Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis

Background/Purpose of the StudyC-arm-guided biopsy is a safe and effective technique for evaluating TB spine and is useful in planning therapy. The purpose of this study was to find a correlation between clinically and radiologically suspected TB spine and C-arm image-guided biopsy-proven cases and to study the complications encountered.MethodsAfter evaluating the clinical, laboratory, X-ray and MRI findings, 92 patients with provisionally diagnosed tubercular spine were subjected to C-arm image-guided biopsy.ResultsAmong our 92 cases, histopathology was positive in 55 cases (59.78%). Out of these 55 histologically positive cases, CBNAAT was positive in 42 cases and negative in the rest 13 cases. Overall, among the 92 cases, CBNAAT was positive in 51(55.43%) of cases, and out of these, histopathology turned out to be positive in 42 of cases. Out of 41 cases with negative CBNAAT, histopathology was suggestive of tuberculosis in 13. The strength of agreement between CBNAAT and histopathology was statistically significant (p < 0.0001; kappa = 0.511). No complication such as bleeding, nerve/cord injury, infection, injury to aorta or pneumothorax was encountered during and after the C-arm biopsy in any case.ConclusionC-arm image-guided biopsy is reasonably accurate and should be used as a tool for diagnosis of TB spine. We recommend histopathological examination as a key component for the diagnosis of TB spine, as it is precise and consumes relatively shorter time. CBNAAT is more rapid but is not a substitute for histopathology for spine TB diagnosis.     

A conservative surgical approach for management of iatrogenic pulmonary artery perforation

Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.     

Minerals and functional groups present in the jackfruit seed: a spectroscopic investigation

In this work, emission and Fourier transform infrared spectra of the jackfruit seed, in powdered form, are recorded. Analysis of the emission spectrum confirms the presence of two hitherto undetected elements, manganese and magnesium. The Fourier transform infrared spectrum reveals the presence of some specific functional groups, attributed to the different bands present in the spectrum.     

Acute streptococcal myocarditis presenting as acute ST-elevation myocardial infarction

Acute streptococcal myocarditis is an uncommon diagnosis in the developed world. Its presentation masquerading as acute myocardial infarction is still uncommon. We describe a case of a young male presenting with a recent diagnosis of streptococcal pharyngitis followed by a classical presentation of post streptococcal myocarditis. This is an unusual presentation of acute rheumatic fever (ARF) masquerading as acute myocardial infarction, with a discussion on its diagnosis and management.     

The histology and histomorphometry of umbilical cord cross section in preeclampsia and normal pregnancies: a comparative study

ABSTRACT

The umbilical cord is the connecting link between the mother and the fetus and its morphology is an indicator of fetal well-being. Preeclampsia is a disorder of pregnancy associated with new-onset hypertension, which occurs most often after 20 weeks of gestation. There are structural differences in the umbilical cord of normotensive and hypertensive pregnant women. This research aimed to study the histology and histomorphometry of umbilical cord areas in preeclampsia and compare the parameters with normal uncomplicated pregnancies of gestational age 37–40 weeks. A total of 70 umbilical cords were studied from preeclampsia (n = 35) and normal (n = 35) pregnancies. The parameters studied included cross-sectional areas (CSA) of umbilical cord, umbilical vein lumen, umbilical vein wall, umbilical artery lumen, umbilical artery wall, and Wharton’s jelly, including the presence of edema in the vessel walls and Wharton’s jelly and basement membrane thickening. The mean umbilical cord CSA was significantly higher in preeclampsia (p = 0.014). The mean umbilical artery lumen CSA was significantly lower than the normal pregnancy cords (p = 0.006). The mean Wharton’s jelly CSA in preeclampsia was significantly higher than the normal pregnancy cords (p = 0.004). The parameters for umbilical vein lumen CSA, umbilical vein wall CSA, and umbilical artery wall CSA did not show any significant difference. Histological findings were edema (p < 0.001) and thickened basement membranes (p < 0.0001) were considered significant.     

Green synthesis of gold nanoparticles using an antiepileptic plant extract: in vitro biological and photo-catalytic activities

Gold nanoparticles are one of the widely used metallic nanoparticle having unique surface plasmon characteristic, offers major utility in biomedical and therapeutic fields. However, chemically synthesized nanoparticle creates toxicity in the living organisms and contradicts the eco-friendly and cost-effective nature. So, developing greener synthetic route for synthesis of gold nanoparticle using natural materials is an enthralling field of research for its effectiveness in synthesizing eco-friendly, non-toxic materials. Moreover, biological components attached as stabilizing agent can exert its own effect along with the advantages of nanoparticle conjugation. In this work, we used for the first time methanolic leaf extract of Moringa oleifera as this fraction of M. oleifera exerts a neuroactive modulation against seizure as evidenced by earlier literature. The green gold nanoparticles synthesized were characterized by different characterization tools, dynamic light scattering and transmission electron microscopy techniques etc. Prepared nanoparticles were biologically (antioxidant, antimicrobial and blood cytotoxicity) characterized to screen their further utility in therapeutic strategies. Characteristics and activities of green gold nanoparticles were compared with conventional citrate stabilized gold nanoparticles. It was observed that green gold nanoparticles prepared using M. oleifera show less cytotoxicity and helps in regeneration of neuronal cells in animal model study. It establishes the fact that conjugation of different plant extract fraction for stabilization of gold nanoparticle may be responsible factor for enhancement of bioactive nature of green gold nanoparticle. In addition, the green gold nanoparticle show efficient photo-catalytic efficiency. Development of such bioactive gold nanoparticles will lead to functional materials for biomedical and therapeutic applications.

Gold nanoparticles are one of the widely used metallic nanoparticle having unique surface plasmon characteristic, offers major utility in biomedical and therapeutic fields.     

Normative magnetic resonance imaging measurements of orbital structures in pediatric population of North-Eastern India: A retrospective cross-sectional study

Purpose:The people of Northeast India comprise mostly of Mongoloid descent with characteristic craniofacial features. The purpose of this study was to evaluate the normal orbital structures with MRI and determine normative data in the Northeast Indian pediatric population.Methods:MRI images of the 302 orbits of 151 pediatric patients below 16 years of age were retrospectively evaluated to measure the various orbital structures. Both axial and coronal MRI images were utilized for various orbital measurements. An independent sample t-test was done to compare various orbital data according to the sex and side. Linear regression was also done.Results:The mean age of the pediatric population was 9.64 ± 1.47 years with a male: Female ratio of 1.13:1. The mean interzygomatic line was 88.4 ± 9.09 mm and the interorbital line was 22.18 ± 3.62 mm. The mean thicknesses of medial, lateral, superior, and inferior recti muscles were 2.58 ± 0.46, 2.34 ± 0.42, 2.16 ± 0.40, and 2.53 ± 0.49 mm in males and 2.41 ± 0.41, 2.08 ± 0.34, 2.08 ± 0.46, and 2.46 ± 0.49 mm in females. The mean horizontal orbital, vertical orbital diameters, orbital index, mean volume of eyeball, and orbital cavity were 30.27 ± 2.97,3 7.06 ± 3.57, 122.58 ± 7.39, 4.63 ± 0.84, and 15.29 ± 3.52 in males, while 29.16 ± 3.23, 34.96 ± 3.99,119.96 ± 7.31, 4.49 ± 0.87, and 14.65 ± 3.47 in females, respectively. With an increase in age, the interzygomatic line (r = 0.883, r² = 0.780; P < 0.0005), anterior medial interorbital line (r = 0.808, r² = 0.652; P < 0.0005), mean volume of eyeball (r = 0.915, r² = 0.838; P < 0.0005), orbital cavity (r = 0.924, r² = 0.854; P < 0.0005), and distance between the optic nerve entry site (r = 0.829, r² = 0.687; P < 0.0005) were increased.Conclusion:This study provides normative data of various orbital structures in a pediatric population and these data likely to be useful for diagnosing various pediatric orbital disorders and helps in the planning of various surgical procedures of orbits.     

Acute diverticulitis--an unusual cause of liver abcesses in a young man: a case report

Liver abscess is a rare complication of sigmoid diverticulitis and must be considered within the differential diagnosis. We report a case of a male patient, age 42, admitted to our hospital with chief complaints of a dull pain in upper right abdominal quadrant, fever, weakness, diarrhoea and weight loss of approximately 3 weeks duration. Physical examination on initial work-up revealed tenderness on palpation in upper right abdomen, and left iliac fosa and a 39 degrees C fever. Biochemistry showed marked inflammatory syndrome, leukocitosis, increased level of platelets, altered liver function. Ultrasound examination revealed inhomogeneous liver nodules and the thickening of the sigmoid wall. Further CT scan examination and MRI confirmed the lesions as beeing abscesses and also revealed trombosis of right portal vein. The sigmoid wall lesions proved to be an acute diverticulitis with perisigmoiditis, stenosis and abscess. Patient underwent a surgical treatment of sigmoid resection, but the punction of the abscesses revealed no pus at aspiration, making the surgical excision of the lesions unnecessary. After the surgery, during the antibiotic treatment, the patient developed pseudomembranous colitis treated with specific antibiotics. The evolution under this treatment was positive and the aspect of the liver lesions was improuved.     

Morphometric study of microvessels in primary CNS tumors and its correlation with tumor types and grade

IntroductionAlterations of microvasculature are integral to CNS neoplasia, and a diagnostic feature of high-grade gliomas. The objectives of this study were two fold: First, to correlate morphometrically measured microvessel density (MVD), microvessel caliber (VC), and percentage of total microvessel area (%TVA) with WHO histologic grade in various types of primary CNS tumors. Second, to evaluate if such a correlation could be further refined by using mathematical derivatives of measured parameters namely coefficient of variation of VC (COofVC), microvessel cross-sectional area (VCSA), and percentage of total VCSA (%TVCSA).Materials and methodsVarious microvessel parameters were assessed in a variety of 30 primary CNS tumors as consecutively encountered in routine surgical pathology practice including gliomas, meningiomas and others by image morphometry using CD34-immunostained sections. We introduced a novel method of effectively determining VC. Results were correlated with tumor type and grade. Appropriate statistical analysis was performed.ResultsMicrovessel characteristics, especially VC (p < 0.0022), VCSA (p < 0.0164), CVofVC (p < 0.0001), %TVCSA (p < 0.0002) and %TVA (p < 0.0003) of tumors were significantly greater than normal tissue. MVD increased in all tumors, excepting meningiomas, and was significantly higher in gliomas (p < 0.0062). MVD showed negative correlation with VC (r = ? 0.808) and VCSA (r = ? 0.848) in the normal brain but was less significant in tumors. Unlike tumors, caliber distribution of microvessels in normal brain was noted to follow a Gaussian pattern. Histological grades of tumors showed positive correlation with MVD (r = 0.547), VC (r = 0.606), CVofVC (r = 0.623), VCSA (r = 0.485), %TVCSA (r = 0.783) and %TVA (r = 0.603). Calculated scores, estimated from multiple regressions of vessel parameters, correlated well with histological grade, with S2 (calculated using all measured as well as mathematically derived microvessel parameters) being better than S1 (calculated using measured parameters: MVD and VC).ConclusionTumor grades positively correlated with all microvessel parameters, with %TVCSA displaying the best. The correlation of %TVA with tumor grade was weaker than %TVCSA mainly due to the impact of MVD. These findings emphasize the value of VC as effectively measured using our novel method and best illustrated by its derivative %TVCSA (an indicator of blood flow), in addition to the well-recognized value of MVD in tumor prognostication. Multiple regressions of microvessel parameters provided the best correlation with grade. Morphometric analysis of microvessels in CNS tumor facilitates a better understanding of the tumor grade, tumor progression and overall prognosis.