A review in enormity of OCT and its enduring understanding of vulnerable plaque in coronary bifurcation lesion

Optical coherence tomography (OCT) has emerged as one of the most promising tools to assist the optimization of percutaneous coronary intervention (PCI). Its ability to provide unique information on the plaque at high risk for rupture, plaque composition, the thickness of the fibrous cap, the presence of macrophage and thrombi has not only assisted simple PCI but also in many complex bifurcation lesions PCI. OCT has helped to provide valuable anatomic information to optimize stent implantation and adapt PCI strategy in individual patients. This review article summarizes the current role of OCT as an imaging technology and prediction of vulnerable plaque, its site and composition at the coronary bifurcation lesions for supporting the clinical decision.     

Management of Total Cancer Pain: A Case of Young Adult

Pain due to cancer is one of the most distressing symptoms experienced by the patients at some or the other time during the course of treatment or disease progression. The multidimensional nature of cancer pain is characterized by various dimensions including physical, social, psychological, and spiritual; which together constitute the term “total pain”. Young cancer patients illustrate their unique psychological and developmental needs. This case report highlights the concept of “total cancer pain” in a young adult and demonstrates his distinctive social, spiritual, and psychological sufferings. The report emphasizes that addressing all these concerns is considerably significant in order to provide optimal pain relief to the patient. In the present scenario, it has been done by a skillful multiprofessional team communicating effectively with both the patient and the carer.     

HIV with Juvenile Dermatomyositis

Dermatomyositis with HIV infection has been very rarely reported. The authors report an 8-y-old boy who presented with skin rashes and edema, muscle weakness and polymicrobial infection along with mild immunosupression. Diagnosis of dermatomyositis was established by raised enzymes, suggestive MRI and muscle biopsy findings. Child responded to systemic steroids and low dose weekly methotrexate.     

Magnetic ion oxidation state dependent magnetoelectric coupling strength in Fe doped BCT ceramics

Polycrystalline samples of Ba_0.96Ca_0.04Ti_0.91Fe_0.09O₃ were prepared using a conventional solid state reaction route with different Fe starting precursors (Fe₂O₃, Fe₃O₄). The Rietveld refined XRD data confirmed the phase purity and tetragonal crystal structure of both the samples. The average grain size measured using SEM was ≈0.40 μm in both the samples. XPS analysis confirmed the presence of only Fe²⁺ and both Fe²⁺/Fe³⁺ in Fe₂O₃ and Fe₃O₄ doped BCT samples. The P_r and M_r values have been measured to be 1.34 μC cm⁻², 2.88 μC cm⁻² and 0.0015 emu g⁻¹ and 0.135 emu g⁻¹ in Fe₂O₃ and Fe₃O₄ doped BCT samples, respectively. The Fe₃O₄ doped samples exhibit much better M-E coupling (≈22%) as compared to Fe₂O₃ (≈7%) doped BCT samples. The results obtained hence suggest that Fe₃O₄ doping in BCT is better suited for multiferroic applications.

Polycrystalline samples of Ba_0.96Ca_0.04Ti_0.91Fe_0.09O₃ were prepared using a conventional solid state reaction route with different Fe starting precursors (Fe₂O₃, Fe₃O₄). A significant difference in the magnetic and ferroelectric properties was observed.     

Undiagnosed Behçet's Disease Complicated by Multiple Pseudoaneurysms and COVID-19 Infection

Behcet''s disease (BD) is a rare multiorgan systemic disorder characterized by recurrent episodes of acute inflammation. Involvement of the vascular system, gastrointestinal tract, and central nervous system portends a poor prognosis.We report the case of a 54-year-old man who presented with a 2-week history of symptoms attributable to infrarenal aortic and left tibioperoneal trunk pseudoaneurysms, defined by CT angiography which also revealed right lower lobe pulmonary artery (PA) and right anterior tibial arterial aneurysms. A prior history of recurrent oral ulceration, periodic fever, cerebral venous sinus thrombosis, and aseptic endocarditis with pulmonary emboli invoked a diagnosis of BD. Immunosuppression was commenced immediately, following synchronous endovascular and open arterial intervention, except the PA aneurysm.He developed a fever and cough 8 days postoperatively as a consequence of COVID-19 infection from which he recovered without complications.The management of the patient''s four aneurysms in different vascular territories and postoperative COVID-19 infection in the presence of mandatory immunosuppression are discussed.     

Pigmented Pheochromocytoma: an Unusual Variant of a Common Tumor

Pheochromocytoma is a neuroendocrine tumor arising from the adrenal medulla. A number of variants of pheochromocytoma are known; however, pigmented pheochromocytoma is extremely rare, with only few cases reported in literature. We report the cases of two patients with pigmented pheochromocytoma. Case 1 was a 28-year-old female who presented with complaints of breathlessness, palpitations, and anxiety for 5 years, which had worsened over the last 8 months. Computed tomography (CT) abdomen showed a right suprarenal mass. Case 2 was that of an 18-year-old girl who presented with similar complaints and was diagnosed with hypertension. CT abdomen showed bilateral adrenal masses. Urinary vanillyl mandelic acid was raised in both patients. Sections examined from all three tumors showed cells arranged in Zellballen pattern, separated by thin fibrovascular septae. Tumor cells showed moderate to marked nuclear pleomorphism in case 1. Mitoses were, however, not seen. There was no evidence of capsular or vascular invasion. Many of the tumor cells showed intracytoplasmic black pigment, which was positive for Fontana–Masson and was bleach-labile, confirming it as melanin. Hemosiderin deposition was also identified. Large areas of hemorrhagic necrosis were seen in case 1. Tumor cells were immunopositive for chromogranin and synaptophysin, while they were negative for HMB-45. Electron microscopy was performed. A final diagnosis of pigmented pheochromocytoma was rendered in both cases. Pigmented pheochromocytoma is a very rare tumor, which needs to be differentiated from other pigmented tumors like malignant melanoma of adrenal gland and pigmented adrenal adenoma. Histochemistry and immunohistochemistry help in making this distinction.     

Alveolar Soft Part Sarcoma of the Oro-Maxillofacial Region in the Pediatric Age Group: Immunohistochemical and Ultrastructural Diagnosis of Two Cases

Alveolar soft part sarcoma (ASPS) is infrequent in children. While head and neck locations, including the orbit and tongue, are described, only six cases of sinonasal ASPS are reported in the literature. We report two cases of pediatric oro-maxillofacial ASPS. The first case presented as a sinonasal mass in a 13-year-old girl, while the second was a tongue lesion in a 4-year-old female. Histologic examination, TFE3 immunopositivity, and ultrastructural findings of rhomboid crystalline inclusions helped confirm the diagnosis. The diagnosis of ASPS is challenging in children and in uncommon sites like the head and neck. Patients should be routinely followed up for detection of residual or recurrent disease, particularly in cases with positive resection margins.