A case of synchronous papillary and clear cell carcinoma in the same kidney

Renal Cell Carcinoma (RCC) comprises 2-3% of all cancers. Bilateral coexistent benign and malignant renal tumors have been defined in many reports. However, unilateral synchronous malignant tumors of different histologic subtypes are very rare and only a few such cases have been reported. Herein we describe a 56 year old male patient with coexistent clear cell RCC and papillary RCC in his left kidney that were successfully treated with radical nephrectomy

Scrub Typhus: Re-emerging Public Health Problem in India

Scrub Typhus is emerging as an important cause of fever of unknown origin and needs to be differentiated from other causes of febrile illnesses. During March to June 2014, a systematic search on ‘Scrub typhus’ was conducted to determine epidemiology and factors causing re-emergence of this disease in India. Scrub typhus is an acute, febrile, infectious illness caused by Orientia tsutsugamushi, transmitted to humans through bites of the trombiculid mites. The infection can range from a mild, self-limiting disease to a fatal illness in 35-50% of cases, with multi-organ dysfunction, if not promptly diagnosed and appropriately treated. The reports of the disease were rare for several decades, but currently a clear re-emergence has been documented from several states in India. This resurgence may be attributed to changes in the human behavior-unplanned urbanization, deforestation and rapid transport leading to displacement of vectors as well the rodents from one place to another. There is an urgent need for awareness generation among the medical and para-medical professionals especially at the peripheral levels. Standard treatment guidelines for timely diagnosis and treatment of Scrub Typhus should be available, especially in rural areas, where the disease remains undiagnosed, and this should be in accordance with the facilities available at sub-centers, PHCs, and CHCs. Active surveillance of rickettsial diseases is required to be carried out to know exact magnitude and distribution of the disease

E-learning in medical education: students’ experience, challenges and perspectives: a cross-sectional study in India

Background: Due to COVID-19 pandemic, online classes were initiated in medical colleges for continuation of learning. Methods: A cross-sectional study was conducted among 537 undergraduate medical students in an Indian medical college using Google forms. The questionnaire contained sections on students’ online or e-learning experience and role of instructor in enhancing it; challenges and further scope of improved implementation of e-learning. Statistical analysis included descriptive statistics. SPSS 23 was used for data analysis. RESULTS: Among study participants, (46.7%) regularly joined e-classes on time. Prior scheduling of classes (88.6%) and sharing of study material in e-learning application (84%) by teachers/instructors; interactive discussion with teachers (71.1%) and their response to students’ queries through e-learning application (77%) facilitated learning among participants. For (42.6%) e-learning represented considerable challenge in acquiring clinical medical skills. Theory lectures were found suitable for learning by e-learning mode while clinical case discussions were not preferred. Conclusion: E-classes had some definite advantages; however, undergraduate medical students preferred blended approach as e-learning represented a challenge for learning clinical medical skills. Instructors were found to have definite role in enhancing e-learning experience. Providing solutions to barriers like poor internet connectivity and resolution of technical glitches are essential for improved implementation of e-learning

Role of Apoptosis in Rabies Viral Encephalitis: A Comparative Study in Mice, Canine, and Human Brain with a Review of Literature

To evaluate the role of apoptosis in rabies encephalitis in humans and canines infected with wild-type street virus, in comparison with rodent model infected with street and laboratory passaged CVS strain, we studied postmortem brain tissue from nine humans, six canines infected with street rabies virus, and Swiss albino mice inoculated intramuscularly (IM) and intracerebrally (IC) with street and CVS strains. Encephalitis and high rabies antigen load were prominent in canine and human brains compared to rodents inoculated with street virus. Neuronal apoptosis was detectable only in sucking mice inoculated with CVS strain and minimal in street virus inoculated mice. In a time point study in suckling mice, DNA laddering was noted only terminally (7 days p.i.) following IC inoculation with CVS strain but not with street virus. In weanling and adult mice, apoptosis was restricted to inflammatory cells and absent in neurons similar to human and canine rabies-infected brains. Absence of neuronal apoptosis in wild-type rabies may facilitate intraneuronal survival and replication while apoptosis in inflammatory cells prevents elimination of the virus by abrogation of host inflammatory response

Expression of nestin - a stem cell associated intermediate filament in human CNS tumours

Background & objectives: Nestin is an intermediate filament protein expressed in undifferentiated cells during the development of brain and is considered as a marker for neuroepithelial stem cells. Expression of this protein in various CNS tumour cells suggests the possibility of existence of tumour stem cell modulating the evolution. We carried out an immunohistochemical study to demonstrate the expression of nestin and its co-expression with neuronal and glial intermediate filament and correlate with the grade of malignancy. Methods: Formalin fixed, paraffin processed sections from two human foetuses, 16 brain tumours of both neuronal and glial lineage and two metastatic tumours were immunostained with polyclonal antibody to nestin. Serial sections from primary brain tumours were also stained with monoclonal antibody to neurofilament (NF) and glial fibrillary acidic protein (GFAP). Fluorescent double labeling was carried out on four cases using laser confocal microscopy, to document co-localization of nestin with other intermediate filaments in the tumour cells. Results: Nestin expression was observed along the paraventricular zone of human foetuses and in brain tumours of both glial and neuronal lineage, of both high and low grades of malignancy. In addition, mature dysplastic spinal motor neurons adjacent to tumour and cerebellar Purkinje cells also expressed nestin along with neurofilament. Interpretation & conclusion: Nestin expression was noted in both low and high grade brain tumours and dysplastic neurons and did not parallel the malignant grade of the tumour. The expression of nestin in tumour cells and dysplastic neurons suggests aberrant expression of antigenically primitive proteins in cells to facilitate remodelling of the cell and migration. More studies are needed to elucidate the concept

De novo sequencing and characterization of Picrorhiza kurrooa transcriptome at two temperatures showed major transcriptome adjustments

<p>Abstract</p> <p>Background</p> <p><it>Picrorhiza kurrooa </it>Royle ex Benth. is an endangered plant species of medicinal importance. The medicinal property is attributed to monoterpenoids picroside I and II, which are modulated by temperature. The transcriptome information of this species is limited with the availability of few hundreds of expressed sequence tags (ESTs) in the public databases. In order to gain insight into temperature mediated molecular changes, high throughput <it>de novo </it>transcriptome sequencing and analyses were carried out at 15°C and 25°C, the temperatures known to modulate picrosides content.</p> <p>Results</p> <p>Using paired-end (PE) Illumina sequencing technology, a total of 20,593,412 and 44,229,272 PE reads were obtained after quality filtering for 15°C and 25°C, respectively. Available (e.g., De-Bruijn/Eulerian graph) and in-house developed bioinformatics tools were used for assembly and annotation of transcriptome. A total of 74,336 assembled transcript sequences were obtained, with an average coverage of 76.6 and average length of 439.5. Guanine-cytosine (GC) content was observed to be 44.6%, while the transcriptome exhibited abundance of trinucleotide simple sequence repeat (SSR; 45.63%) markers.</p> <p>Large scale expression profiling through "read per exon kilobase per million (RPKM)", showed changes in several biological processes and metabolic pathways including <it>cytochrome P450s </it>(<it>CYPs</it>), <it>UDP-glycosyltransferases </it>(<it>UGTs</it>) and those associated with picrosides biosynthesis. RPKM data were validated by reverse transcriptase-polymerase chain reaction using a set of 19 genes, wherein 11 genes behaved in accordance with the two expression methods.</p> <p>Conclusions</p> <p>Study generated transcriptome of <it>P. kurrooa </it>at two different temperatures. Large scale expression profiling through RPKM showed major transcriptome changes in response to temperature reflecting alterations in major biological processes and metabolic pathways, and provided insight of GC content and SSR markers. Analysis also identified putative <it>CYPs </it>and <it>UGTs </it>that could help in discovering the hitherto unknown genes associated with picrosides biosynthesis.</p

Neuropathology of HIV/AIDS with an overview of the Indian scene

Neurological manifestations of HIV infection and AIDS are being recognized with a frequency that parallels the increasing number of AIDS cases. Next to sub-Saharan Africa, India has the second largest burden of HIV related pathology, essentially caused by HIV-1 clade C in both the geographic locales, in contrast to USA and Europe. But the true prevalence of HIV related neuroinfections and pathology is not available due to inadequate medical facilities, social stigma and ignorance that lead to underdiagnosis. Neurotuberculosis, followed by cryptococcosis and toxoplasmosis in various combinations are the major neuropathologies reflecting the endemicity and manifesting clinically by reactivation of latent infection. Discordance in the clinical prevalence of various infections, when compared to pathological studies highlight similarities in clinical, radiological modalities of diagnosis and inherent problems in establishing definitive diagnosis. Viral infections appear to be relatively rare. Inspite of heavy burden of HIV/AIDS, HIV associated neoplasia is infrequent, including primary CNS lymphomas. HIV encephalitis and HIV associated dementia are considered infrequent, though systematic studies have just been initiated in various centres. Peripheral neuropathy characteristically manifests with vasculitic neuropathy while diffuse infiltrative lymphocytosis syndrome (DILS) involving nerves has not been reported from India. Spinal cord pathology including vacuolar myelopathy is rare, even in asymptomatic cases. Till now the AIDS cases in India were drug naÏve but a new cohort of cases following initiation of HAART therapy as a national policy is soon emerging, altering the biology and evolution of HIV/AIDS in India. Lacunae in the epidemiology, diagnosis and study of biology of HIV/AIDS are outlined for future research