Nevin Manimala

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):744-750. doi: 10.4103/ijpm.ijpm_357_22.

ABSTRACT

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is an uncommon form of primary liver carcinoma. It is heterogenous in terms of morphology, immunohistochemistry, radiology, and clinical features; making it a challenging entity for diagnosis.

AIMS: The purpose of the present study was to evaluate clinicopathological characteristics of patients with cHCC-CCA.

SETTINGS AND DESIGN: Retrospective observational study.

MATERIALS AND METHODS: The patients diagnosed with cHCC-CC were identified from hepatic surgical specimens and were evaluated.

STATISTICAL ANALYSIS: Survival was estimated as per Kaplan-Meier method.

RESULTS: Out of six patients, five had undergone resection while one had liver transplant. Five were male and one was female and the mean age was 52 years. Tumor markers revealed raised serum alfa-fetoprotein and CA19.9 in four and three patients, respectively. Five of the liver specimens were cirrhotic. Diagnosis was predominantly based on tumor morphology. All cases were of Allen and Lisa type B and cHCC-CCA as per WHO (2019) classification. Stem cell features <5% were noted in two cases. Immunohistochemistry for programmed death 1/programmed death ligand 1 (PD1/PDL1) was negative in both the hepatocellular and cholangiocellular components in all six cases. Mismatch repair (MMR) protein expression was retained in two and deficient in four cases. The median follow-up after surgery was 21.3 months (range, 5-46.2 months). Five patients had intrahepatic and/or extrahepatic recurrence on follow-up after surgery. The median recurrence-free survival was estimated at 13.1 months (95% CI 5.67-20.6). Three patients had received salvage treatment. The median overall survival was estimated at 20 months (95% CI 0-45.3).

CONCLUSIONS: The present study highlights the role of morphology in the diagnosis of cHCC-CCA. The choice of locoregional and/or systemic therapy after surgery may be individualized based on the clinicopathological characteristics.

PMID:38084526 | DOI:10.4103/ijpm.ijpm_357_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):740-743. doi: 10.4103/ijpm.ijpm_528_22.

ABSTRACT

BACKGROUND: Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy.

AIMS: To study the pathological features of SPE at autopsy.

MATERIALS AND METHODS: Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy.

STATISTICAL ANALYSIS: Nil.

RESULTS: According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis.

CONCLUSION: Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications.

PMID:38084525 | DOI:10.4103/ijpm.ijpm_528_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):732-739. doi: 10.4103/ijpm.ijpm_178_22.

ABSTRACT

BACKGROUND: The information on the pathophysiology of infection in high-risk contacts of SARS-CoV-2 is limited.

AIMS: The aim of the present study was to assess the various factors and their elucidation in the protection of SARS- CoV-2 infection in high-risk contacts.

SETTINGS AND DESIGN: Cross-sectional descriptive clinical study.

MATERIALS AND METHODS: A total of 136 subjects were recruited in the present study including 100 high-risk subjects and 36 control subjects. Out of 100 high-risk subjects, 44 subjects were found positive for SARS-CoV-2 RNA. Further, absolute blood counts of total T-cells (CD3+), T-helper cells (CD4+), T-cytotoxic cells (CD8+), B lymphocytes (CD19+) Natural Killer (NK) Cells (CD16+, CD56+), cytokines, and other parameters were measured in the samples of study subjects.

STATISTICAL ANALYSIS USED: The continuous variables were analyzed by unpaired ‘t’ test, analysis of variance and ‘Tukey test’ for multiple comparisons.

RESULTS: A significant reduction of total leukocyte counts and absolute lymphocyte count was found in the acute SARS-CoV-2 positive group as compared to control group (<0.05). Interestingly, IL-4 level was significantly elevated in SARS-CoV-2 negative high-risk subjects as compared to control and acute SARS-CoV-2 positive group (p < 0.05). A significant decrease of T-cytotoxic, B-cells, and NK cells were found in acute SARS-CoV-2 positive subjects as compared to control groups.

CONCLUSION: The findings of this study may augment our knowledge about the pathogenesis of SARS-CoV-2 infection that could help in making future strategies to control its infection.

PMID:38084524 | DOI:10.4103/ijpm.ijpm_178_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):727-731. doi: 10.4103/ijpm.ijpm_99_22.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy and is the most common metabolic complication of pregnancy. Significant maternal and fetal complications can result from undiagnosed or inadequately treated GDM.

AIM: To investigate the difference in the expression of the CD-68 marker in the Hofbauer cells (HCs) and their distribution within the villi in the placentas of diabetic and non-diabetic mothers.

MATERIALS AND METHODS: Sixty placentas were included in the study, 30 as controls and 30 from mothers with diagnosed GDM as cases. Full-thickness cross sections of placentas were obtained. Tissue processing was done, followed by haematoxylin and eosin (H&E). A study of CD68 markers (placental macrophages) was done using standard protocols of immunohistochemistry.

STATISTICAL ANALYSIS: Frequencies and percentages of Hofbauer cells (HCs) found in case and control placental tissue were calculated. Student’s t-test was used to compare two groups using SPSS 13.0 software. When P is 0.0001, differences were considered statistically significant.

RESULTS AND CONCLUSION: We studied the distribution and number of fetal macrophages (CD68+) in diabetic and non-diabetic placentas. The immunostained CD68+ cell count was identified to be significantly higher in the GDM placenta. In relation to fetal blood vessels in the villus stroma of the GDM placenta in comparison to control, CD68+ cells were found more frequently. This study shows a significant increase in the number of Hofbauer cells in the placenta of mothers with GDM in comparison to control (P < 0.0001). An increase in macrophages in these placentae might be related to the protective mechanism against inflammation. Further studies are required to investigate the mechanism in detail.

PMID:38084523 | DOI:10.4103/ijpm.ijpm_99_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):720-726. doi: 10.4103/ijpm.ijpm_95_22.

ABSTRACT

BACKGROUND: Bladder cancer, the most common malignancy of the urinary tract is a leading cause of morbidity and mortality. But cystoscopy, which is till now the mainstay of screening, is an invasive, high-cost method with low sensitivity especially for flat lesions.

AIM: To find a non-invasive and effective screening method with liquid-based cytology (LBC) using The Paris System (TPS) and CK20 immunocytochemistry.

MATERIALS AND METHODS: It was a prospective study including the patients with clinical or cystoscopic diagnosis of urinary bladder space occupying lesions (SOL). Both conventional (CC) and liquid-based cytology slides were prepared from urine samples. Slides were evaluated by two trained pathologists and categorized according to TPS guidelines. CK20 immunocytochemistry (ICC) was also performed. Consequent formalin-fixed paraffin embedded sections were blindly examined by another pathologist and was taken as gold standard for comparison.

STATISTICAL ANALYSIS: All the statistical analysis were done using MedCalc version 15.8 [Mariakerke, Belgium: MedCalc Software 2015].

RESULTS: The study included 150 cases with a mean age of 62.4 years. Five cases revealed unsatisfactory smears. Rest of the cases were categorized as the following: 18.1% as NH-GUC, 8% as LGUN, 22.1% as AUC, 15.4% as SH-GUC, 32.9% as HGUC. Kappa value of CC and LBC were strong (0.854). LBC alone showed very low specificity (58%) and PPV (74.8%) which improved on application of ICC (specificity: 97.4%, PPV: 96.3%).

CONCLUSION: We conclude that CK20 ICC offers potential for accurate, non-invasive detection and surveillance of bladder cancer and is a better tool when combined with liquid-based cytology, reported using The Paris System.

PMID:38084522 | DOI:10.4103/ijpm.ijpm_95_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):697-701. doi: 10.4103/ijpm.ijpm_720_22.

ABSTRACT

BACKGROUND AND AIM: Hematoxylin and Eosin (H and E) staining is a common and routine staining method used in Histopathology. In origin, Hematoxylin is natural and Eosin is a synthetic dye. Synthetic dyes are widely accepted due to its staining efficiency. However, due to synthetic and toxic properties, natural alternatives have gained importance. In this present study, Curcuma Longa rhizome (Turmeric) extract with and without mordant are examined as a natural substitute for Eosin in H and E staining. This study assessed the staining quality of Turmeric (H and T) compared to Eosin (H and E) and the significance of mordant in H and T staining.

MATERIALS AND METHODS: A comparative study is conducted in a Histopathology laboratory in a tertiary care hospital. Five tissue specimens were collected and stained with H and T with mordant, H and T without mordant, and conventional H and E stain. Two independent pathologists examined the quality of each stain. The results are graded as excellent, good, and poor. These results are statistically compared and analyzed.

RESULT: Staining quality of Turmeric and Eosin are comparable to each other. At the same time, Turmeric gives yellow color instead of pink in Eosin. The result also shows that the addition of mordant in Turmeric significantly improves the staining quality.

INTERPRETATION AND CONCLUSION: Turmeric with mordant can be used as an alternative stain to synthetic Eosin in H and E staining.

PMID:38084518 | DOI:10.4103/ijpm.ijpm_720_22

BMJ Glob Health. 2023 Dec 7;8(12):e013509. doi: 10.1136/bmjgh-2023-013509.

ABSTRACT

OBJECTIVES: Multimorbidity (MM) is a growing concern linked to poor outcomes and higher healthcare costs. While most MM research targets European ancestry populations, the prevalence and patterns in African ancestry groups remain underexplored. This study aimed to identify and summarise the available literature on MM in populations with African ancestry, on the continent, and in the diaspora.

DESIGN: A scoping review was conducted in five databases (PubMed, Web of Science, Scopus, Science Direct and JSTOR) in July 2022. Studies were selected based on predefined criteria, with data extraction focusing on methodology and findings. Descriptive statistics summarised the data, and a narrative synthesis highlighted key themes.

RESULTS: Of the 232 publications on MM in African-ancestry groups from 2010 to June 2022-113 examined continental African populations, 100 the diaspora and 19 both. Findings revealed diverse MM patterns within and beyond continental Africa. Cardiovascular and metabolic diseases are predominant in both groups (80% continental and 70% diaspora). Infectious diseases featured more in continental studies (58% continental and 16% diaspora). Although many papers did not specifically address these features, as in previous studies, older age, being women and having a lower socioeconomic status were associated with a higher prevalence of MM, with important exceptions. Research gaps identified included limited data on African-ancestry individuals, inadequate representation, under-represented disease groups, non-standardised methodologies, the need for innovative data strategies, and insufficient translational research.

CONCLUSION: The growing global MM prevalence is mirrored in African-ancestry populations. Recognising the unique contexts of African-ancestry populations is essential when addressing the burden of MM. This review emphasises the need for additional research to guide and enhance healthcare approaches for African-ancestry populations, regardless of their geographic location.

PMID:38084495 | DOI:10.1136/bmjgh-2023-013509

J Clin Periodontol. 2023 Dec 12. doi: 10.1111/jcpe.13911. Online ahead of print.

ABSTRACT

AIM: To assess the impact of the timing of implant placement following alveolar ridge preservation (ARP) on the need for soft-tissue augmentation (STA) and to identify the risk factors for horizontal and vertical soft-tissue loss.

MATERIALS AND METHODS: Patients with a single failing tooth in the anterior maxilla (15-25) were treated at six centres. Following tooth extraction, they were randomly allocated to the test group (immediate implant placement, IIP) or control group (delayed implant placement, DIP). ARP was performed in both groups and implants were immediately restored with an implant-supported provisional crown. Six months after tooth extraction and ARP, a panel of five blinded clinicians assessed the need for STA on the basis of anonymized clinical pictures and a digital surface model. Lack of buccal soft-tissue convexity and/or mid-facial recession qualified for STA. Pre-operative and 6-month digital surface models were superimposed to assess horizontal and vertical soft-tissue changes.

RESULTS: Thirty patients were included per group (test: 20 females, 10 males, mean age 53.1; control: 15 females, 15 males, mean age 59.8). The panel deemed STA as necessary in 24.1% and 35.7% of the cases following IIP and DIP, respectively. The difference was not statistically significant (odds ratio [OR] = 1.77; 95% confidence interval [CI] [0.54-5.84]; p = .343). Loss of buccal soft-tissue profile was higher following DIP (estimated mean ratio = 1.66; 95% CI [1.10-2.52]; p = .018), as was mid-facial recession (mean difference [MD] = 0.47 mm; 95% CI [0.12-0.83]; p = .011). Besides DIP, regression analysis identified soft-tissue thickness (-0.57; 95% CI [-1.14 to -0.01]; p = .045) and buccal bone dehiscence (0.17; 95% CI [0.01-0.34]; p = .045) as additional risk factors for mid-facial recession. Surgeons found IIP significantly more difficult than DIP (visual analogue scale MD = -34.57; 95% CI [-48.79 to -20.36]; p < .001).

CONCLUSIONS: This multi-centre randomized controlled trial failed to demonstrate a significant difference in the need for STA between IIP and DIP when judged by a panel of blinded clinicians. Based on objective soft-tissue changes, patients with thin buccal soft tissues, with a buccal bone dehiscence and treated with a delayed approach appeared particularly prone to soft-tissue loss.

PMID:38084405 | DOI:10.1111/jcpe.13911

Geriatr Gerontol Int. 2023 Dec 12. doi: 10.1111/ggi.14755. Online ahead of print.

ABSTRACT

AIM: Multiple risk factors are involved in geriatric syndrome (GS) occurring in older adults. Although drug therapy often contributes to GS, the specific causes among older adults in Japan remain unclear. In this study, we examined the possible prescribing cascade rate among older outpatients eligible for Late-stage Elderly Health Insurance and elucidated the differences between GS and GS associated with medication (GSAM) trends.

METHODS: This retrospective study enrolled patients from health insurance claims data in Japan between October 2018 and March 2019; hospitalized patients were excluded. Two groups were identified among the participants with GS: GS (no use of GS-causing medications) and possible-GSAM (p-GSAM; use of GS-causing medications). The collected data were analyzed using the Bell Curve for Excel, and statistical significance was set at P < 0.05.

RESULTS: In total, 137 781 outpatients were enrolled. Of the 32 259 outpatients who did not use GS-causing medications, 7342 were classified into the GS group. Among 105 522 outpatients who used GS-causing medications, 8347 were classified as having p-GSAM. The mean number of prescriptions was significantly higher in the p-GSAM group than in the GS group (P < 0.01). Furthermore, all GS symptoms showed significant differences, with impaired appetite being the most prevalent in the p-GSAM group than in the GS group (P < 0.01). A possible prescribing cascade was suspected in 2826 (33.9%) of 8347 outpatients in the p-GSAM group.

CONCLUSION: Impaired appetite in patients taking GS-causing medications might lead to prescribing cascades. Further studies are needed to prevent such prescribing cascades. Geriatr Gerontol Int 2023; ••: ••-••.

PMID:38084388 | DOI:10.1111/ggi.14755

Health Psychol Rep. 2021 Dec 2;10(1):37-46. doi: 10.5114/hpr.2021.111297. eCollection 2022.

ABSTRACT

BACKGROUND: The objective of this study was to analyse the relationships between anxiety, depression and quality of life in cancer patient-caregiver dyads during the first 6 months after the diagnosis using the actor-partner interdependence model (APIM).

PARTICIPANTS AND PROCEDURE: Sixty-seven cancer patient-caregiver dyads completed the following questionnaires in a prospective longitudinal design, with two assessment points at a 6month interval, T1 (45-60) and T2 (180-200 days after diagnosis): the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey Questionnaire (SF-36). Descriptive statistics, t-test and bivariate correlations were applied. The APIM was used to analyse the influence of anxiety and depression (T1) on own (actor effect) and partner (partner effect) quality of life in T2.

RESULTS: The results did not reveal any differences between T1 and T2 in anxiety and depression in caregivers and patients. Assessing the differences between T1 and T2 with respect to quality of life, the caregiver results showed an improvement in physical functioning and bodily pain, but lower social functioning and mental health scores. For patients, significantly lower scores were observed in general health and vitality scores. Dyadic analysis showed an actor effect of anxiety and depression on most of the quality of life domains and a partner effect in caregiver depression (T1) and general health in patients (T2).

CONCLUSIONS: The early assessment of anxiety and depression may help to prevent declines in quality of life in the first few months following a diagnosis of cancer in patient-caregiver dyads.

PMID:38084368 | PMC:PMC10501425 | DOI:10.5114/hpr.2021.111297