A case of concomitant connective tissue disorder and thrombotic thrombocytopenic purpura in an Indian middle aged female

Thrombotic thrombocytopenia (TTP) is a rare disease which is rarely present in adults. Adults usually have an acquired version of disease, associated with some underlying autoimmune disease. There has been paucity of literature about reports which shows the coexistence of connective tissue disorder in patients of acquired TTP. This is a case report of a female who presented with vague symptoms of breathlessness, abdominal pain and petechial rashes and was diagnosed as TTP, developed neurological complications but was stabilized by timely management through plasma exchanges and steroids. 

Escherichia coli mono articular septic arthritis of shoulder joint in an elderly female

Septic arthritis of the shoulder joint is a very rare entity to encounter in clinical practice. Escherichia coli (E. coli) pathogen isolation is only seen to occur in individuals with multiple comorbidities. We report a similar case of gram-negative E. coli urosepsis in a veteran female that transmitted hematogenously to the shoulder joint and how a prompt diagnosis and treatment prevented extension and damage of the joint space.

Influence of Growth Regulators and Explant on Plant Regeneration in Tomato

Influence of different growth regulators was studied on in vitro growth and regeneration of tomato (Solanum esculentum) explants derived from hypocotyls and cotyledons of aseptically grown seedlings. On the basis of regeneration frequency, number of shoot primordia and shoots produced per explants, it is concluded that the best regeneration is achieved on Murashige and Skoog (MS) medium supplemented with 0.5 mg L"1 of indole-3-acetic acid and 1.0 mg L"1 zeatin. In all the genotypes studied, a good percentage of regeneration frequency was observed in hypocotyl explants used

Lupus with myositis in an adult Indian male

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves various organs and has a vast spectrum of multi system involvement. SLE is an autoimmune illness which is rarely found in males but when present holds a poor prognosis with a predisposition to develop various manifestations. This case involves a 50-year-old male who developed myositis as a complication of lupus despite adequate immunosuppressive therapy.

Massive pulmonary embolism – what you may be missing?

Our patient is a 68-year-old woman with no known comorbid illnesses, who presented with fever, cough and haemoptysis of 20-days duration. The fever was insidious in onset, intermittent, high grade and was associated with productive cough. There were intermittent episodes of scoughing up of blood-tinged sputum mixed with clots. She was evaluated at another centre and was diagnosed with a pulmonary embolism based on a computed tomographic imaging of the thorax. When she presentation to us, she was hemodynamically stable and her systemic examination was within normal limits. Her computed tomography (CT) scan were reviewed and she was labelled to have an intermediate risk pulmonary embolism. She was initiated on Injection enoxaparin and was simultaneously evaluated for the aetiology of her illness wherein an USG guided supraclavicular lymph node biopsy lead to a diagnosis of extrapulmonary tuberculosis. She was initiated on first line ATT and was discharged on the same. Anticoagulation was continued on discharge. She is currently doing well on follow up. Our objective is to shed light on the association between tuberculosis and pulmonary embolism and to emphasize the need for a thorough evaluation to identify an occult infective focus in patients presenting with venous thromboembolism

Morphological and Biochemical Characterization of Chrysanthemum

Ten large flowered chrysanthemum cultivars, viz., 'Beat Rice May', 'Beauty', 'Casa Grande', 'Jet Snow', 'John Weber' , 'Miss Maud Jeffries', 'Penny Lane', 'Shanker Dayal', 'Snow Ball' and 'S.S. Arnold' from National Botanical Research Institute (NBRI), Lucknow, were evaluated for morphological and biochemical characterization. Morphological data were recorded on vegetative and floral characters. Biochemical characterization included analysis of anthocyanins, carotenoides, chlorophyll content (chlorophyll a, b and total) and flavonoids. Results on morphological and biochemical parameters clearly indicated distinctness among cultivars with reference to differences in morphological characters and chemical composition of pigments

Fatal familial hemophagocytic lymphohistiocytosis with perforin gene (PRF1) mutation and EBV-associated T-cell lymphoproliferative disorder of the thyroid

Familial hemophagocytic lymphohistiocytosis (FHL) is a rare fatal autosomal recessive disorder of immune dysregulation. The disease presents most commonly in the first year of life; however, symptomatic presentation throughout childhood and adulthood has also been identified. Biallelic mutation in the perforin gene is present in 20%–50% of all cases of FHL. Secondary hemophagocytic lymphohistiocytosis (HLH) in association with hematological malignancies is known; however, whether mutations in HLH-associated genes can be associated with FHL and hematolymphoid neoplasms is not well documented. Also, Epstein–Barr-virus- (EBV) positive systemic T-cell lymphoproliferative disease (SE-LPD) in the setting of FHL is not clearly understood. Here, we present the case of a young boy who presented with typical features of childhood FHL harboring the perforin gene (PRF1) mutation, and had SE-LPD diagnosed on autopsy, along with evidence of recent EBV infection. The patient expired due to progressive disease. Five siblings died in the second or third decade of life with undiagnosed disease. Genetic counseling was provided to the two surviving siblings and parents, but they could not afford genetic testing. One surviving sibling has intermittent fever and is on close follow-up for possible bone marrow transplantation

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

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

A Population-Based Study to Evaluate the Associations of Nodal Stage, Lymph Node Ratio and Log Odds of Positive Lymph Nodes with Survival in Patients with Small Bowel Adenocarcinoma

Purpose: This study aimed to determine the real-world prognostic significance of lymph node ratio (LNR) and log odds of positive lymph nodes (LOPLN) in patients with non-metastatic small bowel adenocarcinoma. Methods: Patients diagnosed with early-stage small bowel adenocarcinoma between January 2007 and December 2018 from a large Canadian province were identified. We calculated the LNR by dividing positive over total lymph nodes examined and the LOPLN as log ([positive lymph nodes + 0.5]/[negative lymph nodes + 0.5]). The LNR and LOPLN were categorized at cut-offs of 0.4 and −1.1, respectively. Multivariable Cox proportional hazards models were constructed for each nodal stage, LNR and LOPLN, adjusting for measured confounding factors. Harrell’s C-index and Akaike’s Information Criterion (AIC) were used to calculate the prognostic discriminatory abilities of the different models. Results: We identified 141 patients. The median age was 67 years and 54.6% were men. The 5-year overall survival rates for patients with stage I, II and III small bowel adenocarcinoma were 50.0%, 56.6% and 47.5%, respectively. The discriminatory ability was generally comparable for LOPLN, LNR and nodal stage in the prognostication of all patients. However, LOPLN had higher discriminatory ability among patients with at least one lymph node involvement (Harrell’s C-index, 0.75, 0.77 and 0.82, and AIC, 122.91, 119.68 and 110.69 for nodal stage, LNR and LOPLN, respectively). Conclusion: The LOPLN may provide better prognostic information when compared to LNR and nodal stage in specific patients