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Abstract Existing approaches to evaluating companies on sustainability-related issues include limited accounting of impacts on nature and its contributions to human well-being. Here we present an approach for quantifying the direct impacts of companies’ physical assets on nature based on global maps for eight ecosystem service and biodiversity metrics. We apply this approach to a set of over 2000 global, publicly traded companies with 580,000 mapped physical assets and find that companies in utility, real estate, materials, and financial sectors have the largest impacts on average, with substantial variation within all sectors. Using high-spatial-resolution satellite imagery to map individual mine footprints, we compare a set of active lithium mines and find that impacts vary substantially among mines and change over time. By using open-source models and drawing on the growing availability of high-spatial-resolution satellite imagery, this approach could provide more transparent measures of corporate impacts to nature for nature-related reporting.

With the advent of technology, it has become possible to perform direct numerical simulations and the demand for high accuracy computing is increasing. Numerical simulations play an important part in understanding physics of the flow and instability mechanism in flows. For high accuracy, numerical schemes must be chosen that satisfy the physical dispersion relation, should not amplify or attenuate the solution and resolve all possible length and time scales. In the present paper, spectral stability analysis of linear convection equation is performed using first order forward difference (FD1) method and fourth order Runge Kutta (RK4) method, consisting of four stages, for time discretization and a second order central difference (CD2) method for evaluating spatial derivative. The results show that the presence of numerical instability for FD1 method is independent of the CFL number, consistent with the stability analysis which showed FD1 method to be unconditionally unstable. However, for RK4 method, the solution is found to be neutrally stable only for a particular range of CFL number, even stable solution introduced error by attenuating the computed or analytical solution.

In order to obtain important knowledge for raising the performance and efficiency of propulsion systems, in this paper we investigate the dynamics process of pressure gain combustion in the Pulse Detonation Engine. Through comprehensive experimentation, we analyse the intricate mechanisms governing the pressure gain combustion in PDEs. Our findings present innovative methods for increasing combustion efficiency, boosting thrust generation, and addressing operational difficulties in PDE designs. Additionally, we discuss creative strategies for utilizing pressure gain effects to enhance engine performance metrics.

Abstract Skin conditions are becoming increasingly prevalent across the world in current times. With the rise in dermatological disorders, there is a need for computerized techniques that are completely noninvasive to patients’ skin. As a result, deep learning models have become standard for the computerized detection of skin diseases. The performance efficiency of these models improves with access to more data with their primary aim being image classification. In this paper, we present a skin disease detection methodology using image processing techniques, non-local means denoising and convolutional neural network (CNN) backed by sparse dictionary learning. Here, the major benefit of using NLM denoising followed by sparse dictionary learning with CNNs in image classification lies in leveraging a multi-stage approach that enhances the quality of input data, extracts meaningful and discriminative features, and improves the overall performance of the classification model. This combined approach addresses challenges such as noise robustness, feature extraction, and classification accuracy, making it particularly effective in complex image analysis tasks. For denoising, the average Peak Signal to Noise Ratio (PSNR) obtained for images from HAM-10000 dataset is 33.59 dB. For the ISIC-2019 dataset, the average PSNR for the train folder is 34.37 dB, and for the test folder it is 34.39 dB. The deep learning network is trained for the analysis of skin cancer images using a CNN model and is achieving acceptable results in classifying skin cancer types. The datasets used contain high-resolution images. After all the tests, the accuracy obtained is 85.61% for the HAM-10000 dataset and 81.23% for the ISIC-2019 dataset, which is on par with existing approaches validated by benchmarking results.

Pulse Detonation Engine has been a point of interest in the propulsion industry for some time and the interest has been rising due to its better output and results. But any system can perform its task efficiently based on the efficiency of its control system. In this paper we have presented a comparative study between multiple control systems- one based on Bluetooth technology, the other based on infrared sensor technology and one based on wired electrical system. For the wireless system, the signal received from either of the media is passed to the various sensors and systems connected through an Arduino board that further controls the solenoid valves and ignition system. Primarily, a control system circuit is developed using Arduino board and different sensors to connect the fuel supply and ignition system. In the next stage, Bluetooth sensors are connected using an android app and then an infrared sensor based system is integrated with the Arduino to control the engine and the performance of the two systems are compared. Whereas for wired system, every sub system is controlled through optical wires including the solenoid valves, the injection system and the sensors.

Background and Aim: Periodontal disease may result in chronic inflammation and bacteremia in some people. The study aimed to evaluate the connection between periodontal disease and macular degeneration. Materials and Methods: The specialist dental surgeon conducted the dental examination using a community periodontal index probe. An ophthalmologist performed the eye examination. Age-related macular degeneration (AMD) was identified through specific criteria such as the existence of particular types of drusen and pigmentary abnormalities. Results: Two hundred participants were part of the study. According to the data, factors such as advanced age, limited education, low income, hypertension, cardiovascular disease (CVD), and hepatitis B surface antigen (HBsAg) presence were strongly linked to AMD in all participants. Conclusion: Multiple studies have indicated a connection between periodontitis in the mouth and macular degeneration in individuals under 60 years of age.

The lymphocyte-depleted classic Hodgkin lymphoma (LDCHL), the rarest subtype of classic Hodgkin lymphoma (CHL), is usually diagnosed at an advanced stage (stage IV) and one that unusually involves the liver, causing a rapidly progressive clinical course. We describe a 40-year-old immunocompromised man presenting with a progressive non-cholestatic jaundice and intermittent fever. The abdominal ultrasonography revealed a nodular liver with coarse echotexture and periportal hypodensities. The thoracic and abdominal contrast-enhanced computed tomography revealed right cervical and paraaortic lymphadenopathy, hepatosplenomegaly, diffuse mural thickening of duodenal and jejunal loops, and bilateral lobulated kidneys. Subsequently, he succumbed to his illness secondary to refractory septic shock. On postmortem examination, he was diagnosed with classic Hodgkin lymphoma (lymphocyte-depleted type) involving paraaortic and mediastinal lymph nodes based on morphology and immunochemistry findings. The lymphomatous process involved the liver (causing multiacinar confluent hepatic necrosis) and spleen, both showing tuberculous foci. This autopsy case depicts an uncommon case of acute liver failure due to infiltration of the liver by LDCHL in an HIV-infected patient. The findings of angiotropism and angioinvasion establish the pathological mechanism of liver failure (hepatocellular necrosis) in such cases.

The friction consolidation method successfully reinforced aluminum 7075 alloy (AA7075) with high-volume fractions (12 and 24 vol%) of titanium diboride (TiB2) by high pressure and severe plastic deformation at elevated temperatures. The consolidated AMCs have a uniform dispersion of submicron- and micron-sized TiB2 particles in the AA7075 matrix, with significant refinement of the matrix grain size and the particles. The addition of TiB2 significantly increases hardness by up to 50 %, Young’s modulus by up to 62 %, and ultimate tensile strength by up to 28 % to 672 MPa, while reducing ductility by 80 %. Wear resistance of 7075/24 vol% TiB2 improves seven-fold compared to baseline, making it comparable to that of carburized steels. Microstructure-based finite element modeling provided a theoretical strength limit of ∼730 MPa for the composites and indicated that high triaxiality in conjunction with severe equivalent plastic strain in a narrow area between the TiB2 particles led to early fracture initiations, limiting the ductility.

Pulmonary blastoma (PB) is an exceedingly rare and aggressive malignant lung neoplasm that has distinct biphasic morphology. In this report, we document rare manifestations and molecular alterations in PB. A 59-year-old non-smoker female, presented with cough and hemoptysis for 4 months. The high-resolution computed tomography chest scan showed a 3.5x2.7 cm mass in the basal segment of the left lung. Positron emission tomography and computed tomography revealed a fluorodeoxyglucose avid lobulated mass in the superior segment of the lower lobe of the left lung. On core biopsy, the diagnosis of pleomorphic carcinoma in a background of adenocarcinoma was made. A definite diagnosis of pulmonary blastoma was established on the left lung lobectomy specimen based on morphological and immunohistochemical findings. Post-surgical biopsy from the scalp swelling showed metastatic deposits. On Next Generation Sequencing (NGS), in addition to conventional CTNNB1 gene mutation, new pathogenic MYCN and ATM gene mutations were detected. Post-chemotherapy, the patient was doing well after 10 months of close follow-up. PB exhibited rare associations in the form of non-smoker status, scalp metastasis, and MYCN and ATM gene mutations on NGS in addition to conventional CTNNB1 gene mutation. Large cohort studies are required to discover the incidence, significance and therapeutic implications of these co-existing pathogenic molecular alterations in PB.

Invasive fungal infections (IFI) are an upcoming threat in hospitalized patients. We studied the risk factors, aetiology, clinical features and outcomes (in the form of survival or death) in 30 cases displaying IFI. This was a prospective observational study. The prevalence of IFI in our study was 0.665 per 100 patients. Associated comorbidities observed included diabetes mellitus; neutropenia; chronic kidney disease; and malignancy. Therapies used included immunosuppressive therapy, including systemic steroids or chemotherapy drugs, and trauma. Some cases underwent major surgeries, some were treated using broad spectrum antibiotics. Some had sepsis or HIVinfection, some were on total parenteral nutrition (TPN) and some underwent instrumentation or ICU stay. The common IFIs observed were mucormycosis, followed by candidiasis, aspergillosis and cryptococcosis. The survival rate was 73.33% of cases, while death was recorded in 26.67% of cases.

Objective: Fracture around the hip is amongst the most common and serious fractures in the elderly, which leads to significant morbidity and mortality. In literature, many authors noted that even mild hyponatremia adversely affects bone, leading to an increased incidence of fractures. We aim to determine whether chronic hyponatremia (>90-day duration) increases the risk of hip fracture in the elderly and whether primary care physicians can help to prevent it. Materials and Methods: During the period from January 2020 to March 2022, we identified 145 patients aged between 65 and 90 years who were admitted to the hospital with hip fractures following a fall and compared them with 140 healthy controls. We recorded sodium (Na) serum levels in all included patients at the time of arrival and consequently for 3 days and compared them with those of controls. Logistic regression was used to calculate odds ratios (ORs). We measured serum Na levels for 3 days and took the average to ascertain hyponatremia. Result: In the study, the odds of hyponatremia were 70.3% with a confidence interval of 95% versus 3.6% in controls (P = 0.05). Age and hyponatremia were strongly associated with hip fractures following a fall. With a 5-year increase in age, the univariate OR for hip fracture increased by 5.67 (P < 0.0001). After adjusting for age, cases were nearly six times more likely to be hyponatremic than controls (OR = 4.90, P = 0.04). Conclusion: In our study, we noted that even mild chronic hyponatremia in old age increased the chance of falls. Addressing hyponatremia in the elderly may reduce the risk of falls and minimize hip fractures.

Vigna radiata (L.) R. Wilczek, generally known as mung bean, is a crucial pulse crop in Southeast Asia that is renowned for its high nutritional value. However, its cultivation faces substantial challenges due to numerous abiotic stresses. Here, we investigate the influence of salt and drought stress on mung bean genotypes by evaluating its morpho-physiological traits and biochemical characteristics. This phenotypic analysis revealed that both salt and drought stress adversely affected mung bean, which led to reduced plant height, leaf senescence, loss of plant biomass, and premature plant death. Reactive oxygen species (ROS) production increased under these abiotic stresses. In response, to prevent damage by ROS, the plant activates defense mechanisms to scavenge ROS by producing antioxidants. This response was validated through morpho-physiological, histological, and biochemical assays that characterized KVK Puri-3 and KVK Jharsuguda-1 as salt and drought sensitive genotypes, respectively, and Pusa ratna was identified as a drought and salt tolerant genotype.

Agriculture and changing environmental conditions are closely related, as weather changes could adversely affect living organisms or regions of crop cultivation. Changing environmental conditions trigger different abiotic stresses, which ultimately cause the accumulation of reactive oxygen species (ROS) in plants. Common ROS production sites are the chloroplast, endoplasmic reticulum, plasma membrane, mitochondria, peroxisomes, etc. The imbalance in ROS production and ROS detoxification in plant cells leads to oxidative damage to biomolecules such as lipids, nucleic acids, and proteins. At low concentrations, ROS initiates signaling events related to development and adaptations to abiotic stress in plants by inducing signal transduction pathways. In plants, a stress signal is perceived by various receptors that induce a signal transduction pathway that activates numerous signaling networks, which disrupt gene expression, impair the diversity of kinase/phosphatase signaling cascades that manage the stress response in the plant, and result in changes in physiological responses under various stresses. ROS production also regulates ABA-dependent and ABA-independent pathways to mitigate drought stress. This review focuses on the common subcellular location of manufacturing, complex signaling mechanisms, and networks of ROS, with an emphasis on cellular effects and enzymatic and non-enzymatic antioxidant scavenging mechanisms of ROS in Poaceae crops against drought stress and how the manipulation of ROS regulates stress tolerance in plants. Understanding ROS systems in plants could help to create innovative strategies to evolve paths of cell protection against the negative effects of excessive ROS in attempts to improve crop productivity in adverse environments.

Improved and efficient recovery methods are investigated as possible candidates to arrest the production decline and to improve the injection capacity in hydrocarbon fields in Lithuania. The data show that the Cambrian reservoirs in Lithuania are mixed to oil-wet in nature, which results in poor water-flooding efficiency. Wettability alteration could help in improved water injection and, at the same time, it could help recover additional oil from the residual oil saturation zone of the reservoir. In this paper, a screening exercise is conducted to help alter reservoir wettability, improve water injection efficiency, and to improve oil recovery. Analytical and machine-learning supported methods are used for screening. Based on the screening results, dilute surfactant-based injection techniques are suggested as a potential method to improve injectivity and, thereby, recovery from the field. An initial experimental analysis targets the wettability of the rock from the field, followed by testing for wettability-altering surfactants. Based on the findings of the screening study and experimental analysis, it is recommended that we initiate a core flooding experimental program to investigate wettability changes and enhance injection and recovery from the field.

Echinococcosis is a parasitic disease caused by infection with tiny tapeworms of the genus Echinococcus. Echinococcosis is classified as either cystic echinococcosis or alveolar echinococcosis. The common form is a zoonosis from goats and sheep that tends to cause liver lesions. The larval stage of Echinococcus multilocularis causes alveolar echinococcosis/alveolar hydatid disease. It is a zoonosis with field mice and tundra voles as intermediate and wild carnivores like foxes and wolves as definitive hosts. This zoonosis is highly uncommon compared to the other form known as cystic echinococcosis but poses a great human threat if untreated. We report the case of a young man who was working in the Kashmir Valley, North India, and presented with jaundice and right upper quadrant abdominal pain. Computed tomography revealed a large solid-cystic intrahepatic lesion measuring 125x118x123 mm, suggestive of a malignant tumor with central necrosis. A liver biopsy showed necrosis with PAS-positive membranes morphologically consistent with echinococcosis. Alveolar echinococcosis can present as a solid-cystic mass in the liver and can simulate metastatic malignancy.

Copper-graphene composites show remarkable electrical performance surpassing traditional copper conductors albeit at a micron scale; there are several challenges in demonstrating similar performance at the bulk scale. In this study, we used shear assisted processing and extrusion (ShAPE) to synthesize macro-scale copper-graphene composites with a simultaneously lower temperature coefficient of resistance (TCR) and improved electrical conductivity over copper-only samples. We showed that the addition of 18 ppm of graphene decreased the TCR of C11000 alloy by nearly 11 %. A suite of characterization tools involving scanning and transmission electron microscopy along with atom probe tomography were used to characterize the grain size, crystallographic orientation, structure, and composition of copper grains and graphene additives in the feedstock and processed samples. We posit that the shear extrusion process may have transformed some of the feedstock graphene additives into higher defect-density agglomerates while retaining the structure of others as mono-to-tri-layer flakes with lower defect density. The combination of these additives with heterogeneous structures may have been responsible for the simultaneous decrease in TCR and enhanced electrical conductivity of the copper-graphene ShAPE composites.

Inclusion body fibromatosis is a benign, often locally recurring myofibroblastic tumor with distinctive intracytoplasmic eosinophilic inclusions. In 1965, Reye1 was the first to document this entity through a series of 6 cases of digital fibrous tumors of childhood, where he observed intracytoplasmic inclusion bodies. This entity was later termed Reye’s tumor.2 As per the recent 2020 World Health Organization (WHO) classification, the other accepted terminologies include infantile digital fibroma/fibromatosis, recurring digital fibrous tumor(s) of childhood, and recurring digital fibroma(s) of childhood/infancy, where the etiology and pathogenesis remain unclear.3 It is a rare and slow-growing tumor that usually affects infants and children (mostly in less than 5 years) with equal gender distribution.4 These lesions most commonly affect the lateral and dorsal aspects of the last four digits, sparing the thumb, hand, or foot. Rarely, extremities, tongue, and breast act as the primary extradigital site. Grossly, the lesion appeared firm to rubbery and polypoidal dermal nodule with intact overlying stretched-out skin surface. Microscopically, the tumor cells contain characteristic intracytoplasmic 1.5 to 24 μm, rounded, pale pink round bodies located mainly in para nuclear location, highlighted better on Masson Trichrome (red color), phosphotungstic acid-hematoxylin (dark purple color), and Movat (pink color) stains. Ultrastructurally, the inclusions correspond to localized collections of non-membrane-bound, granular fibrillary material contiguous with the rough endoplasmic reticulum. These inclusions show strong immunoreactivity with actin and anti-calponin-1 antibody (inclusion containing calponin 1 as its possible content) but an occasional weak expression for caldesmon (the reason is still unknown). The recurrence rate is common with incomplete excision.5 Figure 1 refers to a 2-year-old female child presented with nodular swelling over the dorsal aspect of the proximal phalanx of the right second toe (Figure 1A). The swelling appeared firm, slightly mobile, and non-tender, with a history of gradual increase in size since birth. The overlying skin was erythematous and stretched out. The mass was seen in close approximation with the nail bed. The respective interphalangeal and metatarsophalangeal joints were mobile. The plastic surgeons kept the possibility of fibromatosis and performed a Ray amputation of the right second toe. The specimen was submitted for histopathological examination. Figure 1Inclusion body fibromatosis. A - a nodular swelling over the dorsal aspect of the proximal phalanx of the right second toe measuring 1.6x1.4cm in size (scale bar = 1 cm). The overlying skin was intact, erythematous, and stretched out; B - the spindle-shaped uniform tumor cells show many intracytoplasmic and para-nuclear eosinophilic bodies causing nuclear indentation of one of the poles at places- black arrows (H&E; x200); C - Masson Trichrome stain highlights these inclusions as red-coloured – black arrows (x200); D - ultrastructurally, the tumor cell within the cytoplasm shows a round, dense body (size: 3.12 µm) located in the para-nuclear region with corresponding nuclear indentation.: The specimen grossly included a dislocated right second toe comprising proximal, middle, and distal phalanges, measuring 5.5cm in length and 1cm in width. In close proximity to the nail bed, the dorsal aspect showed a nodular mass measuring 1.6x1.3x0.4cm. The cut surface revealed a relatively well-demarcated lesion that was firm, homogenous, and white. The lesion was not reaching the underlying bone and also the surgical margins. Microscopically, the dermis showed a relatively well-circumscribed tumor with hyperkeratosis, parakeratosis, and flattened rete ridges of the overlying epidermis. The tumor was composed of spindle-shaped cells arranged in intersecting short fascicles and, at places, in whorls. These cells are benign and uniform and contain elongated nuclei, bland chromatin, inconspicuous nucleoli, and pale eosinophilic cytoplasm with indistinct cell membrane. Mitotic activity is infrequent (less than 1/10hpf) with no significant nuclear atypia or necrosis. In addition, many intracytoplasmic and para-nuclear eosinophilic bodies causing nuclear indentation of one of the poles at places were noted (Figure 1B). These inclusions appeared red-colored on the Masson Trichrome stain (Figure 1C), magenta-colored on the Periodic Acid-Schiff stain, and showed weak-to-moderate immunoreactivity for calponin immunostain. The surgical margins and the underlying bone were not involved in the tumor. Taking into account the clinical findings and histopathological aspects, a diagnosis of inclusion body fibromatosis was given. Subsequently, tissue was retrieved from a representative formalin-fixed, paraffin-embedded block and subjected to transmission electron microscopy. Ultrastructurally, the tumor cells showed round, dense bodies of varying sizes (2.97 µm to 4.32 µm) located in the para-nuclear region within the cytoplasm with corresponding nuclear indentation (Figure 1D). The tumor cells also contained bundles of myofilaments. Thus, the characteristic ultrastructural features further confirmed the diagnosis. Postoperatively, the patient was kept on close observation with no adjuvant therapy. At 4 months follow-up, no local recurrence was evident.

Lithuania is located on the East of Baltic sedimentary basin and has a geothermal anomaly situated in the southwestern region of the country. There are two primary geothermal complexes within the anomaly, composed of Cambrian and Devonian aquifers. The Cambrian formation is composed of sandstones that have a reservoir temperature reaching up to 96 °C (depth > 2000 m). The Devonian aquifer is composed of unconsolidated sands of Parnu–Kemeri and has a reservoir temperature of up to 46 °C (depth > 1000 m). Historically, both formations have been investigated for geothermal energy production. In this article, we present a detailed literature review of the geothermal work carried out on both formations, including past, present, and some possible future studies. The study presented in this paper highlights the key findings of previous research work, summarizes the research gaps, and then elaborates on the possible applications of emerging technologies to bridge the research gaps and improve our understanding of geothermal complexes in Lithuania. Although it is not the main aim of this article, this article also touches upon the important need to develop 2D/3D numerical models, to quantify uncertainties, in the evaluation of the geothermal potential in Lithuania for commercial development. This study also highlights possibilities of extending geothermal development to depleted hydrocarbon reservoirs through repurposing the high-water-production wells. Moreover, from the literature review, it can be concluded that the Lithuanian geothermal aquifers are hyper-saline in nature and temperature changes lead to the deposition of salts both upstream and downstream of the reservoir. Therefore, there is a need for developing multiphysics thermo-mechanical–chemical (THMC) models for evaluation of reservoir behavior. The literature also describes the potential use and development of the THMC model as a part of future work that must be carried out.

Biliary adenofibroma (BAF) is an uncommon liver tumor with a high propensity for malignant transformation. The histomorphology of BAF with malignant transformation can show a spectrum of changes ranging from benign, dysplastic to frank malignancy. Thus, the diagnosis of BAF imposes the pursuit of dysplasia/ malignancy focus. We presented a case of intrahepatic cholangiocarcinoma arising from BAF in a 49-year-old woman with detailed histomorphology. We also performed a PubMed database search and tabulated all previously reported cases of BAF with dysplasia/ malignant transformation. A statistic comparison of age, sex ratio, size of the tumor, and survival following complete resection between BAFs with and without dysplasia/ malignancy from the retrieved data is presented. Our analysis did not highlight any statistically significant difference between BAFs with and without dysplasia/ malignancy in age, sex ratio, tumor size, and survival following complete surgical resection. Our study highlights the histopathology and immunohistochemistry of a case of BAF with malignant transformation and highlights the importance of this diagnosis in management. Further longitudinal studies on a larger cohort of patients are required to validate our findings.

Alcoholic foamy degeneration (AFD) is an uncommon presentation of alcoholic liver disease (ALD) with characteristic histologic findings of foamy-looking hepatocytes due to the presence of abundant microvesicles of fat within the cytoplasm predominantly in perivenular and midzonal regions without inflammation and fibrosis. It is underdiagnosed as the patients quickly recover after alcoholic abstinence and are rarely caught on biopsies. AFD has better prognosis than alcoholic hepatitis, and the injury mechanism is different, warranting a different diagnosis. We present an uncommon case of AFD incidentally diagnosed during autopsy in a chronic alcoholic and diabetic man.

This study aims to study a 42-year-old healthy male, presented to the Eye clinic with sudden diminution of vision in his right eye (RE). He had a history of penetrating high-velocity impact to his Left eye (LE) two months back. He was unable to receive immediate proper ophthalmic care owing to COVID restrictions after sustaining trauma and continued with his daily work. On examination, vision in the RE was reduced to finger counting less than 1 feet. Clinical features of RE showed mutton fat keratic precipitates and reaction in anterior chamber and posterior synechiae. LE showed features of a traumatic subluxated cataract with a sclerocorneal injury. Fundus could not be evaluated in both eyes. B scan revealed retinal detachment and chorioretinal thickening in the RE. Patient was immediately started on oral corticosteroids and topical medication and the patient vision had drastically improved to 6/24 in one week and was able to walk around and perform his daily activities by himself. Prompt treatment of a case of sympathetic ophthalmia (SO) is necessary and essential for the patient to recover his vision to a functional capacity. Prompt treatment of the exciting eye with regular monitoring of the other eye for timely diagnosis and management of SO.

Introduction: The intraoperative anatomical findings (IOAF) of all ureteropelvic junction obstruction (UPJO) cases are not identical. Moreover, there is also controversy in the literature regarding histopathological (HP) findings in cases of UPJO. In the present study, we evaluated different IOAF and assessed their association with specific HP parameters. Materials and Methods: This was a cross-sectional study set-up, which was carried out in a tertiary care centre. Children with UPJO who underwent surgery between 2017 and 2020 were enrolled. The following IOAF were noted: Type of pelvis (extrarenal or intrarenal), insertion of the ureter (high or normal), presence of lower pole crossing vessel (CV), negotiation of UPJ segment with double J stent (3 Fr) and length of internal narrowing (LIN) at UPJ. The resected segment of UPJ was assessed at three levels (pelvis, UPJ and ureter) for various HP parameters including fibrosis, oedema, inflammation and smooth muscle hypertrophy (SMH). Results: Thirty-nine children were included in the study with a mean age of 31 months. The summary statistics of IOAF were intrarenal pelvis in 5 cases, high insertion of the ureter (HIU) in 9, CV in 6, negotiable UPJ in 23, and 16 cases showed LIN >1 cm. All cases showed SMH at the pelvis region and SMH with fibrosis at the UPJ region. At the pelvis region, there was an association between (1) HIU with oedema and chronic inflammation (CIF), (2) CV with CIF and (3) LIN with CIF and SMH. At the UPJ region, there was an association between (1) CV and negotiable UPJ with less fibrosis and (2) LIN with SMH. At the ureteric end, CV showed an association with less fibrosis and more CIF. Conclusion: All UPJO cases have some common HP findings. Although, some particular IOAF, i.e., presence of CV, negotiable UPJ, HIU and LIN showed association with specific HP parameters.

Background: SARS CoV-2 has become a household name since early 2019 and till very recently has shown many mutations, some of which were predictable in behavior whereas some have been quite bizarre. With all these surreal mutants of the virus, the basic signs and symptoms of the infection also were diversified. A few studies compared the conjunctivitis features of the first and second wave of coronavirus disease 2019 (COVID-19) outbreak. Aims and Objectives: The purpose of this study was to compare the evidence of conjunctivitis between the first and second wave of COVID-19 patients. Materials and Methods: In this retrospective and observational research, clinical and laboratory characteristics of the patients with COVID-19 admitted to a tertiary care hospital in Western Maharashtra. We evaluated the patients including detailed history taken from the medical records and ocular evaluation was carried out by a trained ophthalmologist who was posted in the COVID-19 ward at that time. The patient’s symptoms were compared with the severity of COVID-19 disease classified as mild, moderate, and based on oxygen support given to the patient. Results: A total of 150 patients were evaluated in this study, of which 50 patients were from the first wave and 100 were from second wave of COVID-19. Among the total patients, about (80%) of patients with mild severity of COVID-19 disease were from in first wave v/s (61%) patients with mild severity of disease were from the second wave. Furthermore, it was observed that disease severity with moderate patients from the first wave was around (20%) v/s (39%) in the second wave. Among the total patients’ data, 66% of patients infected with conjunctivitis were in the first wave of COVID-19 and approximately 56% of patients infected with conjunctivitis were found in the second wave, respectively. About 18% of patients from the first wave and 39% of patients from the second wave with moderate severity required oxygen support. The fluorescein staining, as well as congestion, showed no significant difference in the number of patients between both waves. Conclusion: The present study concludes that both the waves only reported dryness and no clinical signs of conjunctivitis. The present study concludes that increased oxygenation support may act as one of the contributing factor for increased dryness and thereby may lead to various ocular infections.

Lithuania has a geothermal anomaly situated in the southwestern region of the country. This anomaly is comprised of two primary geothermal complexes located in western Lithuania. The first complex is characterized by the Pärnu–Kemeri Devonian sandstone aquifers, which exhibit exceptionally good flow properties. However, the reservoir temperatures in this complex only reach up to 45 °C. The second complex encompasses Cambrian sandstone reservoirs. Although these Cambrian sandstone reservoirs exhibit high temperatures, with the highest reservoir temperatures reaching up to 96 °C, these Cambrian sandstone reservoirs have less favorable petrophysical properties. This study focuses on the high temperature Cambrian Geothermal sandstone reservoirs. The study aims to conduct a geological screening of the existing and depleted hydrocarbon reservoirs with high water production rates. After initial data gathering, numerical modeling is employed with the help of mechanistic box models to evaluate the geothermal potential of the selected sites for commercial development. Ultimately, the study identifies the top five screened sites, which could be developed further for techno-economical modelling.

Hemophagocytic lymphohistiocytosis is usually considered a rapidly progressive fatal illness with poor outcomes. It is of two types: primary or familial and secondary. In patients with HIV, opportunistic infections are the secondary triggers of HLH. First line of management of infection associated HLH is treatment of the underlying infection. Here, we present a case of HLH in HIV infection due to disseminated histoplasmosis managed with liposomal amphotericin B, who required immunosuppressive therapy with intravenous immunoglobulin and dexamethasone due to nonresponse to primary therapy.

Acute erythroid leukemia (AEL) is an exceedingly uncommon but distinct hematological malignancy that shows neoplastic proliferation of erythroid precursors with maturation arrest and no significant myeloblasts. We describe an autopsy case of this rare entity in a 62-year-old man with co-morbidities. He underwent a bone marrow (BM) examination for pancytopenia during the first outpatient department visit, which revealed an increased number of erythroid precursors with dysmegakaryopoiesis suggesting the possibility of Myelodysplastic syndromes (MDS). Thereafter, his cytopenia got worsened, warranting blood and platelet transfusions. Four weeks later on the second BM examination, AEL was diagnosed based on morphology and immunophenotyping. Targeted resequencing for myeloid mutations revealed TP53 and DNMT3A mutations. He was initially managed along febrile neutropenia with the stepwise escalation of antibiotics. He developed hypoxia attributed to anemic heart failure. Subsequently, he had hypotension and respiratory fatigue pre-terminally and succumbed to his Illness. A complete autopsy showed infiltration of various organs by AEL and leukostasis. Besides, there was extramedullary hematopoiesis, arterionephrosclerosis, diabetic nephropathy (ISN-RPS class II), mixed dust pneumoconiosis, and pulmonary arteriopathy. The histomorphology of AEL was challenging, and the differential diagnoses were many. Thus, this case highlights the autopsy pathology of AEL, an uncommon entity with a strict definition, and its relevant differentials.

Phaeohyphomycosis is a term used for a rare opportunistic infection caused by a group of dematiaceous fungi which contains melanin in their cell walls. In 1974, the term phaeohyphomycosis was first coined by Ajello for an entity caused by pigmented fungi.1 Four clinical forms of phaeohyphomycosis exist: i) cutaneous, ii) subcutaneous, iii) systemic, and iv) cerebral. Among these, the subcutaneous form (phaeohyphomycotic cyst) is the most common subtype which usually presents as nodular swelling mainly over the distal extremities, which may be misdiagnosed as epidermal inclusion cyst, ganglion or lipoma. These fungi are present in the soil, where they infect mostly farmers and persons working in fields and farms. It was also highlighted that these infections are seen mostly in immunocompromised individuals and are byproducts of antimicrobial, steroid, and immunosuppressive therapy for various illnesses, including cancer, autoimmune diseases, and transplant cases.1 The pigment giving the characteristic brownish-black appearance to the fungi is melanin, which prevents phagocytosis and hence acts as a virulence factor.2 This group has more than 120 species and 70 genera.3 They have a broad spectrum of clinical manifestations, including superficial and deep fungal infections, sinus involvement, and disseminated forms, including lung and brain abscesses. The incidence ranges from 1-3.1 per 100,000 patients.4 The gold standard method for diagnosis is histopathological examination and culture. Fontana-Masson stain is of immense help in identifying these dematiaceous fungi in tissue as it highlights the melanin pigment in the cell walls. Figure 1 refers to a 59-year-old farmer man who presented with nodular swelling over the dorsum of the left hand for the last 9 months. Initially, the swelling was of peanut size, which gradually progressed to the present size of 5x3x2cm. The lesion was painless, well-defined, and freely mobile. The joint was not affected. He is on medication for type II diabetes mellitus and hypertension. He underwent Whipple's surgery for periampullary carcinoma. He was treated for proximal sensory-motor axonal neuropathy and tuberculosis three years back. Because of isoniazid-induced hepatitis, the patient received a modified anti-tuberculous regime for 9 months, after which he developed gastric ulceration with hematemesis and melena. On endoscopic biopsy, he was found to have chronic active gastritis with Helicobacter pylori infection. In addition, the patient had severe iron deficiency and hypoalbuminemia due to malabsorption. After treatment, he completely recovered at the time of hospital discharge. Figure 1 Phaeohyphomycotic cyst. A - A well-encapsulated and unilocular cyst measuring 4.5x2.2x1.8cm in size (scale bar = 2.5cm); The cyst lumen contains homogenous and translucent gelatinous soft material; B - Multinucleated giant cells showing fungal profile with septate, branching and globose swelling (H&E; x200); C - Periodic Acid-Schiff stain showing bright magenta positivity (PAS stain; x200); D - Fontana Masson stain giving brownish black color due to melanin in the fungal cell walls (x200).: Thus, the nodular swelling was wholly excised and sent for histopathological examination. Grossly, a well-encapsulated mass measuring 4.5x2.2x1.8 cm was submitted for histological analysis (Figure 1A). The external aspect appeared intact, yellowish-white, and congested. A unilocular cyst was identified on serial slicing with a capsular thickness of 0.1-0.2cm. The cut surface was soft in consistency with homogenous and gelatinous translucent material within the lumen. On light microscopy, an outer thick fibrous capsule layer was identified. Just beneath this capsular layer was the vascularized granulation tissue, proliferating fibroblasts, numerous multinucleated foreign and Langhan’s giant cells, and variable lymphoplasmacytic cell infiltrate. Also, abundant basophilic mucoid material with a background of many degenerated cells. These giant cells engulfed pigmented fungal profiles that depicted branching, septate and globose swelling (Figure 1B). Periodic Schiff-Acid stain gave bright magenta color to these fungi (Figure 1C), whereas Fontana Masson stain gave brownish black color due to melanin in the fungal cell walls (Figure 1D). Given the morphology, a diagnosis of a phaeohyphomycotic cyst was rendered. On follow-up, the patient is doing well, and has not received any antifungal agent. The leading treatment choice in non-invasive subcutaneous phaeohyphomycosis is local excision.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a unique neoplasm attributing to less than 1% of all renal cell carcinoma (RCC). The median age is 6th decade with a significant female preponderance.1 These tumors classically consist of tightly packed, elongated, and anastomosing tubules which merge with bland spindle cells in a myxoid stroma in variable proportions. Tubules with tufting or small papillae and foci of foamy macrophages may occur. The tumor cells are low-grade and may show clear cytoplasm or oncocytic changes with rare mitosis. Immunohistochemically, PAX8, CK7, AMACR, and CD10 are positive in this tumor.1,2 Though it is a morphological diagnosis, it can be challenging to differentiate from a solid variant of papillary RCC, sarcomatoid RCC, or myoid-predominant angiomyolipoma. Immunohistochemistry may be of little help due to overlapping profiles.3 Copy number analyses can help establish a diagnosis in challenging cases or core biopsies since these are associated with multiple chromosomal losses involving chromosomes 1, 4, 6, 8, 9, 13, 14, 15, and 22. Novel biomarkers like VSTM2A overexpression are also emerging, which can be detected by RNA in-situ hybridization. Recurrent Hippo pathway aberrations have been defined as the molecular signature of MTSCC with increased nuclear YAP1 protein expression.4 Adverse features such as necrosis, solid growth, single file infiltration, sarcomatoid transformation, lymphovascular invasion, and increased mitoses are indicators of metastatic disease. Although it has indolent behavior, rare cases with classic morphology have been seen to develop metastases.5-6 We describe gross and histopathological findings of mucinous tubular and spindle cell carcinoma in a 65-year-old male patient. He presented with right abdominal pain for one month. The pain was dull and mild to moderate in intensity. On contrast-enhanced ultrasound, a well-defined, smoothly marginated heterogeneous hyperechoic lesion measuring 5.5x6cm was noted at the upper pole of the right kidney. The lesion was hyper enhancing compared to the rest of the renal parenchyma. Based on the radiological findings, possibilities of chromophobe RCC and oncocytoma were considered. The abdominal computed tomography (CT) revealed a hyperdense lesion in the upper pole of the right kidney with a relatively well-defined margin measuring 63x65x69mm with no evidence of significant post-contrast enhancement in the either arterial, venous or delayed phase. The patient underwent a right radical nephrectomy. On gross examination, a well-encapsulated mass was seen wholly occupying the upper pole of the kidney measuring 6.9x6.5x5.5cm. The cut surface was variegated with grey-white, firm areas admixed with mucinous and hemorrhagic foci (Figure 1A). No capsular breach or perinephric fat extension was noted. The renal pelvis, sinus, and renal vessels were free of tumor. Figure 1 A - gross nephrectomy specimen showing a large, well-demarcated tumor involving the upper pole of the kidney measuring 6.9x6.5x5.5cm. The cut surface is variegated and appears grey-white and firm, along with intervening mucinous and hemorrhagic areas (scale bar = 5 cm); B - microscopically, the tumor is well-circumscribed with sharp demarcation from adjacent normal renal parenchyma (H&E; 40x); C - the dominant epithelial component is seen against the background stroma containing significant extracellular mucin (H&E; 100x); D - higher magnification showing tightly packed anastomosing tubules lined by low-grade cuboidal cells with cytoplasmic vacuoles against mucinous background (H&E; 400x).: Microscopically, the tumor was well-demarcated from the adjacent native renal parenchyma (Figure 1B). It was composed of the dominant epithelial element against the background of extracellular mucinous stroma (Figure 1C). The epithelial component contained tightly packed, elongated, tufted, and anastomosing tubules lined by low-grade cuboidal cells and are seen merging with bland spindle cells (Figure 1D). The nuclei display fine vesicular chromatin, inconspicuous nucleoli, and moderate cytoplasm with vacuolations. Mitotic figures are infrequent (

Renal lymphangiectasia (RL), also known as renal lymphangiomatosis, is a rare benign condition characterized by ectasia of peripelvic, perirenal and intrarenal lymphatic vessels. It accounts for approximately 1% of all lymphangiomas.1 The pathophysiology of renal lymphangiectasia remains unclear. However, it is hypothesized that the failure of draining into the larger retroperitoneal lymphatic channels causes abnormal cystic dilatation of the peripelvic, perirenal and intrarenal lymphatic ducts.2 RL can manifest at any age, with males and females equally affected. Lymphangiectasia can involve both kidneys, albeit unilateral involvement is common. Patients may be asymptomatic or present with flank pain, abdominal distention, lower limb oedema, hematuria and hypertension. Extreme presentation such as renal failure has also been documented. Due to the classical imaging features, computed tomography (CT) scan becomes the best diagnostic modality for the diagnosis, which can be confirmed by aspiration of chylous fluid.3 In the pediatric patient, the differential diagnosis includes cystic diseases of the kidney, nephroblastomatosis, and hydronephrosis with perinephric urinoma. Depending on the presentation, the management varies, including conservative, percutaneous aspiration, marsupialization, and nephrectomy.4 We describe gross and microscopic features of renal lymphangiectasia in a 4-year-old male child who presented with gradually progressive abdominal distension for one month with accompanying vague flank pain and fatigue. No hematuria or bladder bowel complaints were noted. Family and perinatal history were not significant. An ill-defined large mass of approximately 20x10cm occupying the left flank and hypochondrium was palpable on bimanual palpation. The renal function test was within normal limits for this age. Ultrasonography (USG) abdomen revealed bilateral multi-loculated, anechoic, cystic lesions in the perirenal and parapelvic region. Raised cortical echoes indicated the loss of corticomedullary distinction. CT scan revealed bilateral non-enhancing multiloculated cystic collection in the perirenal and parapelvic locations. Exploratory laparotomy showed a well-defined thick-walled sac of 20x15cm encasing the left kidney. Intraoperatively, the left kidney was hard to feel, and the architecture was distorted. A Left nephroureterectomy was done and submitted for histopathological evaluation. The kidney with perinephric fat measures 15x9x5.5cm, and the ureter was 5cm in length. The perinephric fat showed multiple collapsed cysts that enclosed the whole kidney ranging in size from 4 to 8cm in the largest dimension. The cut surface of the kidney exhibited well-demarcated multiloculated cysts in the cortex and medulla. The cysts are of variable size measuring 0.5 to 4cm in maximum dimension and shows thickness of 0.2cm and intervening thin septa (Figure 1A). The luminal aspect appeared smooth, contained brownish serous fluid, and did not show any papillary excrescences or growth. The adjacent spared kidney showed indistinct cortico-medullary junction and focal thinning of the cortex (0.3 to 0.4cm). Microscopically, numerous and variably sized cystic spaces were present in the cortex, medulla, pelvis, and perinephric fat (Figure 1B). Glomeruli and tubules in the intervening renal parenchyma showed no abnormal pathology on microscopy; however, the interstitium appears oedematous containing dilated lymphatic channels (Figure 1C). Cystic spaces were lined by a discontinuous layer of flat endothelial cells as highlighted by D2-40 (Figure 1D), CD31, and CD34 immunostains. Neuromatoid hyperplasia was seen in the sections from renal pelvis. Following clinical-radio-pathological correlation, a diagnosis of renal lymphangiectasia was offered. The patient was on close imaging follow-up to keep track of the right kidney.

Diffuse hepatic hemangiomatosis (DHH) is an uncommon vascular lesion, though hemangiomas are the commonest benign tumors of the liver. The etiology is largely unknown to date; however, its association with giant cavernous hemangiomas (GCH) has been reported in the literature. We present herein, the case of a 37-year-old hypothyroid woman with abdominal fullness for 2 months. The contrast-enhanced computed tomography revealed multiple wellencapsulated lesions involving the liver lobes and was diagnosed as giant cavernous hemangiomas. Most of them, except the deep-seated ones, were enucleated. Histopathological examination highlighted the presence of GCH with irregular margin, replacement of hepatic parenchyma, and presence of multiple micro-hemangiomas suggesting the possibility of DHH further substantiated by retrospective radiological assessment. No extrahepatic vascular lesion was noted, and the post-operative recovery and follow-up were uneventful. Adult DHH is an uncommon entity. The diagnosis of DHH and its distinction from GCH are important from the management and prognostic point of view as recurrence, extrahepatic manifestations, features of consumption coagulopathy, and death from the complications are not uncommon.

This paper presents the development of an underwater crack detection system for structural integrity assessment of submerged structures, such as offshore oil and gas installations, underwater pipelines, underwater foundations for bridges, dams, etc. Our focus is on the use of machine-learning-based approaches. First, a detailed literature review of the state of the current methods for underwater surface crack detection is presented, highlighting challenges and opportunities. An overview of the image augmentation approach for the creation of underwater optical effects is also presented. Experimental results using a standard network-based machine learning approach, which is used for surface crack detection in onshore environments, are presented. A series of test cases is presented in which existing networks’ performance is improved using augmented images for underwater conditions. The effectiveness and accuracy of the proposed approach in detecting cracks in underwater concrete structures are demonstrated. The proposed approach has the potential to improve the safety and reliability of underwater structures and prevent catastrophic failures.

Abstract Lung cancer is a complex thoracic malignancy developing consequential to aberrations in a myriad of molecular and biomolecular signaling pathways. It is one of the most lethal forms of cancers accounting to almost 1.8 million new annual incidences, bearing overall mortality to incidence ratio of 0.87. The dismal prognostic scenario at advanced stages of the disease and metastatic/resistant tumor cell populations stresses the requisite of advanced translational interdisciplinary interventions such as bionanotechnology. This review article deliberates insights and apprehensions on the recent prologue of nanobioengineering and bionanotechnology as an approach for the clinical management of lung cancer. The role of nanobioengineered (bio-nano) tools like bio-nanocarriers and nanobiodevices in secondary prophylaxis, diagnosis, therapeutics, and theranostics for lung cancer management has been discussed. Bioengineered, bioinspired, and biomimetic bio-nanotools of considerate translational value have been reviewed. Perspectives on existent oncostrategies, their critical comparison with bio-nanocarriers, and issues hampering their clinical bench side to bed transformation have also been summarized.

Abstract High-entropy alloys (HEAs) with multiple principal elements represent a paradigm shift in structural alloy design and show excellent surface degradation resistance in corrosive environment. Here, the tribo-corrosion response of laser-engineered net-shaped CoCrFeMnNi HEA was evaluated in 3.5 wt% NaCl solution at room temperature. The additively manufactured (AM-ed) CoCrFeMnNi showed five times lower wear rate, regenerative passivation, and nobler corrosion potential during tribo-corrosion test compared to its arc-melted counterpart. A significant anisotropy was seen in the tribo-corrosion response with 45° to the build direction showing better performance compared to tests along the build direction and perpendicular to it. The open circuit potential curves were characterized by a sharp drop to more negative values as wear began, followed by continuous change for the active tribo-corrosion duration and finally a jump to nobler value at the end of the test indicating excellent surface re-passivation for the AM-ed alloy. The superior tribo-corrosion resistance of AM-ed CoCrFeMnNi was attributed to the refined microstructure and highly protective surface passivation layer promoted by the sub-grain cellular structure formed during additive manufacturing. These results highlight the potential of utilizing additive manufacturing of HEAs for use in extreme environments that require a combination of tribo-corrosion resistance, mechanical durability, extended service life, and net shaping with low dimensional tolerance.

Wilms tumor (WT) can occur at various extrarenal sites; however, the urinary bladder as the primary site is occasional. A 4-year-old-female child presented with difficulty in micturition for the past month. The contrast-enhanced magnetic resonance imaging with magnetic resonance (MR) urography revealed a polypoidal, heterogeneous mass in the urinary bladder with no abnormality in the kidneys. Cystoscopy-guided biopsy was reported as an extrarenal Wilms tumor (ERWT) with triphasic components. Post-chemotherapy, a computed tomography scan revealed a residual tumor for which she underwent partial cystectomy. The diagnosis of ERWT was confirmed. She received adjuvant chemotherapy and remained well at the 9th month post completion of chemotherapy. The primary bladder WT must be considered in the differential of a small blue round cell tumor at an extrarenal site in the pediatric age group. The diagnosis is especially challenging in small biopsy material, although it has immense significance in management and prognosis.

Abstract Background Mantle cell lymphoma (MCL) is a rare type of mature B‐cell lymphoid malignancy with the pathologic hallmark of translocation t(11;14) (q13, q32), which leads to an overexpression of Cyclin D1 (CCND1). The disease is also characterized by the presence of a high number of recurrent genetic alterations, which include aberrations in several cellular pathways. MCL is a heterogeneous disease with a wide range of clinical presentations and a majority presenting with aggressive disease in advanced stages. Recent findings Management of MCL is bereft with challenges due to its resistant and relapsing pattern. Despite improvements in remission durations, the disease is currently incurable with standard therapy and has a median survival of about 3–5 years. The use of small molecules like the bruton tyrosine kinase (BTK) and BCL2 inhibitors, for treating relapsed MCL has been established leading to a diminishing role for conventional chemotherapy. Combinations of small molecule inhibitors with or without chemoimmunotherapy, are showing promising results. Cellular therapy in the form of CAR‐T cell therapy, has been approved recently. Conclusions Personalized cancer treatment and chemo‐free regimens are showing promise and results from well‐planned long‐term studies are evolving. In India, there is a paucity of epidemiological, clinical, and research data in this field.

Introduction: An acquired Nasolacrimal Duct Obstruction (NLDO) can occur at any age, and is classified as either primary or secondary. The nasolacrimal obstruction occurring primarily also known as Primary Acquired Nasolacrimal Duct Obstruction (PANDO) is observed mainly in conditions occurring due to inflammation or fibrosis. Aim: To study the current pattern of bacterial isolates with nasolacrimal passage obstruction and their antibiotic sensitivity patterns. Materials and Methods: This was a cross-sectional study conducted in the Department of Ophthalmology at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, over the period of two years from November 2019 to November 2021. A total of 100 patients were selected for the study. All the patients coming to Ophthalmology Out-patient Department (OPD) with the complaints of epiphora discharge, or both along with regurgitation on pressure over lacrimal sac and mucoid or mucopurulent or clear regurgitant material on sac syringing were taken. Before the beginning of the investigative procedure, informed consent was taken. The Clinical and Laboratory Standards Institute’s (CLSI) standardised Kirby-Bauer disc diffusion test was used to determine antibiotic susceptibility. Results: In the present study, the distribution of patients according to bacterial isolates was as follows, a maximum of 62% of patients were found with no growth, while 18% Methicillin-Sensitive Staphylococcus aureus (MSSA), 10% Coagulase-negative Staphylococci (CoNS), 6% Streptococcus pneumoniae, and 4% Pseudomonas were observed. In the present study, CoNS was observed as the predominant bacterial isolate in the diabetics with a female preponderance followed by MSSA (39%), Pseudomonas (75%), and S. pneumoniae (33%). This study found ciprofloxacin as a broad-spectrum antibiotic that worked against most bacterial isolates. Conclusion: A higher female preponderance was observed in this study with the left side being affected in most of the patients. The pattern of antibiotic sensitivity varies from region to region and thus should be kept in mind while prescribing antimicrobial therapy to the patients.

Peripheral neuropathy (PN) is characterized by the injury to the peripheral nervous system of varied etiology. Lymphoma is one of the etiologies of PN, presenting various neurological manifestations. Neuropathy associated with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is unusual and fewer cases are documented in the literature. In addition, PTCL, NOS is extremely rare as primary in the female genital tract, especially uterine cervix, and exhibits aggressive clinical course with poor therapy response. We hereby describe a 47-year-old female who presented with fever and chills for 15 days. Clinical examination revealed left-sided lower motor neuron type of facial nerve palsy with Bell’s phenomenon. Nerve conduction study of all four limbs illustrated asymmetrical axonal neuropathy (motor > sensory), suggesting mononeuritis multiplex. She developed vaginal bleeding during her hospital stay. Pelvic examination and imaging revealed a 4x3cm polypoidal mass on the posterior lip of the cervix, which was excised and diagnosed as extranodal primary PTCL, NOS based on morphology, immunohistochemistry, and in-situ hybridization findings. Besides, the cerebrospinal fluid (CSF) was infiltrated by the lymphoma cells, detected on cell block preparation. The patient succumbed to her illness within one week despite best efforts and the commencement of chemotherapy. No consent was obtainable for nerve biopsy and autopsy. Thus, we report an extremely rare case of primary extranodal PTCL, NOS of the uterine cervix with unusual presentation of mononeuritis multiplex. Further, we discussed the differentials of PTCL, NOS at this extranodal site.

Rarely, immunophenotypically immature B-cell precursor acute lymphoblastic leukemia (BCP-ALL) carries an immunoglobulin- MYC rearrangement (IG-MYC-r). This can result in diagnostic confusion with Burkitt lymphoma/leukemia and use of individualized treatment schedules of unproven efficacy. Here we compare the molecular characteristics of these conditions and investigate historic clinical outcome data. We identified 90 cases registered in a national BCP-ALL clinical trial/registry. When present, diagnostic material underwent cytogenetic, exome, methylome and transcriptome analyses. The outcomes analyzed were 3-year event-free survival and overall survival. IG-MYC-r was identified in diverse cytogenetic backgrounds, co-existing with either established BCP-ALL-specific abnormalities (high hyperdiploidy, n=3; KMT2A-rearrangement, n=6; iAMP21, n=1; BCR-ABL1, n=1); BCL2/BCL6-rearrangements (n=15); or, most commonly, as the only defining feature (n=64). Within this final group, precursor-like V(D)J breakpoints predominated (8/9) and KRAS mutations were common (5/11). DNA methylation identified a cluster of V(D)J-rearranged cases, clearly distinct from Burkitt leukemia/lymphoma. Children with IG-MYC-r within that subgroup had a 3-year event-free survival of 47% and overall survival of 60%, representing a high-risk BCP-ALL. To develop effective management strategies this group of patients must be allowed access to contemporary, minimal residual disease-adapted, prospective clinical trial protocols.

Background True brachial artery aneurysms (BAAs) are rare compared to other peripheral artery aneurysms. These are usually associated with trauma, infections, and arteriovenous fistulas (AVF), but their association with other aneurysms is unclear. When symptomatic, patients with true BAAs often present with acute limb ischemia. In this report, we describe a case of a thrombosed BAA that was found in association with diffusely ectatic arteries and an aneurysmal para-renal and infra-renal aorta.Case report An 86-year-old male with a well-functioning deceased donor kidney transplant for more than 30 years presented with acute limb ischemia of the right upper extremity. He had a history of a ligated fistula of the right upper extremity several decades ago but had undergone no further access procedures. Initial duplex-imaging revealed an ectatic brachial artery (1 cm) and a 4.2 cm thrombosed BAA. He was taken to the operating room for an emergent exploration and brachial to ulnar artery bypass using reversed greater saphenous vein. He underwent a full body workup to look for other sites of aneurysmal degeneration which revealed a para-visceral aortic aneurysm and a large infra-renal aortic aneurysm.Conclusion We suggest that in patients who present with brachial artery aneurysms or diffusely ectactic vessels, it may be reasonable to obtain abdominal aorta duplex screening for aneurysmal disease, like what is done for patients with popliteal artery aneurysms.

Background: The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads. Methods: A retrospective review of neurosurgical caseloads among seven residency programs between March 2019 and April 2020 was conducted. Cases were grouped by ACGME Neurosurgery Case Categories, subspecialty, and urgency (elective vs. emergent). Residents caseloads were stratified into junior (PGY1-3) and senior (PGY4-7) levels. Descriptive statistics are reported for individual programs and pooled across institutions. Results: When pooling across programs, the 2019 monthly mean (SD) case volume was 214 (123) cases compared to 217 (129) in January 2020, 210 (115) in February 2020, 157 (81), in March 2020 and 82 (39) cases April 2020. There was a 60% reduction in caseload between April 2019 (207 [101]) and April 2020 (82 [39]). Adult spine cases were impacted the most in the pooled analysis, with a 66% decrease in the mean number of cases between March 2020 and April 2020. Both junior and senior residents experienced a similar steady decrease in caseloads, with the largest decreases occurring between March and April 2020 (48% downtrend). Conclusions: Results from our multicenter study reveal considerable decreases in caseloads in the neurosurgical specialty with elective adult spine cases experiencing the most severe decline. Both junior and senior neurosurgical residents experienced dramatic decreases in case volumes during this period. With the steep decline in elective spine cases, it is possible that fellowship directors may see a disproportionate increase in spine fellowships in the coming years. In the face of the emerging Delta and Omicron variants, programs should pay attention toward identifying institution-specific deficiencies and developing plans to mitigate the negative educational effects secondary to such caseloads reduction.

PURPOSEThere are limited reports of quality metrics in glioblastoma. We audited our adherence to quality indicators as proposed in the PRIME Quality Improvement study.METHODSThis is a retrospective audit of patients treated between 2017 and 2020. After postsurgical integrated diagnosis, patients received radiotherapy (RT) with concurrent and adjuvant temozolomide (TMZ). Multiparametric magnetic resonance imaging at predefined times guided management. Numbers with proportions for indices were calculated. Survival was estimated using the Kaplan-Meier method.RESULTSOne hundred six patients were consecutively treated. The median age was 55 years (interquartile range of 47-61 years) with a male preponderance (68%). Ninety-six (90.6%) patients underwent subtotal resection, and 10 (9.4%) biopsy alone. Isocitrate dehydrogenase was wild-type in 96 (91%), and O6-methylguanine-DNA methyltransferase was unmethylated in 70 (66.0%) patients. Telomerase reverse transcriptase promoter was mutated in 64 (60.4%), and TP53 was mutated in 22 (20.8%). Concurrent radiation and TMZ were planned for 104 (98.1%), and radiation alone for 2 (1.9%). The median time to concurrent RT-TMZ was 36 days (interquartile range 30-44 days). All patients planned for RT-TMZ completed treatment, but only 81 (76%) completed adjuvant TMZ. Sixty-three (59%) completed six cycles, 18 (17%) received less than six cycles, and 25 (24%) did not receive adjuvant TMZ. At a median follow-up of 24 months (range 21-31 months), the median (95% CI) progression-free survival and overall survival were 11 (95% CI, 9.4 to 13.0) and 20.0 (95% CI, 15 to 26) months, respectively.CONCLUSIONOur patients met quality indices in most domains; outcomes are comparable with global results. Metrics will be periodically evaluated to include new standards and assess continuous service appropriateness.

INTRODUCTION: Recurrent Clostridioides difficile infection (rCDI) often occurs after standard-of-care antibiotics. VOWST oral spores (VOS, previously SER-109), an FDA-approved orally administered microbiome therapeutic, is indicated to prevent rCDI following antibiotics for rCDI. OBJECTIVE, DESIGN, AND PATIENTS: To evaluate safety and efficacy of VOS from two phase 3 trials, (randomized, placebo-controlled [ECOSPOR III: NCT03183128] and open-label, single arm [ECOSPOR IV: NCT03183141]) of 349 adults with rCDI and prevalent comorbidities. METHODS: VOS or placebo [ECOSPOR III only] (4 capsules once daily for 3 days). Integrated analysis of treatment-emergent adverse events (TEAEs) collected through week 8; serious TEAEs and TEAEs of special interest collected through week 24; and rates of rCDI (toxin-positive diarrhea requiring treatment) evaluated through weeks 8 and 24. RESULTS: TEAEs were mostly mild or moderate and gastrointestinal. Most common treatment-related TEAEs were flatulence, abdominal pain and distension, fatigue, and diarrhea. There were 11 deaths (3.2%) and 48 patients (13.8%) with serious TEAEs, none treatment-related. The rCDI rate through week 8 was 9.5% (95% CI 6.6-13.0) and remained low through 24 weeks (15.2%; 95% CI 11.6-19.4). Safety and rCDI rates were consistent across subgroups including age, renal impairment/failure, diabetes, and immunocompromise/immunosuppression. CONCLUSIONS: VOS was well tolerated and rates of rCDI remained low through week 24 including in those with comorbidities. These data support the potential benefit of VOS following antibiotics to prevent recurrence in high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03183128 and NCT03183141.