Background: Angiogenesis, which is the development of new capillaries from existing blood vessels, occurs in both the developing embryo and postnatal life. The growth of solid tumours requires the development of micro vessels; therefore, tumour expansion correlates with the extent of angiogenesis.Methods: A prospective study was conducted on bone marrow trephine biopsies of 40 new cases of acute leukaemia diagnosed on complete blood count, bone marrow aspiration examination, and flow cytometry, including 20 control cases. Micro sections were stained with immuno-histochemical stains using monoclonal antibodies to CD31, CD34 and vWF. Micro vessel density was analysed at a 400× using automated image analyser by two investigators independently. Data were calculated, tabulated and statistically analysed using statistical package for the social sciences (SPSS) statistical program version 18.Results: A total of 1522 micro vessels were analysed using CD31 including 802 in acute myeloid leukaemia (AML), 512 in acute lymphocytic leukemia (ALL) and 208 in the control group. The bone marrow microvessel density (MVD) in acute myeloid leukaemia using CD31, CD34 and Von Willebrand factor (VWF) was 70.83±20.76, 66.48±18.99 and 60.32±18.75 respectively while MVD in acute lymphoblastic leukaemia was 62.74±21.09, 70.58±22.46 and 51.22±21.13 respectively. The study revealed significant difference between AML, ALL and normal bone marrow cases by using CD31, CD34 and vWF antibody. Serum vascular endothelial growth factor (VEGF) concentration in AML, ALL and control group was 163.74±119.03, 168.23±154.22 and 43.45±9.14 respectively.Conclusions: Higher micro vessel density was observed in acute leukaemia. Present findings suggested the potential significance of characteristics of micro vessel density as potential prognostic marker as well as its application in improved selection of patients for anti-angiogenic and other treatments.

Background Morphological diagnosis of non-Hodgkin lymphoma (NHL) is usually based on lymph node biopsy. Bone marrow biopsy (BMB) is important for staging, and morphology alone can be challenging for subtyping. Immunohistochemistry (IHC) allows a more precise diagnosis and characterization of NHL using monoclonal antibodies. However, there is a need for a minimal panel that can provide maximum information at an affordable cost. Methods All newly diagnosed cases of B-cell NHL with bone marrow infiltration between 2017 and 2019 were included. BMB was the primary procedure for diagnosing B-cell NHL. Subtyping of lymphomas was performed by immunophenotyping using a panel of monoclonal antibodies on IHC. The primary diagnostic panel of antibodies for B-cell NHL included CD19, CD20, CD79, CD5, CD23, CD10, Kappa, and Lambda. The extended panel of antibodies for further subtyping included CD30, CD45, CD56, Cyclin D1, BCL2, and BCL6. Results All cases of B-cell NHL were classified into the chronic lymphocytic leukemia (CLL) and non-CLL groups based on morphology and primary IHC panel. In the CLL group, the most significant findings were CD5 expression, CD23 expression, dim CD79 expression, and weak surface immunoglobulin (Ig) positivity. In the non-CLL group, they were CD5 expression, positive or negative CD23 expression, strong CD79 expression, and strong surface Ig expression. An extended panel was used for further subtyping of non-CLL cases, which comprised CD10, Cyclin D1, BCL2, and BCL6. Conclusion We propose a two-tier approach for immunophenotypic analysis of newly diagnosed B-cell NHL cases with a minimum primary panel including CD5, CD23, CD79, Kappa, and Lambda for differentiation into CLL/non-CLL group and Kappa and Lambda for clonality assessment. An extended panel may be used wherever required for further subtyping of non-CLL.

hronic kidney disease (CKD) is a condition that presents usually with fluid overload. Pleural disease is a common problem in patients with chronic renal insufficiency which may be attributed to many etiologies, including congestive heart failure, infection, the presence of diseases associated with renal and pleural manifestations (e.g. systemic lupus in erythematosus), uremic pericarditis, malignancies, and pulmonary embolism. Unilateral pleural effusion is a diagnostic challenge in CKD patients. Uremic pleuritis results from an unknown putative agent, and therefore, uremic pleuritis is a diagnosis of exclusion [1]. CASE REPORTA 66-year-old male presented to us with a complaint of shortness of breath for 4 days. It was not associated with chest pain, decreased urine output, vomiting, altered sensorium, fever, palpitations, joint pain, cough with sputum, night sweats, and weight loss. There was no history of connective tissue disease such as rheumatoid arthritis (RA). The patient is a known case of type 2 diabetes (for 22 years), hypertension (for 22 years), and CKD (3 years). He was on tab. amlodipine 10 mg OD, prazosin 10 mg OD, torsemide 20 mg BD, and linagliptin 5 mg OD. For the past 3 years, the patient was on regular medication and his renal functions remained stable, not requiring renal replacement therapy.On admission, blood pressure was 160/100 mmHg, pulse rate was 110/min, and tachypneic at rest with a saturation of 85% at room air. On general physical examination, the patient was pale and having bilateral pedal edema. Icterus, clubbing, cyanosis, and jugular venous distension were absent. Respiratory system examination revealed tracheal deviation towards the right, dull percussion notes, and reduced air entry on auscultation over the left lung field. Cardiac examination was unremarkable.Renal function tests performed 6 months back revealed creatinine 5.3 mg/dl and urea 152 mg/dl with estimated glomerular filtration rate (eGFR) of 12 ml/min/1.73 m 2 which were found worsened on this admission with creatinine 6.4 and urea 201 with eGFR 9 ml/min/1.73 m 2 . Complete hemogram revealed hemoglobin 7.1 g/dl microcytic hypochromic, total leukocyte count of 6800/mm 3 , and platelet count of 240,000/mm 3 . Liver function tests were unremarkable with albumin of 3.6 g/dl. Uric acid was 9.6 mg/dl, calcium was 7.9 mg/dl, phosphorus was 8.9 mg/dl, and normal arterial blood gas analysis. Erythrocyte sedimentation rate was 24 mm/h, Mantoux test was negative, and RA factor was negative. Digital chest X-ray revealed left-sided pleural effusion with right-sided tracheal shift with clear costophrenic angle on the right side (Fig. 1a).On thoracentesis, the pleural fluid was hemorrhagic, exudative with pleural fluid-to-serum protein ratio was 0.54(3.5/6.4), and the pleural fluid to serum lactate dehydrogenase ratio >0.6 (294/254) with lymphocytic predominance and adenosine deaminase of 9.1. No organisms were seen on Gram stain, no acid-fast bacilli were seen, and the cartridge-based nucleic acid amplification test was negative...

Eosinophilia refers to peripheral blood absolute eosinophil count above the ULN, normal range of AEC is 0.05-0.5× 109/l (1-6%). Hyper eosinophilia refers to AEC above 1.5×109/l. Hypereosinophilia can affect multiple organs and can cause cardiomyopathy, gastroenteritis, cutaneous lesions, pneumonitis, and neuritis. In addition, some patients develop thromboembolic complications. We are presenting a case who presented to us with thromboembolic complication later diagnosed as hypereosinophilia with Bone marrow showing myeloid associated eosinophilia (Primary eosinophilia).

Background: Scrub typhus is an acute febrile illness causing serious complications leading to significant mortality especially if there is delay in diagnosis and treatment. It is caused by Orentia tsutsugamushi a gram negative bacterium and transmitted by the bite of the trombiculid mite (chigger). This study was undertaken to document the clinical manifestations, laboratory parameters and treatment outcomes of scrub typhus cases.Methods: This retrospective study was done in a tertiary care teaching hospital which included 40 confirmed cases of scrub typhus. The diagnosis was confirmed by positive IgM ELISA. Clinical spectrum and manifestations, laboratory parameters and course in hospital with outcomes were evaluated. Factors associated with complications and mortality were analyzed.Results: The mean age of the patients was 40 ±15 yrs with almost equal proportion of males and females (47.5 vs 52.5%). The most common presenting symptoms were Fever (100%), shortness of breath (40%), altered sensorium (22.5%), nausea/vomiting (10%), and diarrhea (7.5%). Mean duration of fever before presentation to hospital was 11.1±4.9 days. Eschar was seen in 15% of patients. Common laboratory abnormalities documented was thrombocytopenia (85%), elevated transaminases (57%) leukocytosis (45%), and leucopenia (15%). About 37.5% of patients developed multiple organ dysfunction syndrome (MODS) with case fatality rate was 10%. Acute renal failure, acute hepatitis, need of ventilator support and CNS dysfunction was higher among patient with MODS.Conclusions: Scrub typhus patients can have a wide range of manifestation ranging from mild illness to serious and life threatening complications like acute respiratory distress syndrome, acute renal failure, and acute hepatitis and CNS dysfunction. High index of suspicion with early recognition and treatment is key for good outcome. Use of empirical doxycycline may be lifesaving.

Background: Iron deficiency anemia is associated with central and peripheral nervous system disturbances. Iron is an essential component of brain growth, myelination, nerve impulse conduction, protein synthesis, hormone production, fundamental aspects of cellular energy metabolism and is involved in neurotransmitter synthesis including serotonin, norepinephrine and dopamine. Hence, its deficiency adversely affects motor performance, mental development as well as cognitive and behavioral functions. Since myelination is concerned with conduction in nerve fibers, iron deficiency potentially impairs neuronal transmission and leads to functional neurodeficit like hearing loss.Methods: BAEP was recorded using RMS EMG EP MK2 machine in patients of iron deficiency anemia with haemoglobin less than 10.9 g/dl between 18-50 years of age who were followed up after 3 months of treatment and compared with 30 age and sex matched controls.Results: BAEP absolute and interpeak latencies were prolonged in IDA patients as compared to the control groups which was reversible with iron replacement therapy.Conclusions: Increased absolute and interpeak latencies of BAEP indicates impairment of auditory pathways in IDA patients. Thus, the electrophysiological study of BAEP provides an objective method for monitoring the function of CNS, especially the auditory function in iron deficiency anemia patients before and after iron replacement therapy. It is a non-invasive test for early diagnosis and therefore early treatment to prevent complications.

The pandemic of corona virus disease 2019 (COVID-19) has posed challenge not only in management of the primary disease but the emerging complications associated with COVID-19 has further complicated the course of disease. The course of COVID-19 disease is associated with infectious and noninfectious complications former include secondary bacterial and fungal infection adding to mortality and morbidity. COVID-19 disease associated candidiasis and aspergillosis have been reported as super infections but with the steroid and supplemental oxygen as mainstay treatment modality mucormycosis is now complicating the course of disease and presently posing challenge in India with already overburdened health care service. Mucorales is a saphrophytic fungi causes rhinocerebral infection involving nasal passages, sinuses, oral cavity and brain. It is usually seen in immunocompromised host and in diabetics with poorly controlled blood sugar level. High degree of clinical suspicion is needed to suspect and diagnose mucormycosis. It is a fatal disease because of its angioinvasive pathogenesis and treatment is promptly initiated to salvage mortality and morbidity. Authors report a case of rhino-oculo-cerebral mucormycosis in a middle-aged diabetic patient with severe COVID-19 disease.

Aim: Evaluation of nerve conduction in adult patients of iron deficiency anemia and to study the response to treatment. Study Design: Prospective randomized control study Place and Duration of Study: Department of Medicine and Department of Physiology, PGIMS Rohtak Introduction: Iron deficiency anemia is associated with central and peripheral nervous system disturbances. Iron is an essential component of brain growth, myelination, nerve impulse conduction, protein synthesis, hormone production, fundamental aspects of cellular energy metabolism and is involved in neurotransmitter synthesis including serotonin, norepinephrine and dopamine. Hence, its deficiency adversely affects motor performance, mental development as well as cognitive and behavioral functions. Since myelination is concerned with conduction in nerve fibers, iron deficiency potentially impairs neuronal transmission and leads to functional neurodeficit like dysfunction in the peripheral nervous system such as paresthetic complaints. Method: Nerve conduction was recorded using RMS EMG EP MK2 machine in 30 newly diagnosed patients of iron deficiency anemia with haemoglobin less than 10.9-4 g/dl between 18-50 years of age who were followed up after 3 months of treatment and compared with 30 age and sex matched controls. Results: An increase in distal latencies and a decrease in amplitude and nerve conduction velocities of motor and sensory component of all the nerves was seen in IDA patients as compared to the control groups which was reversible with iron replacement therapy. Conclusion: Altered values of nerve conduction parameters indicates peripheral neuropathy in IDA individuals with or without polyneuropathy. Thus, nerve conduction study provides an objective method for monitoring the function of PNS, especially the clinically silent peripheral nerve compromise in patients of iron deficiency anemia before and after iron replacement therapy.  Thus NCS is a non-invasive test for early diagnosis and therefore early treatment to prevent complications.