The urgency of Burkitt lymphoma diagnosis in fluid cytology-A tertiary care experience

BACKGROUND

Burkitt lymphoma (BL) is an aggressive high-grade B-cell non-Hodgkin lymphoma commonly diagnosed in young age and is known to involve extra nodal sites. But the involvement of body fluids by BL is an uncommon presentation. Rapid diagnosis of BL is vital to prevent complications like tumour lysis syndrome. Cytological examination of body fluids continues to be an indispensable tool for rapid diagnosis of BL.

OBJECTIVES

In this study, we aim to study the clinical, cytomorphological and immunophenotypic characteristics of BL involving serous effusions and other fluids.

MATERIALS AND METHODS

In this retrospective study, 17 cases reported as BL in fluid cytology from 2016 to 2022 were collected and reviewed. We performed a comprehensive analysis of the clinical data, cytomorphological features, immunophenotyping data along with the haematological workup of these cases. We have also compared with the histopathological diagnosis for those cases where biopsy was available.

RESULTS

BL more commonly involved ascitic fluid (52%), followed by pleural fluid (4 cases) and cerebrospinal fluid (CSF; 4 cases). Primary diagnosis of BL in fluid was done in 88% of the cases. Bone marrow involvement was noted in two cases. Cytological smears showed discrete monomorphous population of medium-sized atypical lymphoid cells with frequent apoptotic bodies. Classic cytoplasmic punched out vacuoles were observed in 88% of the cases. Immunophenotyping data was available for 12 cases in which tumour cells showed positivity for CD20 (100%), CD10 (4 of 7 cases), BCL6 (3 of 5 cases) and cMYC (7 of 7 cases-100%) and were negative for Terminal deoxynucleotidyl transferase (TdT) (11 of 11 cases). Mean Ki67 labelling index was 95%. Histopathological diagnosis was available for 9 cases, and there was 100% agreement between cytological and histopathological diagnosis in 7 cases.

CONCLUSION

Precise diagnosis of BL can be rendered in body fluids by identification of classic cytomorphological features and by performing supportive ancillary tests in fluids for immunophenotyping.

A Highly Sensitive Graphene-based Field Effect Transistor for the Detection of Myoglobin

Biomedical applications adapt Nano technology-based transistors as a key component in the biosensors for diagnosing life threatening diseases like Covid-19, Acute myocardial infarction (AMI), etc. The proposed work introduces a new biosensor, based on Graphene Field Effect Transistor (GFET), which is used in the diagnosis of Myoglobin (Mb) in human blood. Graphene-based biosensors are faster, more precise, stronger, and more trustworthy. A GFET is created in this study for the detection of myoglobin biomarker at various low concentrations. Because graphene is sensitive to a variety of biomarker materials, it can be employed as a gate material. When constructed Graphene FET is applied to myoglobin antigens, it has a significant response. The detection level for myoglobin is roughly 30 fg/ml, which is quite high. The electrical behavior of the GFET-based biosensor in detecting myoglobin marker is ideal for Lab-on-Chip platforms and Cardiac Point-of-Care Diagnosis.

Predictors of coronary slow flow phenomenon in patients with angina and normal epicardial coronaries

Background

Coronary slow flow phenomenon (CSFP), also called as syndrome Y is characterized by the delayed passage of contrast distally when injected into the epicardial coronaries. It accounts for upto 7% of patients undergoing coronary angiogram (CAG) for angina. Conventionally, it is determined by the coronary filling time. We aimed to determine whether coronary emptying time is a significant predictor of the coronary slow flow.

Purpose

To determine the coronary artery filling time and emptying time at prespecified vascular landmarks in patients with chest pain and normal epicardial coronaries.

To determine the association of coronary arterial filling time and emptying time in patients with coronary slow flow phenomenon.

To determine the association of various conventional coronary artery disease risk factors and various clinical parameters in patients with coronary slow flow phenomenon.

Methods

Patients with angina, having normal epicardial coronaries on CAG were selected consecutively between January 2019 and December 2020. Each angiogram was assessed for the coronary filling and emptying times at prespecified standard vascular landmarks on the basis of TIMI frame counts (TFC).

Results

A total of 37 patients with normal epicardial coronaries were analyzed, out of which 27 patients had slow flow in LAD and 17 patients had slow flow in RCA (10 had normal flow in LAD and 12 had normal flow in RCA). Eight had non dominant RCA, which were too small for analyzing TFC were excluded from the study. We observed positive correlation of coronary filling times and emptying times, both in LAD (R-Sq 0.24) and RCA (R-Sq 0.05) in slow flow patients unlike those with normal flow. We found the filling times and emptying times are significantly prolonged in slow flow patients [with mean CTFC values of 77.94 & 92.85 in LAD and 36.91 & 120.82 in RCA, respectively (P<0.05)]. The capillary and venous transit time is prolonged both in LAD and RCA slow flow groups, which was of statistical significance in the RCA slow flow group (P<0.05), but not in LAD slow flow group (P=0.43). We observed slow flow significantly more in male population (P=0.02) and associated with high LDL/HDL ratios and high triglycerides.

Conclusion

1. In addition to coronary artery filling times, Coronary artery emptying time is an independent and significant predictor of coronary slow flow phenomenon.

2. Capillary and venous transit time is significantly prolonged in patients with slow flow in RCA whereas in patients with LAD slow flow there is non significant prolongation of capillary and venous transit time.

3. There is a positive correlation of coronary emptying time with coronary filling time in Coronary Slow Flow. This correlation is not seen in patients with normal coronary flow.

4. Coronary slow flow is observed significantly more in male population.

5. Coronary slow flow is significantly associated with high LDL/HDL ratios and triglyceride levels.

Funding Acknowledgement

Type of funding sources: None. Study designAngiographic landmarks for LAD and RCA – Pictorial representation

Neuroectodermal tumours of the sino-nasal tract: a clinicopathological study of 18 cases with a newly proposed revised classification and a brief review of literature

AIM

Sino-nasal tract tumours constitute 3% of the head and neck malignancies. Among these tumours, neuroectodermal tumours are rare with histo-morphological and immunohistochemical overlap making them a challenge for the pathologist. We included Ewing's/PNET, olfactory neuroblastoma (OFN), mucosal malignant melanomas (MMM), Melanotic neuroectodermal tumour of infancy (MNTI), small-cell neuroendocrine carcinoma (SNEC), and the newest entity Adamantinoma like Ewing's sarcoma (ALES) as part of the neuroectodermally derived tumours of the sino-nasal tract. The last three entities were added to the existing ones, which also has been emphasized in this paper.

METHODS AND RESULTS

A comprehensive analysis was done on all neuroectodermally derived tumours from 2016 to 2020. A total of 18 cases were collected, which included OFN (10 cases), SNEC (2 cases), MMM (2 cases), Ewing's/PNET (2 cases), MNTI (1 case), and ALES (1 case). The most common presentation in NE tumours was nasal obstruction (80-100%). Except for OFN, all other tumours were confined to the nasal and paranasal sinuses. 4/10 cases of OFN showed orbital extension. Cervical lymph-node metastasis was seen in 50% of cases of SNEC and MMM groups. An array of relevant immune-histochemical markers were performed. The marker expression was very subtle among the groups. On follow-up, recurrence was seen in the OFN and MMM groups in 30 and 50%, respectively. Metastasis was seen in SNEC group (100%) and OFN group (10%).

CONCLUSION

As sino-nasal neuroectodermal tumours pose a diagnostic challenge and have different therapies and are prognostically different, the pathologist must be aware of the subtle morphological, immunohistochemical clues which have been dealt with in-depth in this study.

New TB drugs for the treatment of children and adolescents with rifampicin-resistant TB in Mumbai, India

SETTING: Médecins Sans Frontières (MSF) clinic in Mumbai, India.OBJECTIVE: To determine the final treatment outcomes, culture conversion and adverse events (AEs) during treatment among children and adolescents (0-19 years) with rifampicin-resistant tuberculosis (RR-TB) who received ambulatory injectable-free treatment, including bedaquiline (BDQ) and/or delamanid (DLM) during September 2014-January 2020.DESIGN: This was a retrospective cohort study based on review of routinely collected programme data.RESULTS: Twenty-four patients were included; the median age was 15.5 years (min-max 3-19) and 15 (63%) were females. None were HIV-coinfected. All had fluoroquinolone resistance. Twelve received treatment, including BDQ and DLM, 11 received DLM and one BDQ. The median exposure to BDQ (n = 13) and DLM (n = 23) was 82 (IQR 80-93) and 82 (IQR 77-96) weeks, respectively. Seventeen (94%) patients with positive culture at baseline (n = 18) had negative culture during treatment; median time for culture-conversion was 7 weeks (IQR 5-11). Twenty-three (96%) had successful treatment outcomes: cured (n = 16) or completed treatment (n = 7); one died. Eleven (46%) had 17 episodes of AEs. Two of 12 serious AEs were associated with new drugs (QTcF >500 ms).CONCLUSION: Based on one of the largest global cohorts of children and adolescents to receive new TB drugs, this study has shown that injectable-free regimens containing BDQ and/or DLM on ambulatory basis were effective and well-tolerated among children and adolescents and should be made routinely accessible to these vulnerable groups.

Medical image analysis based on deep learning approach

Medical imaging plays a significant role in different clinical applications such as medical procedures used for early detection, monitoring, diagnosis, and treatment evaluation of various medical conditions. Basicsof the principles and implementations of artificial neural networks and deep learning are essential for understanding medical image analysis in computer vision. Deep Learning Approach (DLA) in medical image analysis emerges as a fast-growing research field. DLA has been widely used in medical imaging to detect the presence or absence of the disease. This paper presents the development of artificial neural networks, comprehensive analysis of DLA, which delivers promising medical imaging applications. Most of the DLA implementations concentrate on the X-ray images, computerized tomography, mammography images, and digital histopathology images. It provides a systematic review of the articles for classification, detection, and segmentation of medical images based on DLA. This review guides the researchers to think of appropriate changes in medical image analysis based on DLA.

Recent developments in graphene based field effect transistors

This paper presents a comprehensive survey on the recent developments in Graphene Field Effect Transistor (G-FET), considering various aspects such as fabrication, modelling and simulation tools and applications especially in sensors, highlighting the future directions. Complying with the Moore's law, to increase the transistor density of an Integrated Circuit, new alternate materials for fabrication have been tried, instead of silicon due to its limitations in reducing transistor dimensions. Graphene, one such material, proves to be a suitable alternate for silicon due to the factors like superior carrier mobility and very high trans-conductance gain, etc and G-FET is becoming the most suitable choice for high-speed analog VLSI, RF, and bio- sensor circuits.

Cyto-morphological and clinical approach to infections presenting with discharging sinuses mimicking malignancy

INTRODUCTION

Discharging sinuses is a form of chronic unhealed infection that can present at any site due to a variety of infectious organisms. These discharging sinuses may be associated with mass lesions and lymphadenopathy to mimic some neoplastic processes. Identifying these infections with accuracy and promptness is essential, as the treatment regimens are specific. Fine-needle aspiration (FNA) of these lesions, along with appropriate cytochemical stains, aids in the rapid and precise diagnosis of these infections and excludes neoplasms at these sites. Also, material for culture and other studies can be obtained by FNA.

MATERIAL AND METHODS

This retrospective study was conducted in the Department of pathology from 2018 to 2020. A total of 179 patients with similar clinical presentation and confirmed infection on cytology were identified. On the evaluation of the requisition forms, 32 (18%) patients were identified with discharging sinus associated along with swelling.

RESULTS

The five infections (32 cases) that were identified, included 18 cases of tuberculosis (56.25%) followed by 9 cases of actinomycosis (28.12%), 3 cases of pheohypomycosis (9.37%), and one case each of Nocardia (3.12%) and eumycetoma (3.12%) which presented as swelling with discharging sinus. Special stains were performed in all cases for confirmation. Histopathological/Microbiological correlation was done whenever available.

CONCLUSION

Infections presenting as swelling with discharging sinuses mimicking malignancy can be diagnosed on FNAC with good accuracy.

Variation of near surface atmosphere microbial communities at an urban and a suburban site in Philadelphia, PA, USA

Microorganisms are abundant in the near surface atmosphere and make up a significant fraction of organic aerosols with implications on both human health and ecosystem services. Despite their importance, studies investigating biogeographical patterns of the atmospheric microbiome between urban and suburban areas are limited. Urban and suburban locations (including their microbial communities) vary considerably depending on climate, topography, industrial activities, demographics and other socio-economic factors. Hence, we need more location-specific data to make informed decision affecting air quality, human health, and the implication of a changing climate and policy decisions. The objective of this study was to describe how the atmospheric microbiome varies in composition and function between urban and suburban sites. We used high-throughput sequencing to analyze microbial communities collected at different times from PM_2.5 samples collected by active sampling method (using a pump and an impactor) and dust settling of TSP collected by passive sampling method (no pump and no impactor) from an urban and suburban site. We found diverse communities unique in composition at both sites with equivalent functional potential. Taxonomic composition varied significantly with Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, and Other phyla in greater relative abundance at the urban site. In contrast, Cyanobacteria, Tenericutes, Fusobacteria, and Deinococcus, were enriched at the suburban site. Community diversity also demonstrated a high degree of temporal variation within site. We identified over one-third of the communities as potentially pathogenic taxa (urban: 47.52% ± 14.40%, suburban: 34.53% ± 14.60%) and determined the majority of organisms come from animal-associated host or are environmental non-specific. Potentially pathogenic taxa and source environments were similar between active- and passive- sampling method results. Our research is novel it adds to the underrepresented set of studies on atmospheric microbial structure and function across land types and is the first to compare suburban and urban atmospheric communities.

Crystal structure and Hirshfeld surface analysis of 1-methyl-4-(2-methyl-10H-benzo[b]thieno[2,3-e][1,4]diazepin-4-yl)piperazin-1-ium 2,5-di-hydroxy-benzoate propan-2-ol monosolvate

The asymmetric unit of the title salt, C17H21N4S+·C7H5O4 -·C3H7OH, consists of an olanzapinium cation, an independent 2,5-di-hydroxy-benzoate anion and a solvent isopropyl alcohol mol-ecule. The central seven-membered heterocycle is in a boat conformation, while the piperazine ring displays a distorted chair conformation. The dihedral angle between the benzene and thiene rings flanking the diazepine ring is 52.58 (19)°. In the crystal, the anions and cations are connected by N-H⋯O and O-H⋯O hydrogen bonds, forming a three-dimensional network.

Investigation of Microstructural and Mechanical Properties of Al 5083-ZrSiO4-Gr Hybrid Composite

In this present work, an attempt is made to compare the microstructural, mechanical and tribological properties of Al 5083-5% and 10% Gr, Al 5083-5% and 10% ZrSiO4 composite with Al 5083-5, 10% Gr-5 and 10% ZrSiO4 hybrid composite. The samples were prepared by using the stir casting technique, and the characterizations of composites and hybrid composite were observed by using SEM, EDAX and X-ray diffraction (XRD). The mechanical properties such as hardness, tensile, compressive strength of hybrid composite were found to be better than those of composites. The wear test was carried out by using a pin-on-disc wear tribometer by varying parameters like normal load (5, 10[Formula: see text]N), sliding speed (1, 1.5, 2[Formula: see text]m/s) with constant sliding distance (2000[Formula: see text]m). The worn surface of the samples is examined by using SEM, and the wear properties of the hybrid composite are found to exhibit superior wear resistance properties than composites.

Influence of perfluorocarbons on Carbamazepine and Benzodiazepine for a neuro-lung protective strategy

Lennox-Gastaut syndrome (LGS) is commonly characterized by a triad of features including multiple seizure types, intellectual disability or regression. LGS type of seizures is epilepsy which is due to abnormal vibrations occurring in seizures. During the time of such abnormal vibrations, both the seizures and the lungs suffer a lack in oxygen content to a considerable extent. This results in prolonged vibrations and loses of nervous control. As a neuro-lung protective strategy, a novel attempt has been made to enrich both seizures and lungs with oxygen content through the support of Perfluorodecalin (an excellent oxygen carrier) C₁₀F₁₈ (PFD) and Perfluorohexane C₆F₁₄ (PFH) along with an enhancement in the antiepileptic activity by the two chosen antiepileptic drugs (AEDs) Carbamazepine (CBZ) and Benzodiazepine (BDZ). Perfluorodecalin C₁₀F₁₈ (PFD) and Perfluorohexane C₆F₁₄ (PFH) emulsions were prepared by sonication process with combination of nonionic emulsifier, Lecithin (l-α-phosphatidylcholine) as a surfactant in Aqueous phase medium. These emulsions were mixed with Carbamazepine (CBZ) and Benzodiazepine (BDZ) drugs maintained at a temperature of about -20°C to 20°C and were set to slow evaporation process. The products are subjected to Optical microscope, Transmission electron microscopy (TEM) and Scanning Electron Microscope (SEM) - Energy dispersive X-ray Spectroscopy (EDS). Study reveals the co-existence of fluorine and drug ensuring the oxygen uptake by the drug. Morphology of TEM, Optical microscopic images and the particle diameter estimated through Image_J confirms this analysis.

Study of the sign change of exchange bias across the spin reorientation transition in Co(Cr1-x Fe x )2O4 (x = 0.00-0.125)

We present the evolution of novel phenomena of magnetic compensation effect, exchange bias (EB) effect and the field induced anomalies in '[Formula: see text]' substituted multiferroic compound [Formula: see text]. A few percent of '[Formula: see text]' substitution for '[Formula: see text]' in [Formula: see text] results in the reversal of field cooled magnetization under low applied fields below compensation temperature T _comp. Further, increase in the field leads to the spin reorientation transition (T _SR). Signature of EB in a narrow temperature window in the vicinity of T _SR and its sign change across T _SR is observed. Magnitude of EB depends on the amount of compensation and rigidity of the spin reorientation. We also notice the appearance of positive EB below the lock-in transition (T _L). Presence of unidirectional anisotropy developed in the commensurate spin-spiral below T _L could be responsible for the appearance of EB below T _L.

NIK regulates MT1-MMP activity and promotes glioma cell invasion independently of the canonical NF-κB pathway

A growing body of evidence implicates the noncanonical NF-κB pathway as a key driver of glioma invasiveness and a major factor underlying poor patient prognoses. Here, we show that NF-κB-inducing kinase (NIK/MAP3K14), a critical upstream regulator of the noncanonical NF-κB pathway, is both necessary and sufficient for cell-intrinsic invasion, as well as invasion induced by the cytokine TWEAK, which is strongly associated with tumor pathogenicity. NIK promotes dramatic alterations in glioma cell morphology that are characterized by extensive membrane branching and elongated pseudopodial protrusions. Correspondingly, NIK increases the phosphorylation, enzymatic activity and pseudopodial localization of membrane type-1 matrix metalloproteinase (MT1-MMP/MMP14), which is associated with enhanced tumor cell invasion of three-dimensional collagen matrices. Moreover, NIK regulates MT1-MMP activity in cells lacking the canonical NF-κB p65 and cRel proteins. Finally, increased expression of NIK is associated with elevated MT1-MMP phosphorylation in orthotopic xenografts and co-expression of NIK and MT1-MMP in human tumors is associated with poor glioma patient survival. These data reveal a novel role of NIK to enhance pseudopodia formation, MT1-MMP enzymatic activity and tumor cell invasion independently of p65. Collectively, our findings underscore the therapeutic potential of approaches targeting NIK in highly invasive tumors.

Design, synthesis and computational evaluation of a novel intermediate salt of N-cyclohexyl-N-(cyclohexylcarbamoyl)-4-(trifluoromethyl) benzamide as potential potassium channel blocker in epileptic paroxysmal seizures

The narrow therapeutic range and limited pharmacokinetics of available Antiepileptic drugs (AEDs) have raised serious concerns in the proper management of epilepsy. To overcome this, the present study attempts to identify a candidate molecule targeting voltage gated potassium channels anticipated to have superior pharmacological than existing potassium channel blockers. The compound was synthesized by reacting (S)-(+)-2,3-dihydro-1H-pyrrolo[2,1-c][1,4] benzodiazepine5,11(10H,11aH)-dione with 4-(Trifluoromethyl) benzoic acid (C₈H₅F₃O₂) in DMF and N,N'-dicyclohexylcarbodiimide (DCC) which lead to the formation of an intermediate salt of N-cyclohexyl-N-(cyclohexylcarbamoyl)-4-(trifluoromethyl)benzamide with a perfect crystalline structure. The structure of the compound was characterized by FTIR, ¹H NMR and ¹³C NMR analysis. The crystal structure is confirmed by single crystal X-ray diffraction analysis. The Structure-Activity Relationship (SAR) studies revealed that substituent of fluoro or trifluoromethyl moiety into the compound had a great effect on the biological activity in comparison to clinically used drugs. Employing computational approaches the compound was further tested for its affinity against potassium protein structure by molecular docking in addition, bioactivity and ADMET properties were predicted through computer aided programs.

Effect of cleft lip palate repair on craniofacial growth

OBJECTIVE

The aim of this cross-sectional study was to compare craniofacial growth among operated and unoperated unilateral cleft lip and palate non-syndromic subjects.

MATERIALS AND METHODS

A sample of 180 subjects of Indian origin was selected. Of them, 90 were operated, and 90 were unoperated complete unilateral cleft lip and palate individuals. The subjects were divided into three age groups of 3-5, 8-10, and 20-25 years comprised of 30 patients in each group. The following measurements were evaluated: Angle and length of the cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship. Comparative analysis of the means between the groups was performed with Student's t-test at the significance levels of 5%. The ANOVA test has been performed to test the effect of time.

RESULTS

No significant differences were observed between the measurements that represented the angle and length of the cranial base of unoperated and the operated patients (P>0.05). There was statistically significant decrease (P˂0.05) in the maxillary length (Co-A; 69.00 mm in 3-5 years, 68.33 mm in 8-10 years, and 67.17 mm in 20-25 years age group), and SNA angle (74.83° in 3-5 years, 74.17 ° in 8-10 years and 73.17 ° in 20-25 years age group) in operated group. No significant difference noticed on cephalometric values of the mandible, except Ar-Go-Me angle (P˂0.05), which showed vertical growth pattern in unoperated patients (132.50 ° in 3-5 years, 132.00 ° I 8-10 years and 138.33 ° in 20-25 years age group).

CONCLUSION

Lip and palate repair has a significant influence on the maxilla and resulting in retarded growth of maxilla, which causes midface deficiency beyond acceptable sagittal limits. The Gonial angle showed vertical growth pattern in unoperated patients, but the cranial base angle and length of unoperated and the operated patients were similar.