Electrocatalytically driven omega-hydroxylation of fatty acids using cytochrome P450 4A1.

The cyclic enzymatic function of a cytochrome P450, as it catalyzes the oxygen-dependent metabolism of many organic chemicals, requires the delivery of two electrons to the hemeprotein. In general these electrons are transferred from NADPH to the P450 via an FMN- and FAD-containing flavoprotein (NADPH-P450 reductase). The present paper shows that NADPH can be replaced by an electrochemically generated reductant [cobalt(II) sepulchrate trichloride] for the electrocatalytically driven omega-hydroxylation of lauric acid. Results are presented illustrating the use of purified recombinant proteins containing P450 4A1, such as the fusion protein (rFP450 [mRat4A1/mRatOR]L1) or a system reconstituted with purified P450 4A1 plus purified NADPH-P450 reductase. Rates of formation of 12-hydroxydodecanoic acid by the electrochemical method are comparable to those obtained using NADPH as electron donor. These results suggest the practicality of developing electrocatalytically dependent bioreactors containing different P450s as catalysts for the large-scale synthesis of stereo- and regio-selective hydroxylation products of many chemicals.     

Minimum diagnostic criteria for plasmablastic lymphoma of oral/sinonasal region encountered in a tertiary cancer hospital of a developing country

Background:  Haematolymphoid tumours other than plasmablastic lymphoma (PBL) may reveal plasmablastic differentiation with overlapping immunoreactivity causing diagnostic dilemma. Elaborate ancillary diagnostic techniques can make the process expensive, tedious and out of reach for pathology laboratory in a developing country.
Methods:  Out of 98 total cases of primary non-Hodgkin's lymphoma and plasmacytoma of oral-sinonasal region recorded in our institute over 4 years, 39 cases showing varied plasmablastic differentiation were selected. Morphological and immunohistochemical criteria were applied to identify minimum diagnostic criteria for PBL. Human Immunodeficiency Virus (HIV) correlation and Epstein–Barr virus expressed RNA (EBER) in-situ hybridisation studies were also performed.
Results:  Minimum morphological criteria required to diagnose PBL were: (1) predominant population of plasmablasts which are large monomorphic cells with high nuclear-cytoplasmic ratio, moderate amount of amphophilic cytoplasm and round nucleus with prominent central nucleolus, (2) high mitotic and/or apoptotic index and (3) absence of neoplastic plasma cells in the background. Essential diagnostic immunophenotype consisted of CD20 negativity, LCA +/−, CD138/VS38c diffuse positivity, light chain restriction and high MIB-1 index (>60 %). Twenty-five of the total 32 PBL cases thus identified, involved oral cavity. Of these, 84% affected gingivo-buccal complex. Twenty-eight cases were HIV positive. EBER positivity confirmed the diagnosis in all the HIV-negative cases.
Conclusions:  A triad of 'rapidly growing lesion with predilection for oral mucosa, classical plasmablastic morphology and limited immunohistochemical panel' can render a reliable diagnosis of PBL, irrespective of HIV and EBV status, especially in developing countries with limited resources.     

Corynebacterium macginleyi` a rare bacteria causing infection in an immunocompromised patient

Corynebacterium species are normal flora of skin and mucous membrane. In recent years, coryneforms have emerged as important opportunistic pathogens in immunocompromised patients. Majority of the Corynebacterium macginleyi isolates are from conjunctiva and cornea. The only reported non ocular isolates are from urinary tract infection, intra-venous catheter related infection, valvular endocarditis and septicaemia. We report herein a rare case of C. macginleyi isolated from tracheostomy site secretions in a patient with carcinoma larynx which was treated successfully with Cefoperazone-sulbactum for seven days and replacing tracheostomy tube. This is the first case of C. macginleyi reported from India.     

Breaking Bad News: Patient Preferences and the Role of Family Members when Delivering a Cancer Diagnosis

Background: Western physicians tend to favour complete disclosure of a cancer diagnosis to the patient, while non-Western physicians tend to limit disclosure and include families in the process; the latter approach is prevalent in clinical oncology practice in India. Few studies, however, have examined patient preferences with respect to disclosure or the role of family members in the process. Materials and Methods: Structured interviews were conducted with patients (N=127) in the medical oncology clinic of a tertiary referral hospital in Bangalore, India. Results: Patients ranged in age from 18-88 (M=52) and were mostly male (59%). Most patients (72%) wanted disclosure of the diagnosis cancer, a preference significantly associated with higher education and English proficiency. A majority wanted their families to be involved in the process. Patients who had wanted and not wanted disclosure differed with respect to their preferences regarding the particulars of disclosure (timing, approach, individuals involved, role of family members). Almost all patients wanted more information concerning their condition, about immediate medical issues such as treatments or side effects, rather than long-term or non-medical issues. Conclusions: While most cancer patients wanted disclosure of their disease, a smaller group wished that their cancer diagnosis had not been disclosed to them. Regardless of this difference in desire for disclosure, both groups sought similar specific information regarding their cancer and largely favoured involvement of close family in decision making. Additional studies evaluating the influence of factors such as disease stage or family relationships could help guide physicians when breaking bad news.     

Impact of the use of digital devices on eyes during the lockdown period of COVID-19 pandemic

Purpose:The purpose of this study is to observe pattern of digital device use and the various ocular, visual and systemic symptoms associated with them during the lockdown period of the novel coronavirus disease (COVID-19) pandemic.Methods:Two hundred and thirty-three volunteers were included in web-based open e-survey. The survey was designed on the ‘Survey Monkey’ website and distributed through social media platform. The information was collected regarding hours and numbers of digital devices along with numbers of digital activities carried out during the pandemic. A pretested symptom questionnaire was also included regarding ocular, visual and systemic symptoms before and during lockdown. The statistical analysis was carried out using Statistical Package of Social Science software.Results:During the pandemic, most of the respondents were engaged in more than two digital activities (73.81%) over more than two digital devices (48.50%) for more than six days (65.66%). Maximum respondents were mobile users (97.85%) spending major time on social media (89.70%). Symptoms including watering eyes (P = 0.000), dry eyes (P = 0.000), shoulder pain (P = 0.020), back pain (P = 0.003) and headache (P = 0.043) showed positive correlation with hours of digital device use per day during lockdown, while itching eyes (P = 0.036) and pain behind eyes (P = 0.025) were the major symptoms in those engaged in a greater number of digital activities. Moreover, red eyes (P = 0.040) were more prominent in respondents using multiple devices for a greater number of hours.Conclusion:A big jump in digital activities on multiple digital devices was seen during lockdown which are more prone to ocular symptoms. Acceleration of ocular and systemic symptoms was particular with rise in time spending on digital devices.     

Primary pulmonary Hodgkin's lymphoma: a rare pitfall in transthoracic fine needle aspiration cytology

Primary pulmonary Hodgkin's lymphoma (PPHL) is extremely rare. At an extranodal location such as the lung this lymphoma is likely to be confused with the more commonly occurring carcinomas at this site. We report the fine needle aspiration cytology (FNAC) findings of a PPHL in a 36-year-old male with a view to discuss the pitfalls and clues to the accurate cytologic diagnosis. This patient presented with a large, heterogeneously enhancing mass involving the anterior segment of right upper lobe without any evidence of nodal involvement. A CT-guided transthoracic FNAC of this mass revealed large connective tissue fragments with entrapped voluminous cells amidst a polymorphous population of eosinophils, polymorphs, and lymphocytes. The large cells showed abundant often stripped off cytoplasm, an irregular nucleus with nucleolus and were initially diagnosed as non-small cell carcinoma of the lung. In view of the locally advanced stage, patient received a carboplatin and gemcite-based chemotherapy with complete response but postchemotherapy patient refused local surgery. Two years later, the patient developed enlarged nodes which were diagnosed as Hodgkin's lymphoma, and a review of prior lung tumor confirmed the diagnosis of PPHL. Hence the rare diagnosis of PPHL should be kept in mind when a cytopathologist observes large cells embedded in collagenous tissue fragments with dominant cell dispersal amidst an inflammatory infiltrate in an aspirate from a primary lung tumor.     

Gliosarcoma occurring 8 years after treatment for a medulloblastoma

Case report We present a rare case of a gliosarcoma occurring 8 years following treatment for a medulloblastoma. The patient was diagnosed with a medulloblastoma at the age of 13 years. We considered the possibility of a radiation-induced tumour and present evidence supporting this view. The second cerebral tumour was excised and confirmed to be a gliosarcoma. The tumour bed was re-irradiated with three-dimensional conformal radiotherapy (3DCRT). She remained well for 6 months, after which there was clinicoradiological progression.Conclusions During long-term follow-up of patients with medulloblastomas, the possibility of radiation-induced neoplasms must be borne in mind.     

Clear cell mesothelioma of the testis with deciduoid areas--a case report

We report a clear cell type of primary purely epithelial malignant mesothelioma with focal deciduoid features in the para-testis of a 75 year old man. This variant requires ancillary studies like immunohistochemistry for confirmation. Awareness of this variant is required to avoid misdiagnosis and treatment as either metastasis from a renal cell carcinoma or as a germ cell tumor. A diagnosis of mesothelioma must be ruled out in elderly patients with epithelial-looking tumor especially if the serum germ cell tumor markers are within normal range.