Cryptococcal immune reconstitution syndrome during steroid withdrawal treated with hydroxychloroquine

SummaryWe present a case report of cryptococcal immune reconstitution syndrome (IRS), in a non HIV infected patient, which we treated with hydroxychloroquine with successful results. We briefly review cryptococcal IRS, possible mechanisms of action of hydroxychloroquine as an immunomodulatory agent, and its potential role in management of IRS

Prospective study of histopathological patterns of ovarian tumours in a tertiary care centre

Background:Ovarian tumours account for 3% of all cancers amongst women, being the second most common cancer of the female genital tract. The ovarian tumours are highly heterogenous with a wide range of histological patterns. Aim of current study was to study the histological patterns and the age incidence of the ovarian tumours in our institute.Methods:The present study is a prospective study conducted in the department of pathology, Andhra Medical College, from August 2011 to July 2013.Results:We received a total of 267 specimens of ovarian tumours during this period, out of which, 263 were primary and 4 were secondary tumours. Benign tumours were 209 (78.3%), borderline were 10 (3.7%) and malignant were 48 (18%) in numbers. Overall surface epithelial tumours constituted the majority of tumours accounting for 214 (80.2%) cases, followed by germ cell tumours 38 (14.2%) and sexcord stromal tumours 11 (4.1%). The single most common tumour diagnosed was serous cystadenoma. The most common malignant tumour was serous cystadenocarcinoma. The age groups affected ranged from 11-70 years. The peak age incidences for different histological types were as follows: surface epithelial tumours: 21-50 years, germ cell tumours: 21-30 years, sexcord stromal tumours: 51-60years. Benign tumours were more common in 21-40 years of age, borderline in 31-50 years and malignant tumours in 41-50 years age group.Conclusion:The results from our study were comparable with those reported in literature; however malignant serous and mucinous tumours showed a lower peak age incidence in our study. Krukenberg tumours also occurred in younger age group in our study.

Cytohistopathological and immunohistochemical correlation of soft tissue tumors

Background: Fine needle aspiration cytology has become an established tool in the diagnostic armamentarium of many clinical practices. The initial diagnosis of many mass lesions, both superficial and deep-seated, can often be readily and safely assessed by fine needle aspiration cytology. In our study, we assessed 361 cases of soft tissue tumors by fine needle aspiration cytology during a period of three years. We tried to follow up as many cases as possible to obtain corresponding excision biopsies for histopathological examination. Immunohistochemical studies were also performed on biopsy sections in some cases for confirmation of diagnoses. Aims and objectives: 1) To study the age, sex and site-wise distribution of soft tissue tumors. 2) To assess the utility of fine needle aspiration cytology in diagnosing various types of soft tissue tumors. 3) To assess the sensitivity, specificity, positive and negative predictive values, and overall histological correlation percentage of fine needle aspiration cytology in diagnosing soft tissue tumors.Methods: Aspirations were carried out using a 22 gauge disposable needle and a 10c.c disposable syringe for suction. Wet-fixed smears were stained with hematoxylin and eosin and pap stain. Dry-fixed smears were stained with May-Grunwald Giemsa stain. Periodic Acid Schiff stain was used in some cases of extraskeletal Ewing’s sarcoma. Corresponding biopsy sections were stained with hematoxylin and eosin. Immunohistochemical stains were also used in some of the cases for confirmation of diagnosis.Results: Of the 361 cases recorded in our study, 320 patients could be successfully followed up and excision biopsies were obtained. The remaining 41 patients were excluded from the study due to inability to obtain biopsy. Of the 320 cases, 200 were diagnosed as benign soft tissue tumors, while 120 were diagnosed as malignant on cytological examination. The median age of occurrence of benign soft tissue tumors was 34.23years, while that of malignant soft tissue tumors was 48.33years. Prevalence was highest in the age group of 20-49years, during which majority were benign lesions. Soft tissue tumors were more common in the lower extremities with predominant benign tumors, while malignant tumors were more common in the trunk. Sexwise distribution showed a male:female ratio of 1.76:1. Various patterns were observed in cytology. The commonest tumors were lipomas (55%), followed by benign peripheral nerve sheath tumors (37%). Malignant soft tissue tumors constituted 37.5% cases, among which malignant fibrous histiocytoma was the most frequent tumor. Soft tissue sarcomas were classified into 5 general categories on the basis of predominant appearance in aspiration smears: I. Myxoid II. Spindle cell III. Pleomorphic IV. Polygonal V. Round cell. Immunohistochemical studies were done for some tumors with vimentin, desmin, S-100 protein and Neuron Specific Enolase (NSE), Leucocyte Common Antigen (LCA), cytokeratin (CK) and Epithelial Membrane Antigen (EMA). A comparative analysis was done between the cytology report and histopathology.Conclusion: Final evaluation of the results showed that the diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors  was 96.88%, sensitivity was 95.08% and specificity was 97.98%.Thus our study proves the efficacy of fine needle aspiration cytology in the diagnosis of soft tissue tumors as a useful cost-effective procedure.

Student understanding of rotational and rolling motion concepts

We investigated the common difficulties that students have with concepts related to rotational and rolling motion covered in the introductory physics courses. We compared the performance of calculus- and algebra-based introductory physics students with physics juniors who had learned rotational and rolling motion concepts in an intermediate level mechanics course. Interviews were conducted with six physics juniors and ten introductory students using demonstration-based tasks. We also administered free-response and multiple-choice questions to a large number of students enrolled in introductory physics courses, and interviewed six additional introductory students on the test questions (during the test design phase). All students showed similar difficulties regardless of their background, and higher mathematical sophistication did not seem to help acquire a deeper understanding. We found that some difficulties were due to related difficulties with linear motion, while others were tied specifically to the more intricate nature of rotational and rolling motion.Comment: 23 pages, 3 figures, 2 tables; it includes a multiple-choice test (in Appendix B

Early clinical and laboratory risk factors of intensive care unit requirement during 2004–2008 dengue epidemics in Singapore: a matched case–control study

Background: Dengue infection can result in severe clinical manifestations requiring intensive care. Effective triage is critical for early clinical management to reduce morbidity and mortality. However, there is limited knowledge on early risk factors of intensive care unit (ICU) requirement. This study aims to identify early clinical and laboratory risk factors of ICU requirement at first presentation in hospital and 24 hours prior to ICU requirement. Method: A retrospective 1:4 matched case–control study was performed with 27 dengue patients who required ICU, and 108 dengue patients who did not require ICU from year 2004–2008, matched by year of dengue presentation. Univariate and multivariate conditional logistic regression were performed. Optimal predictive models were generated with statistically significant risk factors identified using stepwise forward and backward elimination method. Results: ICU dengue patients were significantly older (P=0.003) and had diabetes (P=0.031), compared with non-ICU dengue patients. There were seven deaths among ICU patients at median seven days post fever. At first presentation, the WHO 2009 classification of dengue severity was significantly associated (P<0.001) with ICU, but not the WHO 1997 classification. Early clinical risk factors at presentation associated with ICU requirement were hematocrit change ≥20% concurrent with platelet <50 K [95% confidence-interval (CI)=2.46-30.53], hypoproteinemia (95% CI=1.09-19.74), hypotension (95% CI=1.83-31.79) and severe organ involvement (95% CI=3.30-331). Early laboratory risk factors at presentation were neutrophil proportion (95% CI=1.04-1.17), serum urea (95% CI=1.02-1.56) and alanine aminotransferase level (95% CI=1.001-1.06). This predictive model has sensitivity and specificity up to 88%. Early laboratory risk factors at 24 hours prior to ICU were lymphocyte (95% CI=1.03-1.38) and monocyte proportions (95% CI=1.02-1.78), pulse rate (95% CI=1.002-1.14) and blood pressure (95% CI=0.92-0.996). This predictive model has sensitivity and specificity up to 88.9% and 78%, respectively. Conclusions: This is the first matched case–control study, to our best knowledge, that identified early clinical and laboratory risk factors of ICU requirement during hospitalization. These factors suggested differential pathophysiological background of dengue patients as early as first presentation prior to ICU requirement, which may reflect the pathogenesis of dengue severity. These risk models may facilitate clinicians in triage of patients, after validating in larger independent studies.Published versio

Economic Cost of Dengue in Puerto Rico

Dengue, endemic in Puerto Rico, reached a record high in 2010. To inform policy makers, we derived annual economic cost. We assessed direct and indirect costs of hospitalized and ambulatory dengue illness in 2010 dollars through surveillance data and interviews with 100 laboratory-confirmed dengue patients treated in 2008–2010. We corrected for underreporting by using setting-specific expansion factors. Work absenteeism because of a dengue episode exceeded the absenteeism for an episode of influenza or acute otitis media. From 2002 to 2010, the aggregate annual cost of dengue illness averaged $38.7 million, of which 70$46.45 million ($12.47 per capita)

Building a Quantum Engineering Undergraduate Program

The rapidly growing quantum information science and engineering (QISE) industry will require both quantum-aware and quantum-proficient engineers at the bachelor's level. We provide a roadmap for building a quantum engineering education program to satisfy this need. For quantum-aware engineers, we describe how to design a first quantum engineering course accessible to all STEM students. For the education and training of quantum-proficient engineers, we detail both a quantum engineering minor accessible to all STEM majors, and a quantum track directly integrated into individual engineering majors. We propose that such programs typically require only three or four newly developed courses that complement existing engineering and science classes available on most larger campuses. We describe a conceptual quantum information science course for implementation at any post-secondary institution, including community colleges and military schools. QISE presents extraordinary opportunities to work towards rectifying issues of inclusivity and equity that continue to be pervasive within engineering. We present a plan to do so and describe how quantum engineering education presents an excellent set of education research opportunities. Finally, we outline a hands-on training plan on quantum hardware, a key component of any quantum engineering program, with a variety of technologies including optics, atoms and ions, cryogenic and solid-state technologies, nanofabrication, and control and readout electronics. Our recommendations provide a flexible framework that can be tailored for academic institutions ranging from teaching and undergraduate-focused two- and four-year colleges to research-intensive universities.Comment: 25 pages, 2 figure

Building a Quantum Engineering Undergraduate Program

Contribution: A roadmap is provided for building a quantum engineering education program to satisfy U.S. national and international workforce needs. Background: The rapidly growing quantum information science and engineering (QISE) industry will require both quantum-aware and quantum-proficient engineers at the bachelor\u27s level. Research Question: What is the best way to provide a flexible framework that can be tailored for the full academic ecosystem? Methodology: A workshop of 480 QISE researchers from across academia, government, industry, and national laboratories was convened to draw on best practices; representative authors developed this roadmap. Findings: 1) For quantum-aware engineers, design of a first quantum engineering course, accessible to all STEM students, is described; 2) for the education and training of quantum-proficient engineers, both a quantum engineering minor accessible to all STEM majors, and a quantum track directly integrated into individual engineering majors are detailed, requiring only three to four newly developed courses complementing existing STEM classes; 3) a conceptual QISE course for implementation at any postsecondary institution, including community colleges and military schools, is delineated; 4) QISE presents extraordinary opportunities to work toward rectifying issues of inclusivity and equity that continue to be pervasive within engineering. A plan to do so is presented, as well as how quantum engineering education offers an excellent set of education research opportunities; and 5) a hands-on training plan on quantum hardware is outlined, a key component of any quantum engineering program, with a variety of technologies, including optics, atoms and ions, cryogenic and solid-state technologies, nanofabrication, and control and readout electronics