Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM). MATERIAL AND METHODS: Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion. RESULTS: 0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases. CONCLUSIONS: The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly.

Effect of biostimulation on growth rate and reproductive development of Bos indicus dairy heifers.

The present study aimed to compare the growth rate, feeding behavior, reproductive development, and concentrations of GH and leptin in Sahiwal heifers exposed to direct bull contact, bull contact through a fenceline, or isolated from bulls. Overall, 24 heifers were allotted to three treatment groups (n = eight/group) based on birth weight, body weight, and age. Heifers from the non-exposed group (NBE) remained isolated from bulls; heifers stimulated by fenceline bull contact (FBE) remained continuously exposed to bulls through a fenceline, and heifers with direct bull contact (DBE+FBE) had direct contact with a bull during 6 h/day plus continuous fenceline bull exposure for the entire 24 h period. It was considered that heifers attained puberty when progesterone concentration was >1 ng/mL. Biostimulated heifers achieved puberty at both a lower age and body weight (P < 0.05) than NBE heifers. Overall, average daily gain (g/day) was greater in DBE+FBE (516.3 ± 4.5) and FBE (501.6 ± 4.3) than in NBE (441.8 ± 2.9, respectively; P < 0.01). Leptin and growth hormone concentrations were significantly greater in FBE and DBE+FBE than NBE heifers. Both groups of biostimulated heifers devoted more time eating than NBE heifers, P < 0.05). In conclusion, biostimulation of Sahiwal heifers, either by exposing them to bulls through a fenceline or by both fenceline exposure and direct contact, reduced the age of puberty and increased growth performance. Overall, fenceline bull exposure can be recommended as an easy handling management to stimulate reproductive precocity and growth rate in heifers.

Primary uterine angiosarcoma with "rhabdoid morphology": A case report.

INTRODUCTION: Primary uterine angiosarcoma is a very rare tumour, with only 23 cases described till now. It is a malignant tumour with cells variably recapitulating the morphologic features of an endothelium and expressing immunohistochemical markers of endothelial cells. In general, it is a bulky neoplasm and frequently is at advance stage of disease at presentation. In general, patients with uterine angiosarcoma tend to have a poorer prognosis, mostly related to the aggressive nature and the metastatic potential of these tumours. CASE REPORT: We report a rare case of primary uterine angiosarcoma with unusual rhabdoid morphology in a 41-year-old female, who underwent radical hysterectomy and died of disease after 4 months of treatment. DISCUSSION: We described the differential diagnosis of primary angiosarcoma of the uterus that can pose a diagnostic challenge.

Knowledge, awareness and attitude of dental professionals regarding child maltreatment.

BACKGROUND: Dental professionals could play a significant role in identifying, documenting and reporting child maltreatment to appropriate authorities as children are exposed to various maltreatments that can present in the head and neck region. AIM: The aim of this paper is to assess the level of knowledge, awareness and attitude among dental professionals regarding child maltreatment and to identify the barriers that prevent reporting suspected maltreatment. METHODOLOGY: The present cross-sectional questionnaire-based study was conducted on dental professionals practising in India by emailing a self-structured questionnaire to assess knowledge, awareness and attitude regarding child maltreatment. RESULTS: 422 dental professionals participated in the survey of which 270 were females. A significant difference was observed in mean knowledge (p=.015), awareness (p=.014) score of the participants with regard to place of work and mean knowledge score (p=.024) of the participants with regard to educational qualification. 300 participants reported that lack of adequate knowledge and awareness about the role of dental professionals regarding child maltreatment is one of the major barriers that prevent reporting child maltreatment. CONCLUSION: Findings of the study showed that 43.8% of participants had good knowledge and 44.8% were fairly aware regarding child maltreatment. 86.7% of participants showed a very good attitude towards learning more about the role of dental professionals in the management of child maltreatment.

Isolated lymph node recurrence in epithelial ovarian cancer - management and outcome.

INTRODUCTION: The aim of our study was to assess the clinical outcome of isolated lymph node recurrence in patients with epithelial ovarian cancer treated by surgery and to analyze the impact of various clinico-pathological factors on prognosis. MATERIAL AND METHODS: We conducted a retrospective analysis of all the epithelial ovarian cancer patients who underwent secondary lymphadenectomy surgery for isolated lymph node recurrence at our institute from 2013 to 2020. Univariate analysis of various factors influencing the post-recurrence disease free survival and post-recurrence survival was done using Kaplan-Meier for categorical variables and cox-proportional hazard progression for continuous variables. RESULTS: A total of 21 patients of isolated lymph node recurrence were treated surgically during the study period. The median disease free interval to develop lymph nodal recurrence was 13 months. All the patients achieved complete resection to no gross residual disease without any significant morbidity associated with the procedure. The median post-recurrence disease free survival after treatment of lymph node recurrence was 25 months with 3-year post-recurrence survival of 72% and 3-year overall survival of 85%. Amongst the factors influencing post-recurrence disease free survival, young age (< 50 years), para-aortic lymph node dissection at initial surgery and single site of lymph node recurrence were significantly associated with better prognosis. A single site of lymph node recurrence was associated with significantly better post-recurrence survival. CONCLUSIONS: Complete resection is feasible for epithelial ovarian cancer patients presenting with isolated lymph node recurrence, without any significant perioperative morbidity. When combined with postoperative adjuvant chemotherapy, complete resection is associated with favourable survival outcomes. Young age, para-aortic lymph node dissection during primary surgery and single site of lymph node recurrence are associated with better prognosis.

Dental professional's perspective regarding knowledge, awareness, and attitude towards the importance of charting dental anomalies: a cross-sectional study.

OBJECTIVES: The presence of dental anomalies could play a significant role in the identification of individuals by comparing antemortem and postmortem data. This cross-sectional study aimed to assess the level of knowledge, attitude, and awareness among dental professionals regarding the importance of charting dental anomalies and maintaining dental records. METHODOLOGY: A self-structured questionnaire was e-mailed to dental professionals practicing in India. The responses were recorded, data tabulated, and one-way ANOVA and post hoc tests were applied for analysis. The criterion for significance was p < .05. RESULTS: A total of 406 dental professionals responded to the survey. A significant difference was observed in the mean attitude score of participants towards the importance of charting dental anomalies and maintaining dental records with regard to place of work (p=.001), gender (p=.044) and educational qualification (p=.039). In addition, a statistically significant difference was observed in the mean awareness score of participants with respect to place of work (p=.033) and gender (p=.001). The major barriers in maintaining dental records were lack of time, adequate knowledge, infrastructure, and financial constraints. CONCLUSION: 81.3% and 69.26% study participants had very good awareness and attitude, whereas 71.2% had good knowledge regarding the importance of charting dental anomalies and maintenance of dental records; however, their inaccurate responses in anomaly identification hinted towards the need for proper dental charting and their maintenance to be taught en masse and made part of the BDS curriculum.

Genotypic correlation between post discharge Clostridiodes difficle infection (CDI) and previous unit-based contacts.

BACKGROUND: Cases of Clostridiodes difficile infection (CDI) diagnosed after hospital discharge account for a substantial proportion of new infections. It is unclear whether post-discharge infections originate from hospital-based transmission. METHODS: This was a Retrospective cohort study at a tertiary-care cancer center (non-outbreak setting). For all laboratory-identified cases of CDI in 2015-2016, patients with post-discharge (PD) CDI within eight weeks of their hospital stay were included in the study. Isolates from PD-CDI cases and their CDI-positive unit-based contacts were first genotyped by multilocus sequence typing (MLST). Common strains were further examined by core genome sequencing (CGS) to evaluate transmission links. RESULTS: Of 173 cases examined by MLST, 50% of PD cases matched previous unit contacts. Next, 34 isolates, including 16 PD cases and their 18-unit contacts were examined by CGS. None were ≤3 single-nucleotide variants apart. Seventy percent of PD cases had in-hospital antibiotic exposure before CDI onset in the community. CONCLUSION: Our study results suggest that symptomatic CDI cases are not a substantial source of transmission to PD cases. Frequent antibiotic exposure in post-discharge CDI cases is an important target for surveillance and stewardship efforts.

Generic tacrolimus (Pan Graf) in renal transplantation: an experience of 155 recipients in India.

BACKGROUND: The safety and efficacy of tacrolimus in transplantation are well established. However, tacrolimus (Pan Graf) has only been available in India for the last 2 years. We conducted this study to assess the safety and efficacy of tacrolimus in living related kidney transplantation. Herein we have reported our experience with tacrolimus as de novo therapy in a living related renal transplant program. MATERIALS AND METHODS: One hundred fifty-five consecutive recipients of living donor renal allografts were included in this study after consent and ethical clearance. Immunosuppression consisted of tacrolimus, mycophenolate mofetil or azathioprine, and steroids. The dose of tacrolimus was adjusted according to levels done on a regular basis. All patients were followed for periods ranging from 3 to 33 months. All episodes of graft dysfunction were evaluated by a graft biopsy. We evaluated the effects of this regimen on the incidence of graft rejection, graft survival, patient survival, and new onset diabetes mellitus. Six patients were diabetic prior to transplantation and 9 patients were hepatitis C virus (HCV) positive. RESULTS: There were 137 male and 18 female patients. The incidence of acute rejection was 3.87%; 17.93% developed new onset diabetes mellitus; and 77.7% of HCV-positive patients and 14.07% of HCV-negative patients developed posttransplantation diabetes mellitus. The patient survival at the current follow-up was 94.19%. CONCLUSION: This generic form of tacrolimus is a safe, effective immunosuppressant in living related renal transplantation.

Tacrolimus (Pan Graf) in live related renal transplantation: an initial experience of 101 recipients in India.

BACKGROUND: Success of modern transplantation is in large part due to the successful development of effective immunosuppressive agents. The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus (Pan Graf, Panacea Biotec Ltd, India) has only been available in India for the last 2 years. This study was conducted to assess the safety and efficacy of tacrolimus in live related kidney transplantation. We report an initial experience of tacrolimus as de novo therapy in a live related renal transplantation program. MATERIALS AND METHODS: One hundred one consecutive recipients of a live renal allograft were commenced on triple immunosuppression consisting of tacrolimus, mycophenolate mofetil or azathioprine, and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10-12 ng/mL in the first 3 months, 8-10 ng/mL in the next 3 months, and 5-8 ng/mL thereafter. All patients were followed up for a period ranging from 4 weeks to 24 months. The effect of this regimen on the incidence of graft rejection, graft survival, patient survival, and new-onset diabetes mellitus was evaluated. Any evidence of graft dysfunction was evaluated using a graft biopsy. RESULTS: There were 89 male and 12 female patients with mean age of 32.08 years. The incidence of acute rejection was 3.96%; 21.05% developed new-onset diabetes mellitus. Six patients were diabetic prior to transplantation and 9 patients were hepatitis C virus (HCV)-positive; 77.7% of HCV-positive patients and 15.1% of HCV-negative patients developed posttransplantation diabetes mellitus. The patient survival rate at the current follow-up was 92.07%. No graft was lost due to rejection. CONCLUSION: Tacrolimus is a safe and effective immunosuppressant in live related renal transplantation.

Tacrolimus (Pan Graf) as de novo therapy in renal transplant recipients in India.

The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus has only recently been available in India. We report an initial experience using tacrolimus as de novo therapy in a living related renal transplant program. Fifty-two consecutive recipients of living renal allografts were treated with tacrolimus, mycophenolate mofetil, or azathioprine and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10 to 12 ng/mL in the first 3 months, 8 to 10 ng/mL in the next 3 months, and 5 to 8 ng/mL thereafter. Any evidence of graft dysfunction was evaluated by graft biopsy. The effect of this regimen on the lipid profile as well as the incidence of posttransplant diabetes mellitus was evaluated in an Indian population. All patients were followed for periods ranging from 6 to 72 weeks (mean = 29 weeks). The incidence of acute rejection was 3.84%; 17.3% developed posttransplant diabetes mellitus. Graft and patient survivals at the current follow-up were 100% and 96.26%. In conclusion, tacrolimus is a safe and effective immunosuppressant in a living related renal transplant program.

Comparison of respiratory virus shedding by conventional and molecular testing methods in patients with haematological malignancy.

Respiratory viruses (RV) are a leading cause of infection-related morbidity and mortality for patients undergoing treatment for cancer. This analysis compared duration of RV shedding as detected by culture and PCR among patients in a high-risk oncology setting (adult patients with haematological malignancy and/or stem cell transplant and all paediatric oncology patients) and determined risk factors for extended shedding. RV infections due to influenza virus, parainfluenza virus (PIV), human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) from two study periods-January 2009-September 2011 (culture-based testing) and September 2011-April 2013 (PCR-based testing)-were reviewed retrospectively. Data were collected from patients in whom re-testing for viral clearance was carried out within 5-30 days after the most recent test. During the study period 456 patients were diagnosed with RV infection, 265 by PCR and 191 by culture. The median range for duration of shedding (days) by culture and PCR, respectively, were as follows-influenza virus: 13 days (5-38 days) versus 14 days (5-58 days), p 0.5; RSV: 11 days (5-35 days) versus 16 days (5-50 days), p 0.001; PIV: 9 days (5-41 days) versus 17 days (5-45 days), p ≤0.0001; HMPV 10.5 days (5-29 days) versus 14 days (5-42 days), p 0.2. In multivariable analysis, age and underlying disease or transplant were not independently associated with extended shedding regardless of testing method. In high-risk oncology settings for respiratory illness due to RSV and PIV, the virus is detectable by PCR for a longer period of time than by culture and extended shedding is observed.

Rhodococcus equi brain abscess in a patient without HIV.

Rhodococcus equi, a Gram positive organism, is a cause of infections in immunocompromised individuals. In humans, it mainly causes disease in those infected with human immunodeficiency virus (HIV), and generally presents as chronic pulmonary infection. It may also cause intracranial infections, which manifest as brain abscesses. This report describes a case of rhodococcus brain and pulmonary infection in a patient who did not have HIV or another disorder of cell mediated immunity. He was treated with intravenous imipenem, vancomycin, and rifampin for eight weeks and recovered from the infection.

Specific antibodies in serum of patients with hydatidosis recognised by immunoblotting.

Hydatid fluids from sheep, goat, pig and man, after resolution by sodium dodecyl sulphate-polyacrylamide gel electrophoresis under reducing conditions, revealed at least 15 discrete polypeptide bands of 8-116 Kda. By ELISA, sera from all 20 cases of hydatidosis showed anti-hydatid antibody, but so did 11 (73%) of 15 sera samples from cysticercosis patients, eight (67%) of 12 sera from patients with other parasitic infections (amoebic liver abscess or hymenolepiasis) and one (4%) of 25 sera from healthy controls. Antibody to cysticercus antigen was found in 14 (93%) of 15 sera from cysticercosis patients, 17 (85%) of 20 sera from hydatid patients, six (50%) of 12 sera from patients with other parasitic infections and one (4%) of 25 sera from healthy controls. Sera from 17 (85%) of 20 hydatid patients, 11 (73%) of 15 cysticercosis patients and five (42%) of 12 patients with other parasitic infections had antibodies to both hydatid and cysticercus antigens. Sera from 20 surgically confirmed cases of hydatidosis reacted with 12 polypeptides of 8-116 Kda in Western immunoblot with hydatid antigens. Polypeptides of 16, 24, 38, 45 and 58 Kda were recognised by all hydatidosis sera but also by many sera from patients with other infections. However, polypeptides of 8 and 116 Kda were recognised by all hydatidosis sera but not by any sera from patients with cysticercosis, other parasitic infections or viral hepatitis, or from healthy controls. Thus, recognition of 8- and 116-Kda hydatid antigens by a patient's serum appears to be a specific test confirming a clinical diagnosis in an individual case of hydatidosis.

Incidence of neural tube defects of Lucknow over a 10 year period from 1982-1991.

Open neural tube defects (NTD) in babies, occurring over a 10 yr period (1982-91), in four major maternity hospitals of Lucknow, were identified to analyse the incidence of this disorder. The overall incidence of NTD was found to be 3.9/1000. It was significantly higher in the teaching hospital compared to non-teaching hospitals. But there was no significant difference in the incidence of NTD between the Government and Private hospitals. During the decade (1982-91) under study there was no decline in NTD births. These data could serve as base-line for the incidence of NTD in north India, as NTD is expected to decline with the introduction of folic acid for the prevention of NTD.

Sturge Weber syndrome.

A variant of hemangioma and an uncommon congenital condition, the Sturge Weber syndrome (SWS), also called encephalo trigeminal angiomatosis, is a neurocutaneous disorder with angiomas involving the skin of the face (cutaneous angioma) and pia arachnoid (leptomeningeal angioma). It occurs typically in the ophthalmic and maxillary distributions of the trigeminal nerve (1,2). Here we present a case of a 14 year old girl.

Bilateral fusion of permanent mandibular incisors: a case report.

This case report showing a classical presentation of bilateral fusion of permanent mandibular incisors in a child patient for dental attention. Fusion defined as the merger of two adjacent tooth germs producing one tooth. These teeth may be fused by enamel, dentin, or both. The fused crown is broader than non fused adjacent teeth and thus resembles gemination. However, tooth counting reveals decreased numbers. Fused teeth are rare in the permanent dentition. The incisors are reported to be fused in primary and permanent dentition, but bilateral fusion is a rare occurrence. Hence the case report of bilateral fusion in an 11-year-old boy is presented.

Work-up for infectious diarrhea after allogeneic hematopoietic stem cell transplantation: single specimen testing results in cost savings without compromising diagnostic yield.

BACKGROUND: Diarrhea is a common complication of allogeneic bone marrow transplantation. Microbiologic stool studies are frequently ordered to rule out infectious etiology. The utility of examining multiple stool specimens per diarrheal episode has not been examined. METHODS: . We performed a retrospective review of 169 adult and pediatric patients who underwent hematopoietic stem cell transplantation at Memorial Sloan-Kettering Cancer Center from January 1, 2000 though December 31, 2001, who had at least 1 microbiologic stool study. We report on the incidence of enteric pathogens in our population and diagnostic yield of stool studies. A diarrheal episode was defined as a 14-day period from the date of the first stool study. Cost savings analysis was based on projected savings from implementation of proposed guidelines to the study population. RESULTS: A total of 1649 stool tests were performed (mean 10.6 tests per patient). An infectious cause of diarrhea was found in 45 (28.8%) patients. Diagnostic yield was 6.2% for Clostridum difficile toxin assay, 12.9% for viral cultures, and 1.3% for rotavirus enzyme immunoassay. Bacterial cultures for enteric pathogens, examination for parasites, and rotavirus antigen assay combined had 0.5% positive yield. CONCLUSIONS: Testing of multiple specimens per diarrheal episode did not increase diagnostic yield. The estimated cost savings by implementing single testing for each type of stool study per diarrheal episode was $49,764 annually (in 2001 US dollars). Judicious use of stool tests to evaluate diarrhea results in significant cost savings without compromising diagnostic yield.

Relationship of progesterone in plasma and whole milk of buffaloes during cyclicity and early pregnancy.

Blood and milk samples were collected on alternate days from 5 cycling buffaloes on 16 occasions and 2 pregnant buffaloes on 13 and 8 occasions. The blood and milk samples were analysed for progesterone by sensitive direct radioimmunoassay (RIA) procedures developed in this laboratory. The calculated correlation values (r) between plasma and milk progesterone concentrations during cyclicity were 0.8143, 0.5454 and 0.8147 on 0 to 4, 6 to 14 and -6 to -2 days, prior to next oestrus (day 0 = day of oestrus) and the correlations for individual buffaloes during cyclicity were in the range of 0.82 to 0.89 for plasma and milk progesterone concentration. The correlation between milk and plasma levels during early pregnancy in buffaloes was very low (0.1472). The linear regression equation between milk (Y, ng/ml) and plasma (X, ng/ml) progesterone concentration was Y = 1.8 + 3.61X which indicated that the milk progesterone levels were about 4 times higher than those in plasma. It was concluded from this study that in certain situations, such as during cyclicity when large variations occur in corpus luteum activity, the milk and plasma progesterone concentrations from the same buffalo are highly correlated. However, the correlation is very poor when corpus luteum activity remains more or less unchanged, as seen during pregnancy.

Relationships of maternal blood lead and disorders of pregnancy to neonatal birthweight.

Transient complications of pregnancy (anemia, toxemia, proteinuria, arterial hypertension and hyperemesis) were studied in pregnant women from the general population reporting to local hospitals. Comparison of blood lead levels (PbB) was made between women with normal pregnancies and those with complications. Significantly higher PbB were found in women with pregnancy complications as compared to those with normal pregnancies. Increments in the PbB levels were accompanied by statistically significant decrements in neonate birthweights. Complications of pregnancy may be induced by higher PbB and may also compound the adverse effects of decrements of neonate birthweights

Ameloblastomatous calcifying odontogenic cyst: a rare histologic variant.

Calcifying odontogenic cyst (COC) is an uncommon developmental odontogenic cyst first described by Gorlin in 1962. It is considered as extremely rare and accounts for only 1% of jaw cysts reported. Because of its diverse histopathology, there has always been confusion about its nature as a cyst, neoplasm or hamartoma. Several subclassifications have been proposed. Here, we present a case of calcifying odontogenic cyst with ameloblastic proliferation - an extremely rare histologic variant. The classical histologic features of the lining epithelium in the form of cords and presence of characteristic ghost cells were seen along with ameloblastomatous proliferations. Ameloblastomatous COC microscopically resembles unicystic ameloblastoma except for the ghost cells and calcifications within the proliferative epithelium. The nature of the COC is controversial. The case is presented here for its rarity, and difference between ameloblastomatous COC and ameloblastoma ex COC has been emphasized.