Acinic Cell Carcinoma with Extensive Neuroendocrine Differentiation: A Diagnostic Challenge

Primary salivary gland carcinoma with neuroendocrine differentiation is of rare occurrence, especially so in the parotid gland. Amongst the various reported primary tumors with neuroendocrine differentiation, acinic cell carcinoma (ACC) one such tumor. A 48 year old lady presented with a gradually increasing right infra-auricular swelling for a period of 1 year which enlarged suddenly in a short period. Contrast Enhanced Computed Tomography (CECT) suggested diagnosis of Pleomorphic Adenoma. Fine Needle Aspiration Cytology (FANC) yielded a cystic fluid suggesting a possibility of Warthin’s tumor or Oncocytic lesion. Intraoperative findings were suggestive of a Warthin’s tumor. Initial histopathological examination of the tumor was suggestive of neuroendocrine carcinoma. However, extensive sectioning revealed peripheral islands of ACC. Immunoexpression of S-100, Neuron specific Enolase (NSE), Chromogranin A and Synaptophysin confirmed the diagnosis. The possibility of neuroendocrine differentiation in a primary salivary gland tumor should be kept in mind whenever a salivary gland tumor shows only neuroendocrine histology.     

Agreement between CBNAAT,liquid culture and line probe assay for detection of Mycobacterium tuberculosis and anti-tubercular drug resistance in extrapulmonary samples

PurposeCartridge based nucleic acid amplification test (CBNAAT) has been endorsed by the WHO as the screening test for diagnosing extrapulmonary tuberculosis (EPTB). In the present study we report the agreement between CBNAAT (Xpert MTB/RIF), liquid culture (LC) and line probe assay (LPA) for diagnosis of Mycobacterium tuberculosis and detection of drug resistance among EPTB cases.MethodsThe EP samples were subjected to CBNAAT (Xpert MTB/RIF, Cepheid, USA) and wherever possible, to LC (MGIT 960, Becton Dickinson, USA) followed sequentially by first line and second line-LPA (FL-LPA, SL-LPA, Hain Lifescience, Germany) on the isolates.ResultsTotal 566/4080 (13.9%) EP samples were detected positive for M. tuberculosis on CBNAAT. Aspirates from lymph nodes were most often positive (11/30; 36.6%), followed by pus (240/873; 27.5%) and CSF samples (166/104; 15.8%). The detection of M. tuberculosis was more in adults than children except in tissue biopsy samples. Rifampicin resistance was also higher among adults except CSF in which resistance was more in children. Total 185 of 566 (32.7%) CBNAAT positive and 770 of 3510 (21.9%) CBNAAT negative samples could be cultured of which 110/185 (59.4%) and 33/770 (4.3%) respectively turned positive. FL-LPA and SL-LPA of 143 culture isolates showed that 27 isolates had drug resistance, of which 3 (2.1%) were XDR, 11 (7.7%) were Pre-XDR (FQ) and 13 (9.1%) were MDR. Of these 27 resistant isolates, 12 were negative by CBNAAT and two were mislabeled as Rifampicin sensitive or indeterminate based on the unique RpoB gene mutation patterns on LPA. The positive and negative agreements between LC and CBNAAT for detection of M. tuberculosis were 67.1% and 92.7% respectively and between LPA and CBNAAT for rifampicin resistance detection were 98.9% and 92.9% respectively.ConclusionsFor EPTB, CBNAAT should be accompanied with LC wherever possible irrespective of the CBNAAT result.     

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P<0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.     

Twitter sentiment analysis for COVID-19 associated mucormycosis

Purpose:COVID-19-associated mucormycosis (CAM) was a serious public health problem during the second wave of COVID-19 in India. We planned to analyze public perceptions by sentiment analysis of Twitter data regarding CAM.Methods:In this observational study, the application programming interface (API) provided by the Twitter platform was used for extracting real-time conversations by using keywords related to mucormycosis (colloquially known as “black fungus”), from May 3 to August 29, 2021. Lexicon-based sentiment analysis of the tweets was done using the Vader sentiment analysis tool. To identify the overall sentiment of a user on any given topic, an algorithm to label a user “k” based on their sentiments was used.Results:A total of 4,01,037 tweets were collected between May 3 and August 29, 2021, and the peak frequency of 1,60,000 tweets was observed from May 17 to May 23, 2021. Positive sentiment tweets constituted a larger share as compared to negative sentiment tweets, with weekly variations. A temporal analysis of the demand for utilities showed that the demand was high in the initial period but decreased with time, which was associated with the availability of resources.Conclusion:Sentiment analysis using Twitter data revealed that social media platforms are gaining popularity to express one’s emotions during the ongoing COVID-19 pandemic. In our study, time-based assessment of tweets showed a reduction over time in the frequency of negative sentiment tweets. The polarization in the retweet network of users, based on sentiment polarity, showed that the users were well connected, highlighting the fact that such issues bond our society rather than segregating it.     

Normative database for Spaeth Richman contrast sensitivity test for Indian eyes

Purpose:To ascertain normative database of contrast sensitivity (CS) using Spaeth/Richman CS test (SPARCS) in the Indian population.Methods:This cross-sectional study enrolled 200 healthy individuals, and CS was tested in both eyes of each participant using SPARCS. A detailed ocular examination was done before enrollment to rule out pathologies that may affect CS. A practice test was performed in the right eye (OD), followed by uniocular testing in each eye and a final binocular test.Results:Data of 400 eyes of 200 subjects who fulfilled the inclusion criteria was evaluated. The average age of subjects was 46.57 ± 16.77 years (range 21–79 years), with a slight female preponderance (53%, n = 106). A statistically significant decline in average SPARCS scores was noted with increasing age (P < 0.05), ranging from 86.68 (20–29 years age group) to 67.44 (70–79 years age group). Higher scores were noted in binocular testing than uniocular testing (Interclass correlation coefficient [ICC] = 0.83; P < 0.001). Females achieved statistically significant higher total scores in uniocular SPARCS testing (both OD and OS), but there was no significant difference noted between the two genders in binocular testing. Correlation between practice and main tests was statistically Significant with an interclass correlation coefficient of 0.54 (P < 0.001).Conclusion:Normative database for SPARCS was established for Indian eyes, with a decreasing trend noted in peripheral as well as central CS scores with increasing age.     

Enhancement of paclitaxel and carboplatin therapies by CCL2 blockade in ovarian cancers

Ovarian cancer is associated with a leukocyte infiltrate and high levels of chemokines such as CCL2. We tested the hypothesis that CCL2 inhibition can enhance chemotherapy with carboplatin and paclitaxel. Elevated CCL2 expression was found in three non‐MDR paclitaxel resistant ovarian cancer lines ES‐2/TP, MES‐OV/TP and OVCAR‐3/TP, compared to parental cells. Mice xenografted with these cells were treated with the anti‐human CCL2 antibody CNTO 888 and the anti‐mouse MCP‐1 antibody C1142, with and without paclitaxel or carboplatin. Our results show an additive effect of CCL2 blockade on the efficacy of paclitaxel and carboplatin. This therapeutic effect was largely due to inhibition of mouse stromal CCL2. We show that inhibition of CCL2 can enhance paclitaxel and carboplatin therapy of ovarian cancer.