Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Hormone receptor (ER, PR, HER2/neu) status and proliferation index marker (Ki-67) in breast cancers: Their onco-pathological correlation, shortcomings and future trends

Estrogen receptor (ER) and progesterone receptor (PR) are hormone receptors found on breast cells that pick up hormone signals resulting in cell growth. Similarly, positive human epidermal growth factor receptor-2 (HER2/neu) status of the breast carcinoma means that HER2/neu gene is making too many HER2/neu proteins, which acts as receptors on the cell surface and helps the cells to grow and divide. Hormone receptor studies such as ER, PR, and HER2/neu are routinely done in breast carcinoma. It not only helps in the prognosis of the tumor but also helps in deciding its treatment. The goal of doing this receptor status is to provide right treatment to the right patient. This hormone receptor status is graded using Allred scoring and grading system. Depending on the hormone status, breast carcinomas can be divided into a number of different categories ranging from triple positive through triple negative. Another marker of proliferation (Ki-67) is also being used which is a proliferation index marker. This scoring system has its own limitation and shortcomings, which depends on a lot of pre- and post-analytical factors. Certain new techniques such as genomic assays, PAM50, and HALO screening test are being used nowadays for breast cancer detection

Paravertebral and epidural sarcoma with spinal cord compression in a child: Case report and review of the literature

Spinal cord compression is a rare but serious complication of malignancy in the children. Sarcoma presented with epidural mass, and spinal cord compression is very rare. We present a case of paraspinal and epidural rhabdomyosarcoma (RMS) causing acute spinal cord compression. Parents of an 18-month-old male child brought him with complaints that the child had difficulty in standing and he was unable to walk. There was a soft swelling on the upper back. Ultrasonography was done which showed a soft tissue mass. Radiograph also showed a swelling on the upper back. Magnetic resonance imaging was advised for further evaluation, and it was detected an epidural and left paraspinal mass which was causing severe spinal cord compression. Diagnosis of sarcoma was suggested; differential diagnosis of RMS and Ewing′s sarcoma was given. Biopsy was done, and it showed RMS. Partial excision of epidural mass was done, and then chemotherapy and radiotherapy was done

Cervical Lymph Node Metastasis: Unusual Presentation of Adenoid Cystic Carcinoma - Diagnosed By FNAC

Adenoid cystic carcinoma (ACC) is a rare neoplasm that usually arises from minor salivary glands. It is characteristically locally infiltrative, exhibiting perineural invasion, has a tendency for local recurrence and prolonged clinical course. A 60 year old male, chronic smoker presented with swelling of the left cervical lymph node since two months. Examination revealed a solitary firm, non tender, non mobile left cervical swelling measuring 2 x 1 cm. Fine Needle Aspiration Cytology (FNAC) was done from the cervical lymph node. The diagnosis of metastatic deposits of ACC was given. Detail examination of the oral cavity revealed a small swelling at the floor of the mouth. Biopsy of the swelling confirmed ACC on histopathological examination. An unusual feature of adenoid cystic carcinoma is the low incidence of metastases to regional lymph nodes. The case is presented to highlight its unusual presentation and utility of FNAC in rapid diagnosis

Unicentric Castleman disease at an unusual site

We report a rare case of unicentric Castleman disease (UCD) in a 56-year-old lady, presenting as a soft-tissue mass in an unusual site - mid-dorsal aspect of the arm. She was otherwise asymptomatic. Excision biopsy confirmed the diagnosis. The probable etiological factors, clinical and morphological types, and histological diagnosis are discussed

Platelet volume indices as predictive biomarkers for diabetic complications in Type 2 diabetic patients

BACKGROUND: Platelet volume indices (PVI) such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) are the indicators of increased platelet activity and can be considered as potential biomarkers for diabetic complications. PURPOSE: To study PVI in Type 2 diabetics with and without complications in comparison to nondiabetic patients MATERIALS AND METHODS: A case–control study was conducted on 300 Type 2 diabetics and 200 nondiabetics. Detailed clinical history regarding duration, hypertension, and complications was taken. PVI was obtained using automated cell counter. Fasting blood glucose, hemoglobin A1c, lipid profile, creatinine were also obtained. Diabetics were further categorized into patients with complications and without complications. Statistical analysis was performed by Statistical Package for the Social Sciences Version 17 (Chicago, IL) Student’s t-test and ANOVA test. RESULTS: Platelet count was significantly decreased in diabetics (P = 0.005). MPV was significantly increased in diabetic patients with complications as compared to diabetics without complications and nondiabetic group (P < 0.0001). PDW showed statistically significant difference between diabetics with and without complications and nondiabetics (P < 0.0001). However, no statistically significant difference was observed in platelet-large cell ratio (P-LCR) among all the three study groups. We found statistically significant correlation of MPV with diabetic retinopathy (P = 0.000), nephropathy (P = 0.005), and diabetic foot (P = 0.048). PDW was significantly increased in diabetic retinopathy (P = 0.035) and nephropathy (P = 0.007). P-LCR had no statistically significant correlation with diabetic complications. CONCLUSIONS: MPV and PDW are predictive biomarkers of diabetic vascular complications. They are more significant in microvascular complications than macrovascular complications

Amelanotic melanoma of the nasal mucosa: A rare case report

Melanomas develop due to malignant transformation of melanocytes, which are derived from the neuroectoderm. Although the majority of melanomas are cutaneous, they occasionally arise from extra-cutaneous tissues as well which contain melanocytes, such as uvea, leptomeninges, or the mucosa. Melanomas can be melanotic or amelanotic. Approximately, 15-20% of all malignant melanomas arise in head and neck region and over 80% of these involve the skin. Mucosal malignant melanomas are very rare and may affect the upper aero-digestive tract (UADT). Their incidence is approximately as low as 0.5-3% of all malignant melanomas. Majority of noncutaneous head and neck malignant melanomas affect the ocular origin and only 6-8% originate in the mucous membranes of the UADT. Nasal mucosal melanomas account for <1% of all melanomas and <5% of all nasal tract neoplasms. The incidence of amelanotic melanomas (AMs) has been estimated to be between 1.8 and 8.1% of all melanomas. We present a case of 62-year-old lady presenting with epistaxis and a mass in left nasal cavity, diagnosed as AM and managed by wide local excision and primary reconstruction in our institution

Extensive squamous metaplasia in a benign phyllodes tumor: A rare case report

Phyllodes tumors (PTs) with extensive squamous metaplasia is an uncommon biphasic fibroepithelial neoplasms of breast, comprising of <1% of all breast neoplasm′s. In this article, we report a case of a 55-year-old female patient admitted to the General Surgery Department with a rapidly enlarging, palpable mass in right breast. After histopathological examination, it was diagnosed to be as benign PT with extensive squamous metaplasia. Metaplastic changes are known, but infrequent in these tumors. Extensive squamous metaplasia within PT is rare and may occur in benign, borderline and malignant subtypes. There are only a few cases reported in the literature. We therefore, aimed to present this case in view of its extremely rare nature