Primary vaginal Ewing’s sarcoma/primitive neuroectodermal tumour: diagnostic and treatment challenges

Extra osseous Ewing’s sarcoma/primitive neuroectodermal tumour (PNET) of the genital tract of women is scarcely\ud described in the literature and involvement of the vagina is even rarer with a very few cases reported so far. We present\ud 50-year-old-woman who presented with a vaginal mass that was diagnosed to be a malignant round cell tumour which\ud later was confirmed to be primary vaginal Ewing’s sarcoma/ PNET on light microscopy and immunohistochemical\ud staining. She was then treated with induction chemotherapy followed by local radiotherapy and further maintenance\ud chemotherapy. This rare case of primary vaginal Ewing’s sarcoma/PNET emphasizes the need for combining\ud morphological features with immunohistochemistry with a panel of antibodies in establishing the diagnosis of Ewing’s\ud sarcoma/PNET at an uncommon site. Further, the case also highlights the use of induction chemotherapy followed by\ud radiation therapy and subsequent maintenance chemotherapy as a treatment modality

Modeling and fault tolerant control of an electro-hydraulic actuator

In the modern industry, electro-hydraulic actuators (EHAs) have been applied to various applications for precise position pressure/ force control tasks. However, operating EHAs under sensor faults is one of the critical challenges for the control engineers. For its enormous nonlinear characteristics, sensor fault could lead the catastrophic failure to the overall system or even put human life in danger. Thus in this paper, a study on mathematical modeling and fault tolerant control (FTC) of a typical EHA for tracking control under sensor-fault conditions has been carried out. In the proposed FTC system, the extended Kalman-Bucy unknown input observer (EKBUIO) -based robust sensor fault detection and identification (FDI) module estimates the system states and the time domain fault information. Once a fault is detected, the controller feedback is switched from the faulty sensor to the estimated output from the EKBUIO owing to mask the sensor fault swiftly and retains the system stability. Additionally, considering the tracking accuracy of the EHA system, an efficient brain emotional learning based intelligent controller (BELBIC) is suggested as the main control unit. Effectiveness of the proposed FTC architecture has been investigated by experimenting on a test bed using an EHA in sensor failure conditions

Availability and Use of Emergency Obstetric Care Services in Four Districts of West Bengal, India

Process indicators have been recommended for monitoring the availability and use of emergency obstetric care (EmOC) services. A health facility-based study was carried out in 2002 in four districts of West Bengal, India, to analyze these process indicators. Relevant records and registers for 2001 of all studied facilities in the districts were reviewed to collect data using a pre-designed schedule. The numbers of basic and comprehensive EmOC facilities were inadequate in all the four districts compared to the minimum acceptable level. Overall, 26.2% of estimated annual births took place in the EmOC facilities (ranged from 16.2% to 45.8% in 4 districts) against the required minimum of 15%. The rate of caesarean section calculated for all expected births in the population varied from 3.5% to 4.4% in the four districts with an overall rate of 4%, which is less than the minimum target of 5%. Only 29.9% of the estimated number of complications (which is 15% of all births) was managed in the EmOC facilities. The combined case-fatality rate in the basic/comprehensive EmOC facilities was 1.7%. Major obstetric complications contributed to 85.7% of maternal deaths, and pre-eclampsia/eclampsia was the most common cause. It can be concluded that all the process indicators, except proportion of deliveries in the EmOC facilities, were below the acceptable level. Certain priority measures, such as making facilities fully functional, effective referral and monitoring system, skill-based training, etc., are to be emphasized to improve the situation

Gelatinous Marrow Transformation: A Series of 11 Cases from a Tertiary Care Centre in South India

Gelatinous marrow transformation (GMT) or serous atrophy of bone marrow (BM) is a rare disease characterised by focal marrow hypoplasia, fat atrophy, and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid. This study reviews 11 cases of GMT from South India. Clinical and haematological parameters, BM aspirate, and biopsies of all patients diagnosed with GMT over a period of 7 years were studied. GMT was diagnosed in BM biopsy based on characteristic morphological appearance and was confirmed by alcian blue positive staining pattern at pH levels of 2.5 and 0.5. Eleven patients were diagnosed with GMT. All were males within the age range of 15 to 50 years. The underlying clinical diagnosis was human immunodeficiency virus positivity in 5 cases, 2 with coexistent disseminated tuberculosis, 1 with cryptococcal meningitis, and 1 with oral candidiasis; disseminated tuberculosis in 1 case; pyrexia of unknown origin in 2 cases; Hodgkin’s lymphoma in 1 case; acute lymphoblastic lymphoma with maintenance chemotherapy in 1 case; and alcoholic pancreatitis in 1 case. BM aspirates showed gelatinous metachromatic seromucinous material in 3 cases. BM biopsies were hypocellular in 7 and normocellular in 4 cases and showed focal GMT in 5 and diffuse GMT in 6 cases. Reactive changes were seen in 4 cases and haemophagocytosis in addition to GMT in 1 case. GMT is a relatively uncommon condition and an indicator of severe illness. It should be differentiated from myelonecrosis, amyloidosis, and marrow oedema. A high index of suspicion is required to diagnose this condition

Low grade follicular lymphoma with high proliferation index; diagnostic and management issues

Follicular Lymphoma (FL) is the second most common B-Non Hodgkin Lymphoma after diffuse large B cell lymphoma (DLBCL). Low grade FL is known for its indolent behavior; however, one subset of FL behave aggressively and may require intensive therapy. One of the diagnostic issues in FL is to identify this subgroup of cases. Proliferation index can have prognostic importance in this subset of cases. We discuss one case of low grade FL with a paradoxically high proliferative index. A 63 year male presented with generalized lymphadenopathy of one year duration, which was gradually increasing in size. On examination, patient had bilateral cervical, axillary and inguinal nodes. Biopsy of the left cervical lymph node was reported as FL - Grade 2, with high proliferative Index (60%). The patient was put on CHOP regimen targeted for high grade lymphomas, and had complete remission. High proliferative index in FL is a poor prognostic factor irrespective of the histologic grade. So, proliferative index should be assessed in all cases of FL as an adjunct to histologic grading

Primary extranodal non-Hodgkin lymphoma: A 3-year record-based descriptive study from a tertiary care center in Southern India

Introduction: Primary extranodal lymphoma (pENL) refers to group of disorders arising from tissues other than lymph nodes and even from sites, which normally do not contain lymphoid tissue. This study was undertaken to ascertain the prevalence, anatomical distribution, and histological subtypes of extranodal non-Hodgkin lymphoma (NHL) from a tertiary care institute in Southern India. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology over a period of 3-years. Detailed clinical history, routine complete blood count, microbiological status was obtained from the medical records. Hamatoxylin and eosin slides were reviewed and immunohistochemistry was performed using a panel of antibodies depending on the morphology. All cases were classified based upon morphologic and immunophenotypic criteria according to World Health Organization 2008 classification. Results: Primary extranodal NHL constituting 22.6% (68/300) of all NHL and the majority of patients were from higher age group with peak incidence seen in fourth to fifth decade of life. In the pediatric population, the most common site is ileo-caecal region (42.8%) and the most common morphology is lymphoblastic lymphoma (42.8%). Similarly in the adult population head and neck was the most common site constituting 36% and diffuse large B-cell lymphoma is the most common morphological subtype comprising 54% of all extranodal lymphomas. Conclusion: Although the reported incidence of pENL is low in India compared to other parts of the world, the possibility of pENL should always be kept in mind even though it arises in an extranodal site

Availability and Use of Emergency Obstetric Care Services in Four Districts of West Bengal, India

Process indicators have been recommended for monitoring the availability and use of emergency obstetric care (EmOC) services. A health facility-based study was carried out in 2002 in four districts of West Bengal, India, to analyze these process indicators. Relevant records and registers for 2001 of all studied facilities in the districts were reviewed to collect data using a pre-designed schedule. The numbers of basic and comprehensive EmOC facilities were inadequate in all the four districts compared to the minimum acceptable level. Overall, 26.2% of estimated annual births took place in the EmOC facilities (ranged from 16.2% to 45.8% in 4 districts) against the required minimum of 15%. The rate of caesarean section calculated for all expected births in the population varied from 3.5% to 4.4% in the four districts with an overall rate of 4%, which is less than the minimum target of 5%. Only 29.9% of the estimated number of complications (which is 15% of all births) was managed in the EmOC facilities. The combined case-fatality rate in the basic/comprehensive EmOC facilities was 1.7%. Major obstetric complications contributed to 85.7% of maternal deaths, and pre-eclampsia/eclampsia was the most common cause. It can be concluded that all the process indicators, except proportion of deliveries in the EmOC facilities, were below the acceptable level. Certain priority measures, such as making facilities fully functional, effective referral and monitoring system, skill-based training, etc., are to be emphasized to improve the situation