StresSense: Real-Time detection of stress-displaying behaviors

BACKGROUND

Wrist-worn gadgets like smartphones are ideal for unobtrusively gathering user data, in various fields such as health and fitness monitoring, communication, and productivity enhancement. They seamlessly integrate into users' daily lives, providing valuable insights and features without the need for constant attention or disruption. In sensitive domains like mental health, these devices provide user-friendly, privacy-protected means of diagnosis and treatment, offering a secure and cost-effective avenue for seeking help.

OBJECTIVES

This study addresses the limitations of traditional mental health assessment techniques, such as intrusive sensing and subjective self-reporting, by harnessing the unobtrusive data collection capabilities of smartphones. Equipped with accelerometers and other sensors, these devices offer a novel approach to mental health research. Our objective was to develop methods for real-time detection of stress and boredom behavior markers using smart devices and machine learning algorithms.

METHODOLOGY

By leveraging data from accelerometers (A), gyroscopes (G), and magnetometers (M), we compiled a dataset indicative of stress-related behaviors and trained various machine-learning models for predictive accuracy. The methodology involved collecting data from motion sensors (A, G, and M) on the dominant arm's wrist-worn smartphone, followed by data preprocessing, transformation from time series format, and training a Deep Neural Network (DNN) model for activity recognition.

FINDINGS

Remarkably, the DNN achieved an accuracy of 93.50% on test data, outperforming traditional and ensemble machine learning methods across different window sizes, and demonstrated real-time accuracy of 77.78%, validating its practical application.

CONCLUSION

In conclusion, this research presents a novel dataset for detecting stress and boredom behaviors using smartphones, reducing reliance on costly devices and offering a more objective assessment. It also proposes a DNN-based method for wrist-worn devices to accurately identify complex activities associated with stress and boredom, with benefits in terms of privacy and user convenience. This advancement represents a significant contribution to the field of mental health research, providing a less intrusive and more user-friendly approach to monitoring mental well-being.

Solitary Skull Langerhans Cell Histiocytosis Presenting With a Pus Draining Fistula: An Unusual Presentation and Review of Literature

Langerhans cell histiocytosis (LCH) is a rare condition in adults, especially when it is limited to a single area of the skull, known as solitary calvarial involvement. In this case report, we present a unique instance of LCH affecting the parietal bone with a pus-draining fistula. This is a rare and unusual presentation at this location, which has been scarcely reported in medical literature. A 30-year-old woman with no prior comorbidity presented with complaints of headache that persisted for a year. She also had swelling on her scalp and a yellowish discharge for 3 weeks, but no neurological problems were observed. Radiology revealed thinning of the calvaria, with ragged margins along the inner table, multiple focal erosions, and involvement of overlying soft tissue and bony sequestrum. The patient underwent biparietal craniotomy and excision of the lesion. The histopathology report showed LCH. After 8 months of follow-up, there was no recurrence. The management of solitary calvarial involvement by LCH with masquerading presentation as a scalp infection can be achieved through complete excision of the lesions, resulting in a favorable outcome.

Glial, Neuronal, Vascular, Retinal Pigment Epithelium, and Inflammatory Cell Damage in a New Western Diet-Induced Primate Model of Diabetic Retinopathy

This study investigated retinal changes in a Western diet (WD)-induced nonhuman primate model of type 2 diabetes. Rhesus nonhuman primates, aged 15 to 17 years, were fed a high-fat diet (n = 7) for >5 years reflective of the traditional WD. Age-matched controls (n = 6) were fed a standard laboratory primate diet. Retinal fundus photography, optical coherence tomography, autofluorescence imaging, and fluorescein angiography were performed before euthanasia. To assess diabetic retinopathy (DR), eyes were examined using trypsin digests, lipofuscin autofluorescence, and multimarker immunofluorescence on cross-sections and whole mounts. Retinal imaging showed venous engorgement and tortuosity, aneurysms, macular exudates, dot and blot hemorrhages, and a marked increase in fundus autofluorescence. Post-mortem changes included the following: decreased CD31 blood vessel density (P < 0.05); increased acellular capillaries (P < 0.05); increased density of ionized calcium-binding adaptor molecule expressing amoeboid microglia/macrophage; loss of regular distribution in stratum and spacing typical of ramified microglia; and increased immunoreactivity of aquaporin 4 and glial fibrillary acidic protein (P < 0.05). However, rhodopsin immunoreactivity (P < 0.05) in rods and neuronal nuclei antibody-positive neuronal density of 50% (P < 0.05) were decreased. This is the first report of a primate model of DR solely induced by a WD that replicates key features of human DR.

Anaplerotic nutrient stress drives synergy of angiogenesis inhibitors with therapeutics targeting tumor metabolism

Tumor angiogenesis is a cancer hallmark, and its therapeutic inhibition has provided meaningful, albeit limited, clinical benefit. While anti-angiogenesis inhibitors deprive the tumor of oxygen and essential nutrients, cancer cells activate metabolic adaptations to diminish therapeutic response. Despite these adaptations, angiogenesis inhibition incurs extensive metabolic stress, prompting us to consider such metabolic stress as an induced vulnerability to therapies targeting cancer metabolism. Metabolomic profiling of angiogenesis-inhibited intracranial xenografts showed universal decrease in tricarboxylic acid cycle intermediates, corroborating a state of anaplerotic nutrient deficit or stress. Accordingly, we show strong synergy between angiogenesis inhibitors (Avastin, Tivozanib) and inhibitors of glycolysis or oxidative phosphorylation through exacerbation of anaplerotic nutrient stress in intracranial orthotopic xenografted gliomas. Our findings were recapitulated in GBM xenografts that do not have genetically predisposed metabolic vulnerabilities at baseline. Thus, our findings cement the central importance of the tricarboxylic acid cycle as the nexus of metabolic vulnerabilities and suggest clinical path hypothesis combining angiogenesis inhibitors with pharmacological cancer interventions targeting tumor metabolism for GBM tumors.

Learning from perpetrator replacement to remove crime opportunities and prevent poaching of the Sundarbans tiger

Illegal wildlife trade (IWT) is one of the leading causes of the decline in high-value species. Crime-reduction strategies to counter IWT can have unintended effects, with crime displacement occurring when offenders react to such interventions. Despite the value of understanding how and why displacement occurs for informing conservation strategies, few examples are published. We explored a case of perpetrator replacement following an intervention and drew lessons for conservation strategies for high-value species. Poaching and subsequent trade threaten the Sundarbans tiger (Panthera tigris). Pirate gangs were the dominant poachers from 1980 to 2017, but following an extensive campaign, the Sundarbans was declared pirate free in 2018. We interviewed 280 individuals, including 100 tiger poachers, from 26 administrative unions bordering the Sundarbans and used interviewee responses to compare the poaching situation during and after the pirate era. We analyzed the spatial distribution of tiger poachers among the unions and used crime script analysis of the dominant poacher type to identify intervention. Because pirates opportunistically poached tigers, the government's successful counter-pirate campaign inadvertently removed the dominant tiger poaching type. However, a temporary reduction in poaching was rapidly cancelled out by the emergence of at least 32 specialist tiger-poaching teams. With the risk of extortion and robbery from pirates gone, other groups increased the frequency of opportunistic and targeted tiger poaching. Based on expert interviews, we estimated that 341 tiger poachers of all types are active throughout the unions, with 79% of specialists concentrated in 27% of unions. The highly focused counter-pirate campaign reduced motivations and opportunities for piracy but left intact the opportunity structure and trade connections for tiger poaching, and with insufficient enforcement officers trading has flourished. Interventions targeting opportunities for poaching by specialist tiger poachers include heightened surveillance and reporting mechanisms and alternative livelihood provision to disincentivize poaching.

Targeted delivery of RNAi to cancer cells using RNA-ligand displaying exosome

Exosome is an excellent vesicle for in vivo delivery of therapeutics, including RNAi and chemical drugs. The extremely high efficiency in cancer regression can partly be attributed to its fusion mechanism in delivering therapeutics to cytosol without endosome trapping. However, being composed of a lipid-bilayer membrane without specific recognition capacity for aimed-cells, the entry into nonspecific cells can lead to potential side-effects and toxicity. Applying engineering approaches for targeting-capacity to deliver therapeutics to specific cells is desirable. Techniques with chemical modification in vitro and genetic engineering in cells have been reported to decorate exosomes with targeting ligands. RNA nanoparticles have been used to harbor tumor-specific ligands displayed on exosome surface. The negative charge reduces nonspecific binding to vital cells with negatively charged lipid-membrane due to the electrostatic repulsion, thus lowering the side-effect and toxicity. In this review, we focus on the uniqueness of RNA nanoparticles for exosome surface display of chemical ligands, small peptides or RNA aptamers, for specific cancer targeting to deliver anticancer therapeutics, highlighting recent advances in targeted delivery of siRNA and miRNA that overcomes the previous RNAi delivery roadblocks. Proper understanding of exosome engineering with RNA nanotechnology promises efficient therapies for a wide range of cancer subtypes.

Malignant Phyllodes Tumour with Osteoclast-type Giant Cells in Young Females: A Rare Histology and Differential Diagnoses

Phyllodes tumour (PT) is a biphasic fibroepithelial tumour of the breast that accounts for 0.3-1% of all primary breast neoplasms. It is subdivided into benign, borderline, and malignant categories based on histologic features including stromal overgrowth, stromal hypercellularity, mitotic count, degree of atypia, and type of margins. Malignant PT (MPT) is characterised by infiltrative margins, marked stromal overgrowth, increased stromal hypercellularity, greater than 10 mitoses/10 high-power fields (HPFs), and moderate to severe atypia. It shows aggressive behaviour with a high risk of local recurrence and metastasis. Surgery with adequate margins is the recommended treatment. Heterologous differentiation is not an uncommon phenomenon in MPT. In addition to classic phyllodes histology, the tumour shows areas of benign/malignant mesenchymal differentiation. MPT containing multinucleated osteoclast-type giant cells (OGCs) is extremely rare. We herein report cases of MPT with OGCs in two young females who had a history of swelling in unilateral breast for two-three years. Histologic examination revealed classic phyllodes areas admixed with a sarcomatous stromal component with OGCs. Key Words: Malignant phyllodes tumour, Breast, Osteoclast-type giant cells.

Trends of Erythrocyte Alloimmunization in Transfused Women

Objective: To identify the trends of red cell alloimmunization in multi-transfused females using red blood cell panels.Study design: Cross-sectional study. Place and Duration of Study: Army Medical College and Armed Forces Institute of Transfusion with the collaboration of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Aug 2018. Methodology: Blood samples of 75 females with prior history of blood transfusion were collected from Pak Emirates Military Hospital, Rawalpindi Pakistan, selected by a non-probability consecutive sampling technique. After pilot diagnostic tests for ABO and Rh D blood grouping, samples were screened by three cell panels to identify the presence of RBCs alloimmunization. Positive results were further recognized by 11 cell panels. Results: Seventy-five women with a history of at least one blood transfusion were selected for the screening of red cell alloimmunization. The frequency of alloantibodies in transfused women was 1(1.3%). The only alloantibody identified was anti-e, which was a rare alloantibody. Conclusion: Study confirmed that Rh alloantibodies are the most prevalent antibodies, regardless of age, ABO blood grouping, Rh grouping and ethnicity. Our study also confirmed that multiple transfusions are associated with the development of red cell alloimmunization.

First demonstration of a fiber optic bolometer on a tokamak plasma (invited)

A fiber optic bolometer (FOB) was demonstrated observing a fusion plasma for the first time at the DIII-D tokamak. A FOB uses a fiber optics-based interferometric technique that is designed to have a high sensitivity to temperature changes [75 mK/(W/m²) responsivity in high vacuum with 0.38 mK noise level] with a negligible susceptibility to electromagnetic interference (EMI) that can be problematic for resistive bolometers in a tokamak environment. A single-channel test apparatus was installed on DIII-D consisting of a measurement FOB and shielded reference FOB. The single-channel FOB showed a negligible increase in the noise level during typical plasma operations (0.39 mK) compared to the benchtop results (0.38 mK), confirming an insignificant EMI impact to the FOB. Comparisons to DIII-D resistive bolometers showed good agreement with the single-channel FOB, indicating that the FOB is comparable to a resistive bolometer when the impulse calibration is applied. The noise-equivalent power density of the calibrated FOB during a plasma operation was 0.55 W/m² with an average sampling time of 20 ms. The major potential effect of ionizing radiation on the FOB would be the radiation-induced attenuation, which can be efficiently compensated for by adjusting the probing light power.

Alteration of Coagulation Profile in Malaria Patients and its Correlation with The Degree of Parasitemia

Objective: To determine the alteration of coagulation profile (PT, APTT, D-dimers) in malaria patients and its correlation with the degree of Parasitemia.Study Design: Cross-sectional study. Place and Duration of Study: Pathology department of Combined Military Hospital Lahore, from Jan to July 2018. Methodology: A total of 92 patients were included in the study. The malarial parasite was identified using thick and thin smears. Hemoglobin, Red blood cell, White blood Count, Prothrombin Time, Activated Partial Thromboplastin Time, and Ddimer levels were measured using automated analyzers Sysmex KX-21 and CA-600. Results: The mean age of the patients was 23.35 ± 14.4 years with 53 (57.6%) males and 39 (42.4%) females. Plasmodium falciparum was identified as the causative species in 33 (35.9%) of the cases, 59 (64.1%) cases were caused by Plasmodium vivax. Based on parasitic load, 50 (54.3%) patients were found to have a mild degree of parasitemia whereas 26 (28.3%) had moderate and 16 (17.4%) had severe parasitemia. A significant association was found between the degree of parasitemia and coagulation parameters. Conclusion: Partial thromboplastin time, activated partial thromboplastin time and D-dimer levels were positively correlated with the degree of parasitemia specifically in plasmodium falciparum as compared to the other species. Therefore, special care should be exercised in patients having an underlying inherited bleeding disorder and a strict prevention protocol should be made.

Awareness of Medical Professionals about Common Disinfectants in a Tertiary Care Hospital Against Corona Virus

Objective: To assess the working knowledge of health care workers (HCW) regarding the appropriate use of disinfectants against Coronavirus in hospital care settings using a questionnaire. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Lahore, Pakistan, from Apr 2020. Methodology: Two hundred health care workers were consecutively selected and divided into two groups, irrespective of gender. Each participant had to fill a structured proforma containing twenty-five close-ended questions. Result: Group-1 participants were 126 (63%) and group 2 participants were 74 (37%). 117 (92.8%) group-1 participants were 20–30 years of age and degree holders while 40 (54%) group-2 participants were 31-40 years old and diploma holders. Significant awareness (p<0.001) regarding disinfectants was observed in group-1 (102 81%); all the degree holders were well aware of disinfectants and required less training. In contrast, in group-2, 44 (59%) were fully aware of disinfectants; the rest did not qualify and needed proper training. Participants with a good educational status and work experience of >10 years were the high achievers in both groups. Conclusion: This study revealed that majority of the participants knew about the correct usage of disinfectants and they were fully prepared to handle the ongoing pandemic. Another finding was that awareness was directly related to relevant education, prolonged work experience and age

Paratesticular Solitary Fibrous Tumour Mimicking Cellular Angiofibroma: An Unusual Morphology and Rare Site

Solitary fibrous tumour (SFT) is a ubiquitous benign mesenchymal tumour of fibroblastic origin, which occurs most often in middle-aged adults. It usually presents as lung mass originating from pleura, but extrapleural occurrence is also common. Tumour is characterised by hypo- and hyper-cellular areas of spindle-shaped cells, arranged in haphazard manner with dispersed staghorn-shaped vessels. Surgical excision is the curative treatment. SFTs of the primary testicular or paratesticular region are extremely rare, but they exhibit histologic findings similar to SFTs originating at other body sites. Here, we report the case of a paratesticular SFT in a 37-year male, who presented with a non-tender, firm, mobile, left-sided retrotesticular swelling with unique histological features closely mimicking cellular angiofibroma, a common tumour of paratesticular location. Key Words: Solitary fibrous tumour, Paratesticular, benign, angiofibroma.

DIAGNOSTIC SIGNIFICANCE OF MEASURING RETICULOCYTE MATURITY INDICES IN IRON DEFICIENCY ANAEMIA

Objective: To evaluate the diagnostic significance of reticulocyte maturity indices in iron deficiency anaemia. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, from Sep 2019 to Jun 2020. Methodology: A total of 340 children, ages between 1 and 5 years of either gender, were divided into two groups based on haemoglobin and ferritin level. Group A comprised of 203 children with haemoglobin >11 g/dL andferritin level >7 ng/ mL. Group B comprised of 137 children with haemoglobin <11g/dL and ferritin <7 ng/mL. Red blood cell and reticulocyte parameters were compared. Results: Iron deficiency anaemia was found to be 37.6% in the study population. Comparison revealed that the children in groups B had significantly higher mean red cell distribution width (17.1 ± 1.3% vs. 13.3 ± 1.3%) and significantly lower hemoglobin (9.5 ± 1.0 g/dL vs. 12.7 ± 1.0 g/dL), mean corpuscular hemoglobin (21.8 ± 2.5 pg vs. 28.6 ± 2.3 pg), mean corpuscular volume (69.4 ± 3.5 fL vs. 80.4 ± 3.3 fL), mean corpuscular hemoglobin concentration (31.5 ± 1.8 g/dL vs. 32.7 ± 1.6 g/dL) and serum ferritin level (4.5 ± 2.6 mg/mL vs. 55.9 ± 32.1 ng/mL). No significant differences in the mean total red blood cell count, hematocrit and reticulocytes between two groups were noted (p>0.05) and significant differences were noted in terms of low, medium & high fluorescence ratios in both groups (p<0.05). Conclusion: Our findings suggest that medium fluorescence ratio and high fluorescence ratio.......

Post COVID-19: a solution scan of options for preventing future zoonotic epidemics

The crisis generated by the emergence and pandemic spread of COVID-19 has thrown into the global spotlight the dangers associated with novel diseases, as well as the key role of animals, especially wild animals, as potential sources of pathogens to humans. There is a widespread demand for a new relationship with wild and domestic animals, including suggested bans on hunting, wildlife trade, wet markets or consumption of wild animals. However, such policies risk ignoring essential elements of the problem as well as alienating and increasing hardship for local communities across the world, and might be unachievable at scale. There is thus a need for a more complex package of policy and practical responses. We undertook a solution scan to identify and collate 161 possible options for reducing the risks of further epidemic disease transmission from animals to humans, including potential further SARS-CoV-2 transmission (original or variants). We include all categories of animals in our responses (i.e. wildlife, captive, unmanaged/feral and domestic livestock and pets) and focus on pathogens (especially viruses) that, once transmitted from animals to humans, could acquire epidemic potential through high rates of human-to-human transmission. This excludes measures to prevent well-known zoonotic diseases, such as rabies, that cannot readily transmit between humans. We focused solutions on societal measures, excluding the development of vaccines and other preventive therapeutic medicine and veterinary medicine options that are discussed elsewhere. We derived our solutions through reading the scientific literature, NGO position papers, and industry guidelines, collating our own experiences, and consulting experts in different fields. Herein, we review the major zoonotic transmission pathways and present an extensive list of options. The potential solutions are organised according to the key stages of the trade chain and encompass solutions that can be applied at the local, regional and international scales. This is a set of options targeted at practitioners and policy makers to encourage careful examination of possible courses of action, validating their impact and documenting outcomes.

PERFORMANCE EVALUATION OF NUCLEATED RED BLOOD CELL (NRBC) COUNT USING A FULLY AUTOMATED HAEMATOLOGY ANALYZER VERSUS MANUAL COUNTING

Objective: To evaluate the performance of Nucleated RBC (NRBC) Count using a fully automated haematology analyzer versus manual counting. Study Design: Cross-Sectional Study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, from Sep 2019-Jun 2020. Methodology: Routine fresh whole blood samples were run on Sysmex XN-3000 automated haematology analyzer and 384 samples with results of ≥0.1% Nucleated red blood cells were included in this study. Manual NRBC counting was carried out twice on Leishman-stained peripheral blood smears from all 384 samples. Comparison between manual and automated nucleated red blood cell counting methods was statistically analyzed through linear regression analysis & coefficient correlation. The degree of agreement between two methods was analyzed through Bland-Altman plot. Finally, concordance between the two methods was also analyzed at 5 different ranges of nucleated red blood cells. Results: Linear regression analysis revealed a (r2) value of 0.97. Regression equation was calculated as XN = 0.76MC ± 1.28, with 95% limits of agreement between ± 40.42% and -24.47%. A mean bias of 7.97% was demonstrated through Bland-Altman plot. Concordance analysis revealed a concordance rate of 93.74% (360/384). Nucleated red blood cell counting between two methods were more concordant when nucleated red blood cell counts were <200%. Conclusion: Nucleated red blood cells counting by XN-3000 automated hematology analyzer is statistically comparable to manual nucleated red blood cell counting. We suggest that automated counting can be adopted in routine hematology laboratory as a replacement of manual NRBC counting.

SPECTRUM OF HISTOPATHOLOGICAL PATTERNS OF DUODENAL BIOPSIES IN PATIENTS WITH UNEXPLAINED ANAEMIA AND CHRONIC DIARRHEA AND THEIR CORRELATION WITH ENDOSCOPIC FINDINGS AND SEROLOGICAL MARKERS

Objective: To evaluate different histopathological patterns and correlate them with indications, findings of Esophagogastroduodenoscopy Esophago-gastro-duodenal (EGD) and serological markers in patients presenting of unexplained anemia and chronic diarrhea. Study Design: Cross sectional study. Place and Duration of Study: Departments of Pathology and Gastroenterology, Combined Military Hospital Lahore Pakistan, from Jul to Dec 2020. Methodology: Histopathological patterns of endoscopic duodenal biopsies, submitted for evaluation of unexplained anemia and chronic diarrhea were studied. Hemoglobin and anti-tTG levels were recorded. Adults with history of unexplained diarrhea and anaemia were included. Biopsies with malignant diagnosis or unfit for evaluation were excluded. Histopathological patterns were correlated with indications and findings of Esophagogastroduodenoscopy and serological markers of celiac disease. Results: The most common indication for Esophagogastroduodenoscopy in 145 patients was chronic diarrhea. Upper gastrointestinal endoscopy in 2/3rd of patients revealed no pathology. Histopathological patterns of duodenal biopsies revealed only 15% cases suggestive of celiac disease. Only 12 patients were suggestive of celiac disease both on Esophagogastroduodenoscopy and histopathology combined. Half of patients with anti tTG level >100 u/ml, showed histopathological features of celiac disease on. There was no correlation between histopathological patterns, indications of Esophagogastroduodenoscopy, morphology of Esophagogastroduodenoscopy and serological markers of celiac disease. Conclusion: Indications for Esophagogastroduodenoscopy, Esophagogastroduodenoscopic findings and histopathological patterns cannot diagnose celiac disease alone.

DETERMINATION OF DIAGNOSTIC ACCURACY OF BIOCHEMICAL PARAMETERS (CRP, LDH & FERRITIN) IN THE DIAGNOSIS OF COVID-19 IN SUSPECTED COVID CASES

Objective: To determine the diagnostic accuracy of the Lactate Dehydrogenase, C-Reactive Protein and Ferritin in suspected patients of COVID-19. Study Design: Cross-sectional validation study. Place and Duration of Study: Pathology department of Combined Military Hospital Lahore in the month of May 2020. Methodology: We included 101 adult (>18 years) symptomatic suspected COVID-19 patients of both genders. Children, pregnant women and asymptomatic patients were excluded from study. Age, gender and results of Reverse Transcriptase Polymerase Chain Reaction, Lactate Dehydrogenase, C-Reactive Protein, ferritin were recorded. Results: Lactate Dehydrodenase had highest sensitivity (75%) with positive predictive value of 71.6% and diagnostic accuracy of 65.3% among three biochemical parameters studied. Receiver Operator Characteristic curve was studied. Area under curve of Lactate Dehydrogenase (AUC=0.65) and Ferritin (AUC=0.59) reflected their ability to prognosticate the presence of COVID19 disease. However, C-Reactive Protein (AUC=0.42) appeared to be a poor predictor of the disease. Conclusion: Raised serum Lactate Dehydrogenase (>490 U/L) and Ferritin (>152 ng/L) levels can be used to predict the Reverse Transcriptase Polymerase Chain Reaction positivity for COVID-19 in the population of suspected patients of COVID19. However, C-Reactive Protein is a poor predictor of COVID-19.

ASSOCIATION OF TYPE 2 DIABETES MELLITUS WITH ABO AND RH BLOOD GROUP

Objective: To find out the association of type 2 diabetes mellitus with ABO and Rh blood groups. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Combined Military Hospital Lahore, from Jul to Dec 2020. Methodology: A total 179 patients with type 2 diabetes mellitus and 50 healthy individuals were inducted into the study. Five (5ml) blood from the patients was taken via clean aseptic venipuncture in a tube containing EDTA. HbA1C was generated through automated analyzer Cobas c501 and blood grouping was carried out using tube method by an experienced technician. Results: A total of 179 (77.8%) individuals with diabetes mellitus type 2 and 50 (21.7%) healthy cases were inducted into the study as a control group. A statistically significant difference was observed with blood group B being the most prevalent among them (p=0.001). There was a greater frequency of Rh-negative blood group in patients having diabetes mellitus type 2 as compared to the control group. Conclusion: There is a strong association found between ABO and Rh blood group with diabetes mellitus type 2. Blood group B negative was the most common among the patients having diabetes mellitus type 2. Blood group O positive showed the least association.

Enhanced Gene Delivery and CRISPR/Cas9 Homology-Directed Repair in Serum by Minimally Succinylated Polyethylenimine

Gene therapy aims to treat patients by altering or controlling gene expression. The field of gene therapy has had increasing success in recent years primarily using viral-based approaches; however, there is still significant interest toward the use of polymeric materials due to their potential as flexible, low-cost scaffolds for gene delivery that do not suffer the mutagenesis and immunogenicity concerns of viral vectors. To address the challenges of efficiency and biocompatibility, a series of zwitterion-like polyethylenimine derivatives (zPEIs) were produced via the succinylation of 2-11.5% of polyethylenimine (PEI) amines. With increasing modification, zPEI polyplexes exhibited decreased serum-protein aggregation and dissociated more easily in the presence of a competitor polyanion when compared to unmodified PEI. Surprisingly, the gene delivery mediated in the presence of serum showed that succinylation of as few as 2% of PEI amines resulted in transgene expression 260- to 480-fold higher than that of unmodified PEI and 50- to 65-fold higher than that of commercial PEI-PEG_2k in HEK293 and HeLa cells, respectively. Remarkably, the same zPEIs also produced 16-fold greater efficiency of CRISPR/Cas9 gene knock-in compared to unmodified PEI in the presence of serum. In addition, we show that 2% succinylation does not significantly decrease polymer/DNA binding ability or serum protein interaction to a significant extent, yet this small modification is still sufficient to provide a remarkable increase in transgene expression and gene knock-in in the presence of serum.

Our experience of treating adult bone lymphoma, A retrospective cross-sectional study in a tertiary care center, Aga Khan University Hospital, Karachi

OBJECTIVE

To determine the experience at the Aga Khan University Hospital in diagnosing and treating adult patients with primary lymphoma of bone.

METHODOLOGY

All patients with Primary lymphoma of bone (PLB) that were diagnosed and/or treated at Aga Khan University Hospital, Karachi from 2005 to 2019 were included as part of this study.

RESULTS

There were 17 patients with PLB including 13 (76.5%) males and 4 (23.5%) females with a mean age of 44 ± 16.5 years. Nine patients were between 30-59 years of age at diagnosis. The mean follow-up time of patients was 80±46.7 months. Six patients had tumours of pelvic bone followed by tibia (5) and femur (4). Four patients had a pathological fracture at the time of presentation whereas 2 (11.8%) required surgical fixation of the pathological fracture. The stage of the tumour was based on Ann Arbor classification. Nine (52.9%) cases had Stage 1 disease, 7 (41.2%) had stage IV disease with metastasis in extra nodal tissues. As for treatment, every patient received chemotherapy whereas 5 (29.4%) received adjuvant radiotherapy. Complete remission in the size of the tumour was seen in 11 (64.7%) patients while 6 (35.3%) had partial remission. Post-treatment, 4 (23.5%) patients expired. The mean Overall Survival (OS) time was 80.18 ± 46.71months with a survival rate of 76.5.

CONCLUSIONS

Primary lymphoma of the bone can be treated with medical regime and good prophylactic surgeries to avoid pathological fracture such as intramedullary nailing.

Post COVID-19: a solution scan of options for preventing future zoonotic epidemics

The crisis generated by the emergence and pandemic spread of COVID-19 has thrown into the global spotlight the dangers associated with novel diseases, as well as the key role of animals, especially wild animals, as potential sources of pathogens to humans. There is a widespread demand for a new relationship with wild and domestic animals, including suggested bans on hunting, wildlife trade, wet markets or consumption of wild animals. However, such policies risk ignoring essential elements of the problem as well as alienating and increasing hardship for local communities across the world, and might be unachievable at scale. There is thus a need for a more complex package of policy and practical responses. We undertook a solution scan to identify and collate 161 possible options for reducing the risks of further epidemic disease transmission from animals to humans, including potential further SARS-CoV-2 transmission (original or variants). We include all categories of animals in our responses (i.e. wildlife, captive, unmanaged/feral and domestic livestock and pets) and focus on pathogens (especially viruses) that, once transmitted from animals to humans, could acquire epidemic potential through high rates of human-to-human transmission. This excludes measures to prevent well-known zoonotic diseases, such as rabies, that cannot readily transmit between humans. We focused solutions on societal measures, excluding the development of vaccines and other preventive therapeutic medicine and veterinary medicine options that are discussed elsewhere. We derived our solutions through reading the scientific literature, NGO position papers, and industry guidelines, collating our own experiences, and consulting experts in different fields. Herein, we review the major zoonotic transmission pathways and present an extensive list of options. The potential solutions are organised according to the key stages of the trade chain and encompass solutions that can be applied at the local, regional and international scales. This is a set of options targeted at practitioners and policy makers to encourage careful examination of possible courses of action, validating their impact and documenting outcomes.

DIAGNOSTIC EFFICACY OF RED BLOOD CELL INDICES IN DIAGNOSIS OF BETA THALASSEMIA TRAIT TAKING HAEMOGLOBIN ELECTROPHORESIS AS GOLD STANDARD

Objective: To determine the diagnostic efficacy of haematological indices for the diagnosis of beta thalassemia trait taking haemoglobin electrophoresis as a gold standard. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology Combined Military Hospital Lahore, from Aug to Dec 2019. Methodology: Two hundred and six anaemic patients 20-70 years of age of both genders were included in the study. Blood was collected from all the patients and complete blood count were generated through automated haematology analyser Sysmex KX-21. Based on the complete blood count parameters like mean cell volume, red blood cell count, red cell distribution width and mean cell haemoglobinthe haematological indices such as Mentzer, Ricerca, mean density of Hb/litre of blood, mean cell Hb density and red cell distributon width indices were calculated. The haemoglobin A2 band of >3.5% on haemoglobin electrophoresis was taken as cut off for Beta thalassemia trait. Results: Out of the 206 blood samples analysed, 120 (58%) were labelled as Beta thalassemia trait after Hb electrophoresis and 86 cases had anemia due to other causes. Mentzer index established the highest sensitivity of 92.5% whereas RICERCA index established the highest specificity of 94.1%. Mentzer and red cell distribution width indexhad highest diagnostic efficacy value up to 90.3%. Conclusion: We conclude that Mentzer and red cell distribution width index showed the highest diagnostic significance. The Mentzer index has the highest sensitivity whereas Ricerca index has the highest specificity. The red blood cell count, haemoglobin and mean cell volume.............

EVALUATION OF GERMICIDAL UV-C LIGHT FOR SURFACE DISINFECTION IN A TERTIARY CARE HOSPITAL

Objective: To check the efficacy of 36-Watt Ultraviolet-C tube light, in terms of distance and time against medically important microorganisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Candida albicans and Aspergillus species). Study Design: Quasi-experimental study. Place and Duration of Study: Pathology department, Combined Military Hospital, Lahore Pakistan, from Jun to Sep 2020. Methodology: ATCC control organisms of above mentioned bacteria, yeasts, and fungi were exposed to ultraviolet-C light for different times and distances to ascertain its germicidal effect. Two methods were selected, one in which micro-organisms inoculated plates were exposed to ultraviolet-C light and second in which McFarland suspensions of microorganisms were exposed before inoculation. Both the methods were compared. Observations were noted down after repeated performance of both the procedures. Results: An exposure time of 15 minutes, mean ± SD (13.8 ± 10.1) at 1-foot distance was proved ideal for all the tested bacteria, but yeasts and fungi required >30 minutes, mean ± SD (17.5 ± 13.5) to be killed. Moreover, distance and time of exposure were found out to be directly proportional irrespective of microbial load. Greater the distance longer the ultraviolet C exposure was required. Conclusion: Ultrviolet-C light 36-Watt can have efficient inactivation of bacterial, fungal and archaeal species up to 6 feet for >30 minutes exposure time. Ultraviolet-C light disinfection is best for areas like closed rooms, operation theatres, PCR Labs, and bio-safety cabinets keeping bio-safety guidelines in view.

Spermatocytic Tumor of Testis in a Young Male

Spermatocytic tumor is a rare germ cell tumor not related to germ cell neoplasia in situ, and derived from postpubertal-type germ cells. It was previously called "Spermatocytic Seminoma" due to false belief of its origin from germ cell neoplasia in situ. The tumor usually occurs in an older age group and orchidectomy is curative. We present a case of spermatocytic tumor in a 25-year male who presented with right-sided testicular swelling and right-sided varicocele. Radiology revealed a 9.8 × 9 cm testicular mass and the patient underwent right-sided orchidectomy. Microscopic examination showed classic morphology with three characteristic cell types and diagnosis of spermatocytic tumor was made. Key Words: Spermatocytic tumor, testis, young.

RELATIONSHIP BETWEEN RED BLOOD CELL AND PLATELET INDICES IN IRON DEFICIENCY ANEMIA

Objective: To find out the correlation between the red blood cell and platelet indices in patients presenting with iron deficiency anemia at a tertiary care hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Hematology, Combined Military Hospital Lahore, from Sep 2018 to Mar 2019. Methodology: The patients of age 1-70 years of either gender presenting with IDA were included in the study. The blood sample of patients were sent to laboratory to assess the red blood cell and platelet indices. SPSS-23 was used to analyze data. Results: Two hundred and seven patients fulfilling the inclusion criteria were included in this study. The mean age was 25.6 ±17.8years. Correlation was weak and insignificant between haemoglobin and packed cell volume (r=-0.385**, p<0.01), haemoglobin and mean cell volume (r=-0.225**, p<0.01), packed cell volume and mean cell haemoglobin (r =0.263**, p<0.01), & mean cell haemoglobin and mean platelet volume (r=0.143*, p<0.05). Correlation was moderate and significant between platelet distribution width and mean platelet volume (r=0.511**) & platelet distribution width and platelet large cell ratio (0.502**, p<0.01). Correlation was strong between mean platelet volume and platelet large cell ratio (r=0.759**, p<0.01). Conclusion: In conclusion, there was significant relation between red blood cell and platelets indices in iron deficiency anemia. Furthermore, haemoglobin and packed cell volume are weekly correlated, platelet distribution width and mean platelet volume are moderately correlated and mean platelet volume and platelet large cell ratio are strongly correlated.

A 10-year review of histopathological findings of enucleated eyes from a tertiary-care center, Pakistan

OBJECTIVE

To determine the histopathology of enucleated eye specimens.

METHODS

The 10-year inventory was conducted at Aga Khan University Hospital, Karachi, and comprised all histopathology reports of enucleated eye specimens received from January 2007 to December 2016 by the Section of Histopathology, Department of Pathology. SPSS 19 was used for data analysis.

RESULTS

A total of 232 ocular tissue specimens from 231 patients were evaluated. Ocular tumours were the most common histopathological diagnosis 186(80%). Among tumours, retinoblastoma was the most common 137(59%) followed by malignant melanoma 31(13%) and squamous cell carcinoma 15(6.5%). Overall, 16(6.9%) specimens had degenerative changes secondary to different ocular disorders. Staphyloma and Coat's disease was diagnosed in 3(1.3%) cases each. In 4(1.7%) cases, there was no formal diagnosis.

CONCLUSIONS

Early identification of tumours may allow for conservative management and limit the need for enucleations.

Physiological Responses to Linear and Nonlinear Soccer-specific Match Simulations and Their Effects on Lower-Limb Muscle Fatigue

Uddin, N, Jeffries, O, Read, P, Howe, L, Patterson, S, and Waldron, M. Physiological responses to linear and nonlinear soccer-specific match simulations and their effects on lower-limb muscle fatigue. J Strength Cond Res 34(11): 3232-3240, 2020-The aims of this study were to: (a) investigate the effects of linear and nonlinear soccer simulations on lower-limb muscle function and physiological responses and (b) evaluate the relationship between match-running demands and changes in lower-limb muscle function. In a repeated-measures cross-over design, 8 participants completed either a linear or nonlinear adapted Loughborough Intermittent Shuttle Test (LIST) on 2 occasions. The movement of players was tracked with a global positioning system, while lower-limb muscle function tests and physiological measurements were performed before and every 15 minutes during the simulation. There were no differences in distance covered, yet high-speed running (p = 0.007), accelerations (p = 0.008), and decelerations (p = 0.015) were higher in the linear LIST. Mean heart rate (p = 0.001) and ratings of perceived exertion (p = 0.013) were higher in the nonlinear LIST. Peak landing forces (p = 0.017) and jump height (p = 0.001) were reduced between baseline and 90 minutes but were not different between conditions. Changes in peak landing forces from baseline to half-time (r = -0.57, n = 16, p = 0.022) and full-time (r = -0.58, n = 16, p = 0.019) were related to high-speed running. Hamstring force was unaffected by time (p = 0.448) but was reduced in the linear LIST (p = 0.044). Protocols posing different external and internal demands elicited similar levels of fatigue across simulations. Hamstring function was not an effective indicator of fatigue, but our results highlight the greater demands placed on this muscle group when higher-speed running is performed.

Molecular docking between human TMPRSS2 and SARS-CoV-2 spike protein: conformation and intermolecular interactions

Entry of SARS-CoV-2, etiological agent of COVID-19, in the host cell is driven by the interaction of its spike protein with human ACE2 receptor and a serine protease, TMPRSS2. Although complex between SARS-CoV-2 spike protein and ACE2 has been structurally resolved, the molecular details of the SARS-CoV-2 and TMPRSS2 complex are still elusive. TMPRSS2 is responsible for priming of the viral spike protein that entails cleavage of the spike protein at two potential sites, Arg685/Ser686 and Arg815/Ser816. The present study aims to investigate the conformational attributes of the molecular complex between TMPRSS2 and SARS-CoV-2 spike protein, in order to discern the finer details of the priming of viral spike protein. Briefly, full length structural model of TMPRSS2 was developed and docked against the resolved structure of SARS-CoV-2 spike protein with directional restraints of both cleavage sites. The docking simulations showed that TMPRSS2 interacts with the two different loops of SARS-CoV-2 spike protein, each containing different cleavage sites. Key functional residues of TMPRSS2 (His296, Ser441 and Ser460) were found to interact with immediate flanking residues of cleavage sites of SARS-CoV-2 spike protein. Compared to the N-terminal cleavage site (Arg685/Ser686), TMPRSS2 region that interact with C-terminal cleavage site (Arg815/Ser816) of the SARS-CoV-2 spike protein was predicted as relatively more druggable. In summary, the present study provides structural characteristics of molecular complex between human TMPRSS2 and SARS-CoV-2 spike protein and points to the candidate drug targets that could further be exploited to direct structure base drug designing.

Knowledge, attitude, and practice of a local community towards the prevention and control of rabies in Gaibandha, Bangladesh

OBJECTIVES

Knowledge, attitude, and practice (KAP) of rabies in the community are essential for developing post-exposure behavioral treatment and for understanding current prevention and control policy on rabies. This was a cross-sectional study in Gaibandha Sadar, a northern district of Bangladesh, investigating the level of KAP about rabies.

MATERIALS AND METHODS

A total of 368 interviewed respondents, of whom 280 (76.09%) were male, and 88 (23.91%) were female. A structured questionnaire was used for the data collection from respondents on socio-demographic information and KAP regarding rabies. The data analyzed with STATA-IC-11.0 and the association of independent variables with rabies KAP scores were calculated using Pearson's Chi-square.

RESULTS

Most respondents had adequate KAP levels and positive thoughts on rabies prevention. The KAP scores were strongly associated with education and employment status (p < 0.05). Most respondents said that stray dogs are a headache in the area and believed that control of the dog population in Gaibandha is essential.

CONCLUSION

These outcomes also revealed that there is an information gap about rabies that might improve by developing an education program for awareness.

Identification of key pathways and genes responsible for aggressive behavior

Aggression is a complex behavior, underpinned by cross talk between several biomolecules. To date a composite molecular network of the behavioral disorder has not been constructed. The present study aims to develop the same from the system network analyses recruiting genes with empirical evidence demonstrating their role in the incidence and progression of aggression. In short, 327 genes were recruited in the study after extensive literature survey and subsequent shortlisting by sieving out the comorbidities like cancer and other pathological and physiological ailments, other languages and repeated citations. Subsequent String network analysis coalesces 275 genes in a network with 2223 edges. The developed network was then subjected to delineate modules using MCODE which via gene clustering on the basis of gene ontology segregate all genes into 14 modules. Of these, as expected top 5 modules involved entailing of neuronal signaling pathways with redundant repetitions. Finally, 10 genes (known) were picked randomly, accounting average module size, and subjected to the network analysis with 100,000 bootstrap replicates. This results in the detection of certain novel genes that lacks empirical evidence for their association with the aggression. Amongst those, most notable are genes involved in protein turnover regulation like UBC, UBA, mitogenic proteins such as Rho and Myc, transcription factors like Tp53. The findings in turn fill caveats in the molecular resolution of cross talk that underscore the development of aggressive behavior and may then be exploited as screening biomarker and/or therapeutic intervention for aggression.

Biological Applications of Isoniazid Derived Schiff Base Complexes: An Overview

Antibiotic resistance has been growing at an alarming rate and consequently the activity of antibiotics against Gram-negative and Gram-positive bacteria has dropped dramatically day by day. In this sense there is a strong need to synthesis new substances that not only have good field of activity, but having new appliances of action. Inorganic compounds particularly metal complexes have played a significant role in the development of new metal based drugs. Like few compounds, isonicotinic acid hydrazide (Isoniazid INH) is well known as first-line anti-tuberculosis (TB) drug to treat TB infection worldwide for more than 60 years. Unfortunately, people are only dependent on this drug and consequently, the rate of use of this drug has been increasing day by day. As the bacterial strains resistant to isoniazid are getting same for the long-term extensive use and even abuse so there is an urgent need to synthesis new drugs not only for anti-tuberculosis properties but also for having significant activity in various biological areas with mechanisms of action. Isoniazid derivatives and their metal complexes, particularly medicinal inorganic metal complexes have been considered as new drugs for their antimicrobial activities like anti-bacterial, anti-fungal, anti-tuberculosis, DNA binding, antioxidant, cytotoxic, scavenging and antiviral activities. In this review, we have focused on the various synthesized metal complexes of isoniazid and its hydrazones and have compared their biological activities which are more or less strong against microorganisms. It is found that INH has moderate to strong antimicrobial activity.

Structural-Phase Catalytic Redox Reactions in Energy and Environmental Applications

The structure-property engineering of phase-based materials for redox-reactive energy conversion and environmental decontamination nanosystems, which are crucial for achieving feasible and sustainable energy and environment treatment technology, is discussed. An exhaustive overview of redox reaction processes, including electrocatalysis, photocatalysis, and photoelectrocatalysis, is given. Through examples of applications of these redox reactions, how structural phase engineering (SPE) strategies can influence the catalytic activity, selectivity, and stability is constructively reviewed and discussed. As observed, to date, much progress has been made in SPE to improve catalytic redox reactions. However, a number of highly intriguing, unresolved issues remain to be discussed, including solar photon-to-exciton conversion efficiency, exciton dissociation into active reductive/oxidative electrons/holes, dual- and multiphase junctions, selective adsorption/desorption, performance stability, sustainability, etc. To conclude, key challenges and prospects with SPE-assisted redox reaction systems are highlighted, where further development for the advanced engineering of phase-based materials will accelerate the sustainable (active, reliable, and scalable) production of valuable chemicals and energy, as well as facilitate environmental treatment.

Prognostic markers in Chronic Lymphocytic Leukaemia - A flow cytometric analysis

Objective

To find out the frequency of ZAP-70, CD38 and CD49d in patients diagnosed with CLL in our population.

Methods

This is a cross sectional study conducted in Army Medical College in collaboration with Armed Forces Institute of Pathology and Military Hospital Rawalpindi from 1^st January 2018 to 30^th November 2018. Permission from Institutional Ethical Committee was obtained. Blood samples were collected by non-probability consecutive sampling technique and analyzed for blood counts and flow cytometry was done for ZAP-70, CD38 and CD49d. Manufacturer's instructions for the kits were strictly followed.

Results

Fifty-one newly diagnosed patients with CLL were studied for the prognostic markers in CLL. CD 38 was expressed in 25(49%) and CD49d in 21(41.2%). ZAP-70 expression was not detected in our series of patients.

Conclusion

We conclude that CD38 and CD49d expression was detected in almost half of the patients of CLL in our series. CD49d showed statistically positive correlation with CD38, showing that it is a more pragmatic choice for reliable prognostication of CLL along with CD38.

Frequency of Transducer-like Enhancer of Split 1 Immunohistochemical Expression in Synovial Sarcoma: An Institution-based Cross-sectional Study

Background Soft-tissue sarcomas comprise a diverse group of sarcomas with characteristic histologic features. However, histology alone is not adequate for a definitive diagnosis for many tumors. In such cases, immunohistochemistry (IHC) plays a key role in determining the line of differentiation and exact characterization. Transducer-like enhancer of split 1 (TLE1) has been recently described as a novel marker for synovial sarcoma (SS). Its high sensitivity and specificity make it a potential marker that distinguishes SS from histologic mimics such as malignant peripheral nerve sheath tumor (MPNST), Ewing's sarcoma (ES), and fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP). The objective of our study was to assess the frequency of TLE1 immunohistochemical expression on SS cases of various subtypes. Methods This cross-sectional study was conducted at the Department of Histopathology, Aga Khan University, Karachi, Pakistan from February 3, 2018 to February 10, 2019. Tissue samples of 89 SS cases were selected for this study. Tumor sections were stained with hematoxylin and eosin (H&E), cytokeratin AEI/AE3 (CKAE1/AE3), epithelial membrane antigen (EMA), and TLE1 immunohistochemical stain. TLE1 expression was assessed based on the Remmele scoring system. Results Tissue samples of 89 SS cases were processed for the study. Mean (±) standard deviation (SD) of age was 25 (±7.36) years. Male:female ratio was 1.1:1. Of the 89 SS cases, 42 (47.2%) were monophasic, six (6.7%) were biphasic, and 41 (46.1%) were poorly differentiated. All the 89 cases showed positivity for TLE1 immunostain: 86 (96.6%) cases showed strong positivity, one (1.1%) case showed moderate expression, and two (2.2%) showed weak positivity. Conclusion This study shows that TLE1 is a highly sensitive immunostain for SS irrespective of the histologic type. However, it may show weak-to-moderate staining in poorly differentiated types. No statistically significant association was seen with respect to age group, gender, or type of SS.

Usefulness of Delayed Films of Contrast Enema for Detecting Hirschsprung's Disease

Background

Contrast enema (CE) in Hirschsprung’s disease (HD) provides a road map to surgeons by ascertaining the transition zone (TZ) and helps in pre-surgical planning. In our institute, we use CE as the initial investigation for HD and carry on till the whole colon is fully distended, followed by a 24-hour abdominal film which is also a part of the international protocol. The main aim of this study was to evaluate the usefulness of this 24-hour delayed film in detecting HD, compare it with gold-standard biopsy results, and to evaluate other imaging features of contrast enema for diagnosis of HD in our tertiary-care hospital in Pakistan. 

Methods

This retrospective study was conducted at the Department of Radiology, Aga Khan University Hospital, Karachi. Records of pediatric patients referred for radiological evaluation of symptoms and signs suspicious of HD during the years 2007-2017 were reviewed. A delayed film was labeled positive if the contrast was not completely evacuated when the residual contrast was present till transverse colon and not beyond. Specificity and sensitivity along with positive and negative predictive values were calculated for each finding according to rectal biopsy, taken as the gold standard.

Results

In all, 82 patients met the inclusion criteria out of 111 cases, as they had both biopsy results and delayed 24-hour films. HD was confirmed using rectal biopsy in 56 (43 patients were males and 13 were females) of 82 cases. The most sensitive radiological finding was the transition zone with a sensitivity of 91.07%. The rectosigmoid index was the second most common finding on contrast enema with a sensitivity and specificity of 91.07% and 83.93%, respectively. In all, 59% patients had a positive delayed 24-hour film and were confirmed with having HD on biopsy. The sensitivity, specificity, and positive predictive value of delay in contrast evacuation after 24 hours in our study was 81.25%, 90.91%, and 97.50% respectively.

Conclusion

Contrast enema examinations along with the 24-hour delayed film with mid transverse colon cut-off are optimal for initially investigating HD in a developing nation, and our results show that it correlates well with biopsy. However, rectal biopsy still remains the gold standard for diagnosis. 

Orthokeratinized odontogenic cyst (OOC): Clinicopathological and radiological features of a series of 10 cases

BACKGROUND

Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later renamed as keratocystic odontogenic tumor (KCOT). The treatment of OOC is by enucleation and the prognosis, following enucleation is excellent with a recurrence rate of less than 2%. On the other hand, OKC has a recurrence rate between 8 and 25% after enucleation. Thus it is important to differentiate between the two entities.

METHODS

All cases reported in our section as OOC during the period 2013 to 2018 were retrieved from the surgical pathology files and slides were reviewed by the authors. All cases which met the histological criteria for OOC were included.

RESULTS

A total of 10 cases were included. 70% patients were males, ages ranged from 23 to 60 years, with mean age of 38.9 years. 70% of cases were located in the mandible and 90% patients presented with swelling. Radiologically, 90% cases were unilocular, all were radiolucent lesions. Mean size was 4.0 cm. Histologically, all cases demonstrated the classic microscopic features. Follow-up was available in 8 patients. All were treated by enucleation. All 8 were alive with no recurrences over a follow-up period ranging from 7 to 62 months.

CONCLUSIONS

OOC has a better prognosis than OKC and needs to be differentiated from OKC due to differences in treatment and prognosis. Large majority of our cases presented with swelling and occurred in the mandibles of young males. All were radiolucent and most were unilocular. All were treated by enucleation and no recurrences occurred over follow up period ranging up to 62 months. Our findings were similar to those described in other published series.

Real-Time Interrogation of Aspirin Reactivity, Biochemistry, and Biodistribution by Hyperpolarized Magnetic Resonance Spectroscopy

Hyperpolarized magnetic resonance spectroscopy enables quantitative, non-radioactive, real-time measurement of imaging probe biodistribution and metabolism in vivo. Here, we investigate and report on the development and characterization of hyperpolarized acetylsalicylic acid (aspirin) and its use as a nuclear magnetic resonance (NMR) probe. Aspirin derivatives were synthesized with single- and double-¹³ C labels and hyperpolarized by dynamic nuclear polarization with 4.7 % and 3 % polarization, respectively. The longitudinal relaxation constants (T₁ ) for the labeled acetyl and carboxyl carbonyls were approximately 30 seconds, supporting in vivo imaging and spectroscopy applications. In vitro hydrolysis, transacetylation, and albumin binding of hyperpolarized aspirin were readily monitored in real time by ¹³ C-NMR spectroscopy. Hyperpolarized, double-labeled aspirin was well tolerated in mice and could be observed by both ¹³ C-MR imaging and ¹³ C-NMR spectroscopy in vivo.

Expression of cyclin D1 in clear cell sarcoma of kidney. Is it useful in differentiating it from its histological mimics?

BACKGROUND

Clear cell sarcoma of the kidney (CCSK) is a rare malignant pediatric renal neoplasm with a heterogeneous histological appearance which often results in misdiagnosis. There are no specific immunohistochemical markers which can help in differentiating CCSK from other pediatric renal neoplasms. Recently Cyclin D1 has been investigated as a possible marker in this regard. In this study, we aim to determine the usefulness of Cyclin D1 in differentiating between CCSK and other pediatric renal neoplasms and to compare our results with those of recently published studies.

METHODS

A total of 48 cases of CCSK, Wilms tumor (WT), renal rhabdoid tumor, mesoblastic nephroma, renal Ewing sarcoma and neuroblastoma were included in the study. All cases were stained with cyclin D1. Extent of Cyclin D1 staining was graded according to percentage of positive tumor cells as diffuse (> 70%), focal (5 to 70%), and negative (< 5%). Intensity of Cyclin D1 staining was graded as strong or 3+, moderate or 2+ and weak or 1 + .

RESULTS

Most or all cases of CCSK, neuroblastoma and renal Ewing sarcoma demonstrated diffuse and strong positivity for Cyclin D1. Most cases of Wilms tumor (epithelial component) also demonstrated diffuse and often strong positivity for Cyclin D1. In most cases of WT, blastemal component was negative.

CONCLUSIONS

Cyclin D1 is a sensitive but not specific immunohistochemical marker for CCSK and many other pediatric renal malignant neoplasms as well as for neuroblastoma. Hence, careful examination of histological features is important in reaching an accurate diagnosis in CCSKs. However, Cyclin D1 is very helpful in distinguishing between blastema-rich WT and CCSK.

Osteoid osteoma: Contemporary management

Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but also for specifying location of the lesion, i.e. cortical vs sub periosteal or medullary. Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing. Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs. Available surgical procedures include radiofrequency (RF) ablation, CT-guided percutaneous excision and en bloc resection.

Unicameral bone cysts: Current concepts

Unicameral bone cysts (UBC) or simple/solitary bone cysts are benign fluid filled cavities that enlarge over time, resulting in thinning of the bone. Usually these cysts are reported in the metaphyseal areas of long bones with open physes. 85% of UBCs occur almost exclusively in children and adolescents. UBCs are more aggressive in the first decade of life and correspondingly the recurrence rate for these patients is four times that for adolescents. The proximal humerus and femur account for almost 90% of these cases. UBCs are classified as active when they are within 1 cm of the physis and latent as they progress to a diaphyseal location. Differential diagnoses for UBC include aneurysmal bone cyst, fibrous dysplasia, enchondroma, and intraosseous ganglia. By the time of skeletal maturity most UBCs tend to resolve. Nonoperative treatment may be a viable option for many patients with small or symptomatic lesions. Interventions include steroid injection, open curettage and bone grafting, decompression and percutaneous injection of marrow or graft substitutes.

Lipoblastoma: a clinicopathologic review of 23 cases from a major tertiary care center plus detailed review of literature

Objective

Lipoblastoma is a rare neoplasm that occurs mostly in infants and children. Although benign, it has a tendency for local recurrence.

Results

Clinical and pathological features of 23 cases of lipoblastoma described. Patients’ age ranged from 8 months to 18 years with mean and median age 4.1 and 2.5 years, respectively. Male:female ratio was 2.8:1. Most common sites were lower extremities (9 cases), followed by abdominal cavity and retroperitoneum (4 cases), and scrotum/groin (3 cases). Grossly, 22 tumors were well circumscribed and multi nodular. All cases showed lobules composed of adipocytes and lipoblasts with intervening fibrous septa and fine vascular network. Myxoid change, capsule formation and septation were seen in all cases. Zonation was seen in 2 cases. Follow-up was available in 14 out of 23 patients. Of these, 13 were alive and free of disease with no evidence of any recurrent lesion. One patient with a mediastinal infiltrating lipoblastoma experienced 4 recurrences. Lipoblastoma is a benign adipocytic neoplasm of infants and young children. Correlation of clinical and histological features helps in reaching a correct diagnosis. Owing to a high recurrence rate following incomplete resection, a complete resection is essential. Prognosis is excellent after complete resection.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3153-8) contains supplementary material, which is available to authorized users.

Intrahepatic biliary cystadenoma mimicking hydatid cyst of liver: a clinicopathologic study of six cases

BACKGROUND

Intrahepatic biliary cystadenomas are rare hepatic neoplasms, which are usually cystic. These tumors are often misdiagnosed as simple liver cysts and hydatid cysts clinically and radiologically owing to nonspecific clinical and radiologic features. These tumors require complete resection, as recurrence and malignant transformation can occur following incomplete excision. It is essential that these tumors be diagnosed accurately so that they can be adequately excised.

METHODS

Clinical and radiological features of six cases of biliary cystadenoma are described.

RESULTS

All of these cases were resected with the clinical and/or radiological impression of simple liver cysts and/or hydatid cysts. Out of the six patients, five were female and one was male. Ages of the patients ranged from 28 to 60 years (mean 45 years). The patients presented with nonspecific symptoms. Internal septations were seen on preoperative imaging (when available). On gross examination, all tumors were cystic; their sizes varied from 5.5 to 14 cm, mean size was 9.0 cm. On histopathologic examination, cystic spaces were lined by cuboidal to columnar mucin-secreting epithelium with underlying ovarian-type stroma. In one case, ovarian-type stroma was not seen. Recurrence was seen in three cases at 1 to 5 years of follow up.

CONCLUSIONS

Owing to their malignant potential and high recurrence rate following incomplete resection, an aggressive surgical approach is recommended. Prognosis is excellent after complete resection.

Errors in Surgical Pathology Reports: a Study from a Major Center in Pakistan

BACKGROUND

Errors in surgical pathology diagnosis can have serious consequences for the patient. Since the final product of a surgical pathology lab is the report, errors can be picked by reviewing reports of cases.

AIM

To determine the frequency and types of error in surgical pathology reports of cases signed out in 2014 in a laboratory in Karachi, Pakistan.

MATERIALS AND METHODS

All surgical pathology reports in which changes were made in the original report after sign out and an amended report was issued were included. Errors included: (1) misinterpretations; (2) missing critical information; (3) erroneous critical information; (4) misidentification; and (5) typographic errors.

RESULTS

Errors were identified in 210 cases (0.37%). These comprised 199 formalin fixed specimens and 11 frozen sections. The latter represented 3.8% of a total of 2,170 frozen sections. Of the 11 frozen section errors, 10 were misinterpretations. Of the 199 permanent specimens, 99 (49.7%) were misinterpretations, 65 (32.7%) belonged to missing critical information category, 8 (4%) belonged to erroneous critical information category, 8(4%) were misidentifications, 16(8%) were typographic errors while 3 cases (1.5%) were other errors. Most misinterpretations occurred in the gastro intestinal, liver and pancreato biliary tract (23.2%) and breast (13.1%). Another 87 cases were reviewed on the clinicians' request. However diagnosis after review remained the same as the original diagnosis. In 49 out of these (56.3%), additional workup was performed at the time of the review.

CONCLUSIONS

Our findings were similar to other published studies. We need to develop documented procedures for timely review of cases to detect errors.

Commonest Cancers in Pakistan - Findings and Histopathological Perspective from a Premier Surgical Pathology Center in Pakistan

CONTEXT

There are no recent authoritative data about incidence and prevalence of various types of cancers in Pakistan.

AIM

To determine the frequency of malignant tumors seen in our practice and provide a foundation for building a comprehensive cancer care strategy.

MATERIALS AND METHODS

10,000 successive cases of solid malignant tumors reported in 2014 were included. All cases had formalin fixed, paraffin embedded specimens available and diagnosis was based on histological examination of H and E stained slides plus ancillary studies at the Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi. The latest WHO classifications were used along with the latest CAP protocols for reporting and the most updated TNM staging.

RESULTS

There were 9,492 (94.9%) primary tumors while 508 (5.1%) were metastatic. Some 5,153 (51.5%) were diagnosed in females and 4,847 (48.5%) in males. The commonest malignant tumors in females were breast (32%), esophagus (7%), lymphomas (6.8%), oral cavity (6.7%) and ovary (4.8%), while in males they were oral cavity (13.9%), lymphomas (12.8%), colorectum (7.9%), stomach (6.9%) and esophagus (6.6%). Malignant tumors were most common in the 5th, 6th and 7th decades. About 8% were seen under 20 years of age.

CONCLUSIONS

Oral cavity and gastrointestinal cancers continue to be extremely common in both genders. Breast and esophageal cancers are prevalent in females. Lung and prostate cancer are less common than in the west. Ovarian cancer was very common but cervix cancer was less so.

Abnormal vocal cord movement in patients with and without airway obstruction and asthma symptoms

BACKGROUND

Abnormal vocal cord movements can cause laryngeal extrathoracic airway obstruction (often called vocal cord dysfunction - VCD) leading to asthma-like symptoms. These aberrant movements are characteristically present during inspiration and termed paradoxical vocal cord movement (PVCM). We have reported PVCM in up to 40% of severe asthmatics, but it is not known if PVCM is detectable in all patients with asthma-like symptoms and if the condition is more often associated with abnormal lung function.

OBJECTIVE

We hypothesized that PVCM is frequently associated with asthma symptoms accompanied by airflow limitation. Studies examined whether PVCM is solely linked to experiencing asthma symptoms, or if PVCM is related to airflow limitation and/or other disease characteristics.

METHODS

Patients with asthma symptoms were recruited from general practice and severe asthma clinics (n = 155). Pulmonary function measurements were conducted, asthma control and Nijmegen (dysfunctional breathing) questionnaires were administered and skin prick testing was carried out. PVCM was quantified using dynamic 320-slice computerized tomography of the larynx. Groups were divided into patients with FEV₁ ≥ 80% predicted or FEV₁ < 80% predicted and FEV₁ /FVC < 0.7. ATS/ERS definitions of severity were also applied and evaluated. Detection of PVCM in the groups was compared and analyses performed to identify features associated with PVCM.

RESULTS

Overall (n = 155), PVCM was detected in 42 cases (27.1%). Patients with FEV₁ < 80% predicted had PVCM more often (25/68, 36.8%) than individuals with normal spirometry (17/87, 19.5%; P = 0.016). PVCM was associated with older age (P = 0.003) and with Nijmegen scores > 20 (P = 0.04). Patients with FEV₁ < 80% predicted plus Nijmegen scores > 20 were more likely to have PVCM (OR = 9.3, P = 0.02).

CONCLUSIONS AND CLINICAL RELEVANCE

Paradoxical vocal cord movement is more often associated with asthma symptoms accompanied by airflow limitation and dysfunctional breathing. Further studies are needed to determine whether PVCM is induced by dysfunctional breathing practices and/or airway obstruction. How PVCM links with symptomatic asthma and VCD also requires evaluation.

Quantification of nanoparticle release from polymer nanocomposite coatings due to environmental stressing

Certain engineered nanoparticles (ENP) reduce the flammability of components used in soft furnishings (mattresses and upholstered furniture). However, because of the ENP's small size and ability to interact with biological molecules, these fire retardant ENPs may pose a health and environmental risks, if they are released sometime during the life cycle of the soft furnishing. Quantifying the released amount of these ENPs under normal end-use circumstances provides a basis for assessing their potential health and environmental impact. In this article, we report on efforts to identify suitable methodologies for quantifying the release of carbon nanofibers, carbon nanotubes, and sodium montmorillonites from coatings applied to the surfaces of barrier fabric and polyurethane foam. The ENPs released in simulated chewing and mechanical stressing experiments were collected in aqueous solution and quantified using Ultraviolet-Visible and inductively coupled plasma-optical emission spectroscopy. The microstructures of the released ENPs were characterized using scanning electron microscopy. The reported methodology and results provide important milestones to estimate the impact and toxicity of the ENP release during the life cycle of the nanocomposites. To our knowledge, this is the first study of ENP release from the soft furnishing coating, something that can be important application area for fire safety.