells. Desmin, pancytokeratin, and leukocyte common antigen were negative. Based on cytomorphological features and ICC findings, a diagnosis of epithelioid variant of amelanotic melanoma was rendered. Later on, true cut biopsy and histologic examination of excised specimen and adjunct immunohistochemistry with positive Melan-A and S-100 confirmed the diagnosis.

Usefulness of serum CA-15.3 in the management of benign breast lesion.

Benign breast lesion is an important risk factor for breast cancer and elevated CA-15.3 in serum is a well established marker of breast cancer. Core-needle biopsy is now the method of choice to sample non-palpable mammographic abnormality and as well as clinically palpable lesion. To asses relationship of serum CA-15.3 with different histologic entities of benign breast lesion and usefulness of this marker in predicting breast cancer in this high risk group, a study was conducted among 140 patients who had a diagnosis of benign breast lesion and malignancy following fine needle aspiration cytology (FNAC) at department of surgery, Medical College, Kolkata between 2007 and 2009. We prospectively estimated serum CA-15.3 level in all patients. Different histologic entities of benign breast lesion, who showed serum CA-15.3 level >30U/ml underwent tru-cut biopsy to detect malignancy. Of 140 patients studied, 50 were stamped as malignancy and 90 as benign after FNAC of which 20 patients had fibroadenoma, 25 had fibro-adenoma with fibrocystic disease, 20 had fibrocystic disease with epitheliosis and 25 had fibrocystic disease with atypia. All breast cancer patients and 10 each from fibro-adenoma with fibrocystic disease, fibrocystic disease with epitheliosis and fibrocystic disease with atypia had serum CA -15.3 level>30U/ml. Thirty patients with benign breast lesion who had raised CA-15.3 underwent core-needle biopsy. Fifteen patients were detected to have intraductal carcinoma, mostly with fibrocystic disease with atypia. Clinical applicability of serum CA-15.3 to detect breast cancer should be strongly considered in management of patients with benign breast lesion and tru-cut biopsy than FNAC be done before benign breast lesion being stamped as benign. Biopsy results that are not concordant with the targeted lesion require surgical biopsy.

Mucormycosis of pouch of douglas in a diabetic woman.

Mucormycosis is a severe fungal infection which is rare in clinical practice. This infection is usually acquired by inhalation; other portals of entry are ingestion and traumatic implantation, especially in immuno-compromised patients. Here, we present a case of mucormycosis in a 44-year-old diabetic woman. The patient had collection of fluid in the Pouch of Douglas (POD) and history of bleeding per vagina. Hysterectomy was done which showed a blackish serosal surface of the posterior uterus. Subsequent investigations revealed mycormycosis caused by Rhizopus oryzae (R. arrhizus) affecting the POD. Patient was treated with liposomal amphotericin B and is now keeping well.

Histologic pattern, bilaterality and clinical evaluation of 957 ovarian neoplasms: a 10-year study in a tertiary hospital of eastern India.

OBJECTIVE: The aim was to study the distribution of morphological pattern of benign and malignant ovarian neoplasms in different age groups in eastern India and to determine the likelihood of bilateral involvement in different morphologic subtypes. MATERIALS AND METHODS: 957 cases of ovarian tumors were studied over a period of 10 years (from January 2001 to December 2010). RESULTS: Most of the benign tumors occurred between 20 and 40 years of age, while the malignant lesions presented commonly between 41 and 50 years. The most common histological types were serous cystadenoma (29.9%), followed by mature teratoma (15.9%) and mucinous cystadenoma (11.1%). Major proportion of malignant ovarian tumors was contributed by surface epithelial tumors (60.9%). Serous cystadenocarcinoma was the predominant malignant tumor (11.3%). Metastatic tumors were found to involve the bilateral ovaries in 72%, while 49.5% of malignant serous tumors were bilateral. Borderline serous tumors showed bilateral involvement more commonly (27.4%) than borderline mucinous tumors (15.7%). Most of the malignant tumors presented as stage III (60%) or stage II (20%) disease. The overall survival rate was 85% for stage I tumors, 65% for stage II, 30% for stage III and 15.5% for stage IV tumors. CONCLUSION: We noted an earlier age at presentation of malignant tumors. Mature teratoma was found to be the second most common benign tumor (after serous cystadenoma). We also noted a lower percentage of endometrioid tumors. Lower number of stage IV tumors was noted, with a significant number of malignant ovarian tumors presenting at an earlier age.

Neurofibroma of kidney: an uncommon neoplasm and diagnostic dilemma with solitary fibrous tumor.

Neurofibroma of kidney is an extremely rare tumor. To our knowledge, only five such cases have been reported worldwide till date. Here, we report a solitary neurofibroma of right kidney in a 54-year-old woman. Radiological investigations (ultrasonography and computed tomography) detected a solid mass in the upper pole of right kidney and clinicoradiologically renal cell carcinoma was suspected. A radical nephrectomy was performed under diagnosis of cancer. Microscopically, tumor consisted of benign spindle-shaped cells accompanied by fibrous tissue. Differential diagnoses of neurofibroma and solitary fibrous tumor (SFT) were made on morphological features. Immunohistochemically, the tumor cells were positive for S-100 protein, but negative for CD34 and CD99. Thus, a diagnosis of neurofibroma was established.

Fine needle aspiration cytology of parapharyngeal tumors.

BACKGROUND: Parapharyngeal tumors are rare and often pose diagnostic difficulties due to their location and plethora of presentations. OBJECTIVES: The study was undertaken to study the occurrence in the population and to evaluate the exact nature by fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: A total of five hundred and six cases of lateral neck lesions were studied over three and half years. Of these 56 suspected parapharyngeal masses were selected by clinical and radiological methods. Cytopathology evaluation was done by fine needle aspiration cytology with computed tomography and ultrasonography guidance wherever necessary. Histopathology confirmation was available in all the cases. RESULTS: On FNAC diagnosis could be established in 54 cases while in two cases the material was insufficient to establish a diagnosis. The tumors encountered were, pleomorphic adenoma (33), schwannoma (3), neurofibroma (11), paraganglioma (5), angiofibroma (1) and adenoid cystic carcinoma (1). Four false positives and two false negative cases were encountered. Overall sensitivity was 96%, with specificity of 99% and accuracy being 98.8%. CONCLUSIONS: With proper clinical and radiological assessment, FNAC can be extremely useful in diagnosing most of these lesions except a few which need histopathological and even immunohistochemical confirmation.

Gaucher's disease with uncommon presentations.

Gaucher's disease is the most common lysosomal storage disorder gene defect, which leads to deficiency or decreased activity of glucocerebrosidase, followed by accumulation of glucosylceramide. There is autosomal recessive transmission leading to varied clinical manifestations. This disease has three main types: Type I - nonneuronopathic; type II - acute neuronopathic; and type III - chronic neuronopathic. The nonneuronopathic type has the highest prevalence and also the greatest variability. The authors here report two cases of Gaucher's disease with uncommon presentations in early childhood, highlighting the importance of early diagnosis of the disease, as now-a-days enzyme replacement therapy may arrest further progress of disease.