Crystal storing histiocytosis: a rare presentation of plasma cell myeloma

Crystal storing histiocytosis (CSH) is a very rare association with plasma cell dyscrasias. It is presumed to be an intra-lysosomal accumulation of the secreted paraprotein aggregated into crystals and is associated with presence of variable numbers of histiocyte-like cells with phagocytosed crystalline inclusions in the bone marrow and other extramedullary sites Herein we report a case of multiple myeloma associated with CSH with a rapidly downhill clinical course. There was diagnostic confusion at the outset with a histiocytic disorder which was clarified with the use of Immunohistiochemistry along with serum protein electrophoresis and immunofixation.     

Multiple brain abscesses and bacteremia in a child due toFusobacterium necrophorum

Summary A case ofFusobacterium necrophorum bacteremia and multiple brain abscesses in a 6-year-old child following aMycoplasma pneumoniae infection is described. Brain abscess due to this microorganism has only been described in three other cases since 1977. The clinical picture was consistent with postanginal septicemia, with septic metastatic complications normally only seen in teenagers and young adults. The patient was successfully treated with a 2-month course of parenteral penicillin G and metronidazole.

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Multiple Hirnabszesse und Bakteriämie durch Fusobacterium necrophorum bei einem Kind

Zusammenfassung Eine Bakteriämie, kompliziert durch multiple Hirnabszesse, trat bei einem sechs Jahre alten Kind nach einer Atemwegsinfektion durchMycoplasma pneumoniae auf. Seit 1977 wurden nur drei Fälle von Hirnabszeß durchF. necrophorum beschrieben. Das klinische Bild war vergleichbar mit einer postanginösen Bakteriämie mit septischer Komplikation, wie sie normalerweise bei jungen Erwachsenen gefunden wird. Die parenterale Behandlung mit Penicillin-G und Metronidazol für zwei Monate führte zur Heilung.

     

Hepatitis-G Virus Infection in Multi-transfused Patients and Intravenous Drug Abusers: New Delhi Experience

Hepatitis G virus (HGV) is a newly described virus that has been implicated in transfusion-associated hepatitis. HGV-RNA indicating current infection has frequently been isolated from the sera of multi-transfused patients (MTPs) and that of intravenous drug abusers (IVDAs). There is insufficient data on its prevalence among these high-risk groups in India. Hence this study was designed to evaluate the prevalence of HGV infection in MTPs and IVDAs. A total of 90 (57 males and 33 females) MTPs and 65 (44 males and 21 females) IVDAs were recruited in the study. Patients’ sera were tested for liver function profile, HGV-RNA, anti-HCV, HCV-RNA, HBsAg, and HBV-DNA. HGV-RNA was detected in 17.7% (16/90) MTPs and 23% (15/65) IVDAs, and 93.5% of our HGV-positive patients were found to be co-infected with either HBV (38.7%) or HCV (74.1%). The sero-prevalence of HBV was found out to be 40% and 21.5%, respectively, in the two groups, that of HCV was 32.2% and 32.3%, respectively, and dual infection was observed in 15.5% and 10.7% of the subjects, respectively. There were no statistically significant differences between the clinical, biochemical, and serological profiles of HGV-positive and negative patients. The prevalence of HGV infection in these high-risk groups is significantly higher than in controls. HGV is found to be co-infected more frequently with HCV than with HBV.     

Long-term dietary exposure to low concentration of dichloroacetic acid promoted longevity and attenuated cellular and functional declines in aged Drosophila melanogaster

Dichloroacetic acid (DCA), a water disinfection by-product, has attained emphasis due to its prospect for clinical use against different diseases including cancer along with negative impact on organisms. However, these reports are based on the toxicological as well clinical data using comparatively higher concentrations of DCA without much of environmental relevance. Here, we evaluate cellular as well as organismal effects of DCA at environmentally and mild clinically relevant concentrations (0.02–20.0 μg/ml) using an established model organism, Drosophila melanogaster. Flies were fed on food mixed with test concentrations of DCA for 12–48 h to examine the induction of reactive oxygen species (ROS) generation, oxidative stress (OS), heat shock genes (hsps) and cell death along with organismal responses. We also examined locomotor performance, ROS generation, glutathione (GSH) depletion, expression of GSH-synthesizing genes (gclc and gclm), and hsps at different days (0, 10, 20, 30, 40, 50) of the age in flies after prolonged DCA exposure. We observed mild OS and induction of antioxidant defense system in 20.0 μg/ml DCA-exposed organism after 24 h. After prolonged exposure to DCA, exposed organism exhibited improved survival, elevated expression of hsp27, gclc, and gclm concomitant with lower ROS generation and GSH depletion and improved locomotor performance. Conversely, hsp27 knockdown flies exhibited reversal of the above end points. The study provides evidence for the attenuation of cellular and functional decline in aged Drosophila after prolonged DCA exposure and the effect of hsp27 modulation which further incites studies towards the therapeutic application of DCA.     

Guidelines for the management of diabetes in care homes during the Covid-19 pandemic

The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.     

Myxoid glioneuronal tumor,PDGFRA p.K385‐mutant: clinical,radiologic, and histopathologic features

“Myxoid glioneuronal tumor, PDGFRA p.K385‐mutant” is a recently described tumor entity of the central nervous system with a predilection for origin in the septum pellucidum and a defining dinucleotide mutation at codon 385 of the PDGFRA oncogene replacing lysine with either leucine or isoleucine (p.K385L/I). Clinical outcomes and optimal treatment for this new tumor entity have yet to be defined. Here, we report a comprehensive clinical, radiologic, and histopathologic assessment of eight cases. In addition to its stereotypic location in the septum pellucidum, we identify that this tumor can also occur in the corpus callosum and periventricular white matter of the lateral ventricle. Tumors centered in the septum pellucidum uniformly were associated with obstructive hydrocephalus, whereas tumors centered in the corpus callosum and periventricular white matter did not demonstrate hydrocephalus. While multiple patients were found to have ventricular dissemination or local recurrence/progression, all patients in this series remain alive at last clinical follow‐up despite only biopsy or subtotal resection without adjuvant therapy in most cases. Our study further supports “myxoid glioneuronal tumor, PDGFRA p.K385‐mutant” as a distinct CNS tumor entity and expands the spectrum of clinicopathologic and radiologic features of this neoplasm.