Epidemiological analysis of SARS-COV-2 B.1.617.2 (delta variant) transmission in an educational institute.

Background: Despite having an effective COVID-19 vaccine, the COVID-19 pandemic is far from over and the delta variant continues to cause havoc across several continents. The present study was conducted to analyze and describe the occurrence of COVID-19 cases among completely vaccinated individuals. Methods: In an educational institute in Western Maharashtra, we analyzed a cluster of RTPCR positive COVID-19 cases among fully vaccinated students which occurred in 12 days. The cases were linked to a series of curricular and co-curricular events in the institute. A detailed epidemiological investigation and genome sequencing of cases were conducted. IgG antibodies against S1 protein of novel SARS-CoV-2 were estimated for cases and age, sex, and vaccination status matched controls. Results: All 37 identified cases were mild COVID. 188 high risk (HR) contacts of the cases were identified. The overall secondary attack was 9.5%. Out of 31 cases and 50 controls, 09 (29%) cases and 08 (16%) controls were found to have IgG antibodies against S1 protein of novel SARS-CoV-2 titer of more than 60 U/ml. Whole-genome sequencing of 15 samples of the cluster showed the presence of the Delta variant of SARS-CoV-2. No correlation was observed between Ct value and IgG S1 antibody titers. Conclusion: The study provides significant evidence that only vaccination alone does not completely protect against SARS-CoV-2 B.1.617.2 (Delta) variant infection. An all-encompassing multicomponent strategy involving implementation of NPIs, robust contact tracing, early identification and isolation of cases, and high vaccination coverage is the way forward for the prevention of COVID-19.

Usefulness of Wieneke criteria in assessing morphologic characteristics of adrenocortical tumors in children.

PURPOSE: Adrenocortical tumors (ACT) occur rarely in pediatric age group. Pediatric ACTs behave differently from their histologically similar adult counterparts and standard adult criteria often cannot accurately predict their clinical behavior. The aim of the present study was to document the clinicopathologic spectrum of pediatric ACTs and to assess the utility of Wieneke scoring system in predicting clinical behavior of these tumors. METHODS: This multi-institutional study comprised of 13 cases of pediatric ACTs from January 2005 to May 2014. Clinical features and gross pathologic characteristics were obtained from records. Comprehensive analyses of microscopic features were performed. Each tumor was assessed according to criteria proposed by Wieneke et al. and was assigned to benign, intermediate for malignancy or malignant group. The standard adult Weiss criteria were also applied for comparison. RESULTS: There were total 6 cases of adrenocortical adenomas and 7 cases of adrenocortical carcinomas. Most of the children (76.9%) presented with endocrine dysfunction. Lower age of presentation was significantly associated with better prognosis. Applying Wieneke criteria, there were 6 benign and 6 malignant cases and one case was assigned to intermediate for malignancy group. The clinical behavior of all the cases was consistent with Wieneke criteria categorization. Applying Weiss criteria, 3 cases with benign clinical behavior were assigned to malignant group. CONCLUSION: Our study validates the reliability of Wieneke scoring system in predicting malignancy in pediatric ACTs. It is simple and easy to use and therefore useful in day-to-day practice.

Assessment of iodine and non-iodine deficiency hypothyroidism in women of reproductive ages in the sub-Himalayan plains of West Bengal.

Indian women of reproductive age groups commonly suffer from hypothyroidism which may be due to iodine or non iodine deficiency causes. This study was undertaken with a view to ascertain the leading cause of hypothyroidism in women of reproductive age group residing in the sub-Himalayan plain areas of Darjeeling district of West Bengal. Serum TSH, T4, T3 and Urinary Iodine Excretion (UIE) levels were measured in 101 non pregnant women. Our results reveal that among 37.62% (n=38) of bio-chemically established hypothyroid women; majority 76.32% (n=29) are suffering from iodine deficiency and the rest 23.68% (n=9) have Hypothyroidism due to other causes. Moreover, iodine deficiency persists among 57.42% (n=58) of the women in our study. We conclude that iodine deficiency disorders are still a major problem in this region and hypothyroidism due to iodine deficiency is more prevalent than the non iodine deficiency causes. Hence lacunae in the iodine supplementation process needs to be reviewed.

Histopathological study of adrenocortical masses with special references to Weiss score, Ki-67 index and p53 status.

BACKGROUND: Adrenal mass present with wide morphological spectrum and clinical manifestation, which can give rise to diagnostic confusion. Proper categorization is essential for individualized treatment. AIM AND OBJECTIVE: (1) Application of Weiss criteria to differentiate between benign and malignant adrenocortical neoplasm (2) co-relation of Ki-67 and p53 expression with the Weiss score. MATERIALS AND METHODS: A prospective, observational study was conducted in the Department of Pathology in collaboration with department of Endocrinology and Urology of a tertiary care hospital including 19 patients presented with clinically symptomatic or radiologically detected adrenocortical mass. Tissue for histopathological study was obtained in the form of the postoperative material. Histopathological categorization was done, and Weiss score was calculated in all tumors. Ki-67 and p53 immunohistochemistry were performed. RESULT: A total 19 cases of adrenal mass lesions were included. Cushing syndrome was the presenting symptoms in 26.3% adrenocortical masses. All patients with tumors with Weiss's score <3 (Group 1) were alive after 24 months of follow-up compared to 20% of those with Weiss's score >3 (Group 2). Statistically significance difference was noted in average weights and size of the tumors. Distribution of Ki-67 and p53 expression between Group 1 and Group 2 were compared and found statistically highly significant with Fisher's two-tailed P < 0.001. CONCLUSION: The combination of the meticulous evaluation of clinical, morphological and immunohistochemical profile helps in proper categorization of adrenocortical mass.

Metastatic vulvo-vaginal choriocarcinoma mimicking a Bartholin cyst and vulvar hematoma-two unusual presentations.

Metastatic choriocarcinoma may present solely as a vulvo-vaginal growth. It may pose initial diagnostic dilemmas and thus treatment delay. Two cases of metastatic choriocarcinoma which presented as vulvo-vaginal swelling are described here. Both the cases were initially misdiagnosed. Later, unresponsiveness to treatment alerted us to the possibility of metastatic choriocarcinoma. Combination chemotherapy was started following diagnosis by serum ß-HCG titer. In spite of initial responsiveness in both cases, one could not be saved due to poor compliance. Suspicion of metastatic choriocarcinoma should be kept in mind while dealing with any recent onset vulvovaginal swelling following a pregnancy. It may initially mislead the clinician due to its apparent benign appearance.

Statistical characterizers of transport in communication networks.

We identify the statistical characterizers of congestion and decongestion for message transport in model communication lattices. These turn out to be the travel time distributions, which are Gaussian in the congested phase, and logarithmic normal in the decongested phase. Our results are demonstrated for two-dimensional lattices, such the Waxman graph, and for lattices with local clustering and geographic separations, gradient connections, as well as for a one-dimensional ring lattice with random assortative connections. The behavior of the distribution identifies the congested and decongested phase correctly for these distinct network topologies and decongestion strategies. The waiting time distributions of the systems also show identical signatures of the congested and decongested phases. The distributions are explained using a stochastic differential equation to model the transport.

Evaluation of the prevention of parent to child transmission program in a rural tertiary care hospital of west bengal, India.

BACKGROUND: In India, 67,500 infants acquire HIV infection yearly due to mother to child transmission. OBJECTIVE: The objective was to assess the operational aspect of the Prevention of Parent to Child Transmission (PPTCT) program in a tertiary care hospital and explore its bottleneck. MATERIALS AND METHODS: A 5-year (2004-2008) prospective evaluation study was conducted among the pregnant women attending Obstetrics Department of a rural tertiary care hospital, since the year of implementation. Indicators were used according to UNAIDS/WHO guideline. RESULTS: Out of 40,140 registered pregnant women, 23,812 were counseled of which 19,794 were agreed to undergo HIV testing and 111 were found HIV positive with a prevalence of 0.56%. Overall HIV counseling and testing rates were 59.32% and 83.13%, respectively. The nevirapine (NVP) dispensing rate of the mother and newborn were 29.72% and 85.4%, respectively. At 18 months of age, 85% babies were found HIV negative in the mother baby pair who received NVP with absolutely formula feeding but it was 42.8% without such intervention. CONCLUSION: Majority of the pregnant women who came to the labor room directly were deprived of the program (PPTCT) coverage. Although the HIV testing rate reached the WHO target which was excellent, but the NVP dispensing rate lagged far behind.

Histopathological study of adrenocortical masses with special references to Weiss score, Ki-67 index and p53 status.

Background: Adrenal mass present with wide morphological spectrum and clinical manifestation, which can give rise to diagnostic confusion. Proper categorization is essential for individualized treatment. Aim and Objective: (1) Application of Weiss criteria to differentiate between benign and malignant adrenocortical neoplasm (2) co-relation of Ki-67 and p53 expression with the Weiss score. Materials and Methods: A prospective, observational study was conducted in the Department of Pathology in collaboration with department of Endocrinology and Urology of a tertiary care hospital including 19 patients presented with clinically symptomatic or radiologically detected adrenocortical mass. Tissue for histopathological study was obtained in the form of the postoperative material. Histopathological categorization was done, and Weiss score was calculated in all tumors. Ki-67 and p53 immunohistochemistry were performed. Result: A total 19 cases of adrenal mass lesions were included. Cushing syndrome was the presenting symptoms in 26.3% adrenocortical masses. All patients with tumors with Weiss’s score <3 (Group 1) were alive after 24 months of followup compared to 20% of those with Weiss’s score >3 (Group 2). Statistically signifi cance difference was noted in average weights and size of the tumors. Distribution of Ki-67 and p53 expression between Group 1 and Group 2 were compared and found statistically highly signifi cant with Fisher’s two-tailed P < 0.001. Conclusion: The combination of the meticulous evaluation of clinical, morphological and immunohistochemical profi le helps in proper categorization of adrenocortical mass.

Optimized point dose measurement: An effective tool for QA in intensity-modulated radiotherapy.

In some cases of Intensity-modulated radiotherapy (IMRT) point dose measurement, there exists significant deviation between calculated and measured dose at isocenter, sometimes greater than ±3%. This may be because IMRT fields generate complex profiles at the reference point. The deviation arises due to lack of lateral electronic equilibrium for small fields, and other factors such as leakage and scatter contribution. Measurements were done using 0.125-cc ion chamber and Universal IMRT phantom (both from PTW-Freiburg). The aim is to find a suitable point of measurement for the chamber to avoid discrepancy between calculated and measured dose. Various beam profiles were generated in the plane of the chamber for each field by implementing patient plan on the IMRT phantom. The profiles show that for the fields which are showing deviation, the ion chamber lies in the steep-gradient region. To rectify the problem, the TPS (Treatment Planning System) calculated dose is found out at various points in the measurement plane of the chamber at isocenter. The necessary displacement to the chamber, as noted from the TPS, was given to obtain the optimum result. Twenty cases were studied for optimization, whose percentage deviation was more than ±3%. The results were well within tolerance criteria of ±3% after optimization. The mean percentage deviation value for the 20 cases studied, with standard deviation of 2.33 under 95% confidence interval, was found out to be 2.10% ± 1.14. Those cases that have significant variation even after optimization are further studied with film dosimetry.

Assessment of iodine and non-iodine deficiency hypothyroidism in women of reproductive ages in the Sub-Himalayan plains of west Bengal.

Indian women of reproductive age groups commonly suffer from hypothyroidism which may be due to iodine or non iodine deficiency causes. This study was undertaken with a view to ascertain the leading cause of hypothyroidism in women of reproductive age group residing in the sub-Himalayan plain areas of Darjeeling district of West Bengal. Serum TSH, T4, T3 and Urinary Iodine Excretion (UIE) levels were measured in 101 non pregnant women. Our results reveal that among 37.62% (n=38) of bio-chemically established hypothyroid women; majority 76.32% (n=29) are suffering from iodine deficiency and the rest 23.68% (n=9) have Hypothyroidism due to other causes. Moreover, iodine deficiency persists among 57.42% (n=58) of the women in our study. We conclude that iodine deficiency disorders are still a major problem in this region and hypothyroidism due to iodine deficiency is more prevalent than the non iodine deficiency causes. Hence lacunae in the iodine supplementation process needs to be reviewed.