An unusual localization of mucormycosis diagnosed by fine needle aspiration cytology: a case report

Mucormycosis is an uncommon fungal infection, occurring mainly in patients with acidosis, chronic illnesses and malignancies. The most frequent site of involvement in patients of hematological malignancies is the respiratory tract. Isolated subcutaneous localization of mucormycosis in such patients is extremely rare. We report a case of a young patient of non-Hodgkin's lymphoma on chemotherapy who presented with a subcutaneous swelling on the anterior aspect of right thigh. Fine needle aspiration cytology (FNAC) smears from the swelling revealed numerous characteristic broad, irregularly contoured and pleomorphic hyphae of mucormycosis. This fungus seldom grows in culture and confirmation of the diagnosis depends on cytological or histological examination of infected tissues. Our case report documents a rare site of isolated mucormycosis infection and emphasizes the role of FNAC as a simple, rapid, accurate, and useful method of diagnosing fungal infections.     

Silencing of a metaphase I-specific gene results in a phenotype similar to that of the Pairing homeologous 1 (Ph1) gene mutations

Although studied extensively since 1958, the molecular mode of action of the Pairing homeologous 1 (Ph1) gene is still unknown. In polyploid wheat, the diploid-like chromosome pairing is principally controlled by the Ph1 gene via preventing homeologous chromosome pairing (HECP). Here, we report a candidate Ph1 gene (C-Ph1) present in the Ph1 locus, transient as well as stable silencing of which resulted in a phenotype characteristic of the Ph1 gene mutants, including HECP, multivalent formation, and disrupted chromosome alignment on the metaphase I (MI) plate. Despite a highly conserved DNA sequence, the C-Ph1 gene homeologues showed a dramatically different structure and expression pattern, with only the 5B copy showing MI-specific expression, further supporting our claim for the Ph1 gene. In agreement with the previous reports about the Ph1 gene, the predicted protein of the 5A copy of the C-Ph1 gene is truncated, and thus perhaps less effective. The 5D copy is expressed around the onset of meiosis; thus, it may function during the earlier stages of chromosome pairing. Along with alternate splicing, the predicted protein of the 5B copy is different from the protein of the other two copies because of an insertion. These structural and expression differences among the homeologues concurred with the previous observations about Ph1 gene function. Stable RNAi silencing of the wheat gene in Arabidopsis showed multivalents and centromere clustering during meiosis I.The Pairing homeologous 1 (Ph1) gene was discovered in 1958 based on the observation that plants lacking wheat chromosome 5B exhibit homeologous pairing (1, 2). Lack of the gene results in multivalents during metaphase I (MI) of meiosis, resulting in partial sterility. Conversely, six doses of the gene in the triisosomic line of chromosome 5BL resulted in interlocking of the bivalents and reduced chiasmata frequency even among homologs, along with rare multivalents (3). Several other genes promoting or suppressing homeologous chromosome pairing (HECP) have also been reported (4, 5), although their effect is difficult to measure in the presence of the Ph1 gene (6). Ph1-like genes were also reported in other sexually propagating polyploids, including Avena sativa, Festuca arundinacea, Brassica napus, Gossypium hirsutum, and Gossypium barbadense, as well as in some diploids, including Lolium perenne, Lolium multiflorum, and Lolium rigidum (7–11).Ph1 gene mutants in tetraploid (ph1c) (12, 13) and hexaploid (ph1b) (14) wheat were shown to be interstitial deletions involving an ∼0.84-μm region and an ∼1.05-μm region around the gene, respectively (15, 16) (SI Appendix, Fig. S1). Physical mapping localized the gene to an ∼2.5-Mb chromosomal region referred to as “Ph1 gene region,” bracketed by the distal breakpoint of ph1c deletion on the distal end and the breakpoint of deletion line 5BL-1 on the proximal end (16) (SI Appendix, Fig. S1). Various marker enrichment efforts identified nine markers for the region (17). Detailed microsynteny analyses and comparative mapping identified a 450-kb region of rice chromosome 9 (17). The corresponding rice region contained 91 genes. The major objective of the present study is to identify the gene(s) responsible for the Ph1 gene-like function using the available mapping information.     

Nodular hidradenoma arising on the site of a BCG scar

Hidradenomas are tumours that arise from the adnexal structures, both eccrine and apocrine and are histologically benign. The tumours that arise from eccrine differentiation are known as poroid hidradenomas and when they arise from the apocrine glands they are called nodular hidradenomas. In our centre a 13‐year‐old boy presented with a slow‐growing, painless erythematous fungating nodule on the left upper arm over a period of 18 months at the site of the BCG vaccination. The nodule was surgically excised and sent for histopathological examination, leading to a diagnosis of nodular hidradenoma. This case is presented to highlight its rarity, together with its clinical features that were suggestive of malignancy but proved ultimately to be benign.     

Current concepts in articular cartilage repair

Our knowledge of articular cartilage pathophysiology has advanced hugely in the last 20 years. Although once thought of as a structure incapable of intrinsic repair, we now have a selection of treatment options available in clinical practice, which we can use to attempt to reproduce the specific zonal architecture and mechanical composition of hyaline cartilage. This review will focus on the structure and function of articular cartilage, the aetiology of cartilage injury, and how the disease process can be investigated and treated. Different treatment options will be described providing an up to date review of the spectrum of treatment modalities, from the simple marrow stimulation techniques, to osteochondral transfer, chondrocyte transplantation and finally tissue engineering. Each will be illustrated with examples from the literature, providing a current concepts review on the outcomes following these repair strategies.     

Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion

Most of the small increased risk in pelvic inflammatory disease (PID) associated with the intrauterine contraceptive device (IUCD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion. This randomized clinical trial of 1813 women in Nairobi, Kenya, assessed the effectiveness of 200 mg of doxycycline given orally at the time of insertion in reducing the occurrence of PID. The rate of this infection in the doxycycline-treated group was 31% lower than that in the placebo-treated group (1.3 and 1.9%, respectively; RR 0.69; 95% CI 0.32 to 1.5). The rate of an unplanned IUCD-related visit to the clinic was also 31% lower in the doxycycline-treated group (RR 0.69; 95% CI 0.52 to 0.91). Although the significance level (P = 0.17) for the reduction is PID does not meet the conventional standard of 0.05, the results may be suggestive of an effect. Moreover, the reduction in IUCD-related visits (P = 0.004) not only represents an important decrease in morbidity but also substantiates the reduction found for PID. Further studies are needed to corroborate these results. Consideration should be given to the prophylactic use of doxycycline at the time of IUCD insertion as an approach to preventing PID and other IUCD-related morbidity.     

Effect of fundal pressure on maternal to fetal microtransfusion at the time of cesarean delivery

AIM: To determine if fundal pressure at the time of cesarean delivery increases the amount of transplacental microtransfusion from mother to infant. METHODS: Pregnant women undergoing cesarean delivery were randomized to the standard uterine fundal pressure at the time of hysterotomy versus no fundal pressure. Babies of patients randomized to no fundal pressure were delivered with either vacuum or forceps. The proportion of placental alkaline phosphatase between maternal and cord blood was then determined and compared between the groups. RESULTS: Eighty-four women were randomized into two groups (44 in the pressure and 40 in the no pressure groups). There was no difference between the groups in demographic variables, or indications for cesarean. There was no difference in percentage of umbilical cord blood placental alkaline phosphatase between the pressure and no pressure groups (0.06 +/- 0.2 vs 10 +/- 0.29 IU, P = 0.43). CONCLUSIONS: Fundal pressure at the time of cesarean delivery does not increase the amount of transplacental microtransfusion, suggesting that modifying the method of cesarean would not decrease the chances of vertical transmission in HIV positive pregnant women.     

Isolation of Chlamydia Trachomatis from fallopian tubes of healthy women undergoing tubal sterilisation by minlaparotomy in Kenya

A prospective study of 47 healthy women undergoing tubal sterilisation for contraception was undertaken to find out the rate of isolation of Chlamydia trachomatis from fallopian tubes of these individuals. Chlamydia trachomatis was isolated from the tubes in 7 (14.9%) out of 47 of them. The possible role of this pathogen in the aetiology of salpingitis in our population is discussed.