Surgically challenging inflammatory myofibroblastic tumor: A rare neoplasm of lung

Inflammatory myofibroblastic tumor is considered one of the rarest benign tumors constituting 0.7% of all lung neoplasms. It was first described in 1939. We report a case of a 10-year-old child who presented with recurrent cough and fever. Chest radiography and computed tomography demonstrated complete involvement of right lung by the tumor. The tumor along with the affected lung was meticulously dissected from the surrounding structures and was delivered outside. The histopathology of the specimen revealed it to be inflammatory fibroblastoma.

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study

BACKGROUND

Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage.

METHODS

A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR.

FINDINGS

A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3-7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2-2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties.

INTERPRETATION

Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage.

Increased Tenascin-C expression contributes to cardiac dysfunction and fibrosis in Duchenne muscular dystrophy

Introduction and aims

Cardiac fibrosis is characterized by the net accumulation of extracellular matrix (ECM) proteins in the cardiac interstitium and contributes to cardiac contractile dysfunction. In Duchenne muscular dystrophy (DMD), cardiomyopathy develops as a result of a dystrophin deficiency causing fibrofatty replacement of the myocardium, however the underlying mechanisms are not fully understood. There is a growing collection of evidence that ECM proteins, including Tenascin C (TN-C), plays a maladaptive role in left ventricular (LV) remodelling and cardiac fibrosis in ischemic heart disease. The aims of our study were 1) to assess TN-C levels, fibrosis and cardiac dysfunction in DMD patients, and 2) to clarify the role of TN-C in cardiovascular dysfunction and fibrosis using male mdx (n=10) and mdx TN-C KO mice (n=8).

Results

In male patients with DMD (n=18) and age matched controls (n=12) undergoing cardiac MRI, we detected greater myocardial fibrosis than in control hearts. In addition, we observed an elevation of TN-C plasma levels [median concentration (3.55); interquartile range (0.61–7.43) ng/mL] in DMD patients, and its expression negatively correlated to LV ejection fraction (EF) [median LVEF (45); interquartile range (37.5–51.5) %]. Male wt, mdx and mdx TN-C KO age-matched (10 months) mice were used. Transthoracic echocardiography was performed and fibrosis was assessed on cardiac tissue sections. Wire myography was used to assess vascular endothelial function. To explore the signalling pathways contributing to cardiac fibrosis, human cardiac fibroblasts (hCFs) were treated with recombinant human TN-C or TGF-β and gene expression and epigenetic regulation of NF-kB/p65 were assessed. Mdx mice showed significantly increased cardiac fibrosis which was accompanied with markedly elevated TN-C level in cardiac tissue and plasma compared to wt animals (p<0.05, respectively). Moreover, TN-C level in plasma correlated positively with the degree of cardiac dilation in dystrophic mice. In addition, vascular endothelial function was notably impaired in mdx mice. In contrast, we observed preserved vascular function in mdx- TN-C KO mice, this was accompanied by a significant reduction in cardiac fibrosis in compared to age-matched mdx mice (p<0.05, respectively). hCFs treated with TN-C or TGF-β showed increased collagen and α-SMA expressions which could be prevented by application of siRNA against TN-C. In addition, both TN-C and TGF-β caused p65/NF-κB promoter demethylation and subsequently triggered pro-inflammatory and pro-fibrotic signalling, which could be reversed by applying p38 MAPK inhibitor in hCFs.

Conclusion

TN-C is a critical component of cardiac fibrosis and cardiac dysfunction in DMD. The activation of NF-κB p65 signalling pathway may play a role in TN-C induced fibrosis. Thus, TN-C may be a mediator and potential target for therapy in DMD-associated cardiovascular complications.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Österreichische MuskelforschungFWF - Austrian Science Found P 35878

Pulmonary tuberculosis with superadded infection of echinococcus and aspergillus

Pulmonary tuberculosis is one of the most common immunosuppressive infections in India, seldom accompanies other parasitic and fungal infections. In our case, we describe the three coexistent infections and their clinical presentation in a 53-year-old woman. A fibro-cavitary lesion in lung with superadded infections of hydatid cyst and aspergillus which is rare has been elaborated in the present case.

A maze of pearls in the chest

Hydatid disease is a prevalent disease in India. The most common organs involved are the liver and the lungs. Most of the time, the lung cysts are single and large. Multiple cysts have been described in literature but they are generally bilateral. We present here a case of multiple hydatidosis which involved only one lung, but occupied all the segments of the lung. The cysts were numerous and interconnected giving the appearance of a maze. The images of the computed tomography (CT) scan reveal that there was very little identifiable lung tissue. But after surgery, the healthy lung tissue expanded and occupied the chest cavity.

Spontaneous Rupture of a Congenital Diaphragmatic Eventration in an Infant

Rupture of eventration of diaphragm is a rare entity that commonly presents as sudden onset respiratory distress. We report a case of a 7-month-old infant with congenital diaphragmatic eventration having spontaneous diaphragmatic rupture which led to secondary diaphragmatic herniation with gastric volvulus. Clinical diagnosis of gastric volvulus was suspected on the basis of imaging and failed entry of nasogastric tube into stomach. Exploratory laparotomy revealed rupture of eventration of diaphragm and gastrothorax with volvulus. Anatomical repair of diaphragmatic perforation followed by diaphragmatic plication resulted in successful outcome in our patient.

Genetic Diversity among Group A Streptococcus Isolated from Throats of Healthy and Symptomatic Children

BACKGROUND

Group A streptococcus (GAS) is the commonest bacterial cause of pharyngitis. Children in the age group of 5-15 years are most commonly affected. It can also colonize throats of healthy children in this age group. Both cases and carriers can transmit it in the community.

METHODS

Throat swab samples were collected from 1849 asymptomatic and 371 symptomatic children.

RESULTS

The rate of isolation of GAS was 1.41% among the asymptomatic group and 7.55% among the symptomatic group. Nine different emm types were encountered in the asymptomatic children and 14 among the symptomatic children.

CONCLUSION

Throat swab cultures must be used in all cases of pharyngitis. Early and appropriate antibiotic therapy will prevent complications. Asymptomatic throat carriage of GAS in children was low in our study. However, they can still act as reservoirs. Emm typing helps in understanding epidemiology and finding new types.

Influence of Temperature and Humidity on Pregnancy Rate of Murrah Buffaloes under Subtropical Climate

Heat stress has adverse effects on fertility of dairy animals. Decline in fertility is linearly associated with an increase in combination of both temperature and humidity. The purpose of this study was to investigate the relationship between temperature humidity index (THI) and the pregnancy rate of Murrah buffaloes in a subtropical climate. The effects of genetic and non-genetic factors viz., sire, parity, period of calving and age group at first calving were found non-significant on pregnancy rate. The effect of THI was found significant (p<0.001) on pregnancy rate of Murrah buffaloes calved for first time and overall pregnancy rate. The threshold THI affecting the pregnancy rate was identified as THI 75. The months from October to March showed THI<75 and considered as non heat stress zone (NHSZ), while months from April to September were determined as heat stress zone (HSZ) with THI≥75. The lowest overall pregnancy rate (0.25) was obtained in July with THI 80.9, while the highest overall pregnancy rate (0.59) was found in November with THI 66.1. May and June were identified as critical heat stress zone (CHSZ) within the HSZ with maximum decline (-7%) in pregnancy rate with per unit increase in THI. The highest overall pregnancy rate was estimated as 0.45 in NHSZ with THI value 56.7 to 73.2. The pregnancy rate was found to have declined to 0.28 in HSZ with THI 73.5 to 83.7. However, the lowest pregnancy rate was estimated as 0.27 in CHSZ with THI value 80.3 to 81.6.

Carney Complex: case report and review

Carney complex is a very rare multiple neoplasia syndrome with cardiac, cutaneous, and neural tumours with a variety of pigmented lesion of skin. We are reporting a rare case of carney complex in which left atrial myxoma with superficial angiomyxoma, giant cell tumour of bone and lentigines showed a unique association. This patient underwent successful surgical excision of left atrial myxoma under cardiopulmonary bypass.

A rare case of congenital diaphragmatic hernia with ectopic liver and absent pericardium

We present a 37-year-old woman with a rare combination of absent pericardium with congenital diaphragmatic hernia. Only 3 patients with congenital diaphragmatic hernia with complete absence of pericardium and ectopic liver have been described, and all of them were neonates. This interesting case gives us an opportunity to study the natural history of this rare combination of anatomic defect and consolidate the existing scarce data on this condition.

Design and evaluation of biodegradable, biosensitive in situ gelling system for pulsatile delivery of insulin

Biodegradable glucose-sensitive in situ gelling system based on chitosan for pulsatile delivery of insulin was developed. The sols/gels were thoroughly characterized for swelling properties, rheology, texture analysis and water content. The developed glucose-sensitive gels responded to varied glucose concentrations in vitro indicating their ability to function as environment-sensitive systems. Insulin load onto the gels was optimized and was found to affect the rheological behavior of these gels, the final preparation used for in vitro contained 1IU/200mul of the sol. These gels released the entrapped insulin in a pulsatile manner in response to the glucose concentration in vitro. Furthermore, the formulations when evaluated for their in vivo efficacy in streptozotocin-induced diabetic rats at a dose of 3IU/kg, demonstrated their ability to release insulin in response to glucose concentration and were preferred much better against subcutaneously given plain insulin formulation used as the control. Together, these preliminary results indicate that biosensitive chitosan in situ gelling systems have substantial potential as pulsatile delivery systems for insulin.

Hydrogels for pharmaceutical and biomedical applications

Hydrogels are crosslinked hydrophilic polymer structures that can imbibe large amounts of water or biological fluids. Hydrogels are one of the upcoming classes of polymer-based systems that embrace numerous biomedical and pharmaceutical applications. This review discusses various parameters of hydrogels such as surface properties, water content and swelling behavior, effect of nature of polymer, ionic content, and thermodynamics, all of which can influence the biomedical usage of hydrogels. Meanwhile, intelligent or environment-sensitive hydrogels and bioadhesive hydrogels continue to be important materials for medical applications; therefore, a part of this review is devoted to some of their important classes. Hydrogels are extensively used for various biomedical applications--tissue engineering, molecular imprinting, wound dressings materials, immunoisolation, drug delivery, etc. Thus, this review aims to throw light on the numerous applications that hydrogels have in the biomedical arena.