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Background: Altered T‐cell repertoire with an aberrant T‐cell activation and imbalance of the Th17/Treg cells has been reported in acquired aplastic anemia (aAA). miRNAs are well known to orchestrate T‐cell activation and differentiation, however, their role in aAA is poorly characterized. The study aimed at identifying the profile of miRNAs likely to be involved in T‐cell activation and the Th17/Treg‐cell imbalance in aAA, to explore newer therapeutic targets. Methods: Five milliliters peripheral blood samples from 30 patients of aAA and 15 healthy controls were subjected to flow cytometry for evaluating Th17‐ and Treg‐cell subsets. The differential expression of 7 selected miRNAs viz; hsa‐miR‐126‐3p, miR‐146b‐5p, miR‐155‐5p, miR‐16, miR‐17, miR‐326, and miR‐181c was evaluated in the PB‐MNCs. Expression analysis of the miRNAs was performed using qRT‐PCR and fold change was calculated by 2−ΔΔCt method. The alterations in the target genes of deregulated miRNAs were assessed by qRT‐PCR. The targets studied included various transcription factors, cytokines, and downstream proteins. Results: The absolute CD3+ lymphocytes were significantly elevated in the PB of aAA patients when compared with healthy controls (p < 0.0035), however, the CD4:CD8 ratio was unperturbed. Th17: Treg‐cell ratio was altered in aAA patients (9.1 vs. 3.7%, p value <0.05), which correlated positively with disease severity and the PNH positive aAA. Across all severities of aAA, altered expression of the 07 miRNAs was noted in comparison to controls; upregulation of miR‐155 (FC—2.174, p‐value‐0.0001), miR‐146 (FC—2.006, p‐value‐0.0001), and miR‐17 (FC—3.1, p‐value‐0.0001), and downregulation of miR‐126 (FC—0.329, p‐value‐0.0001), miR‐181c (FC—0.317, p‐value‐0.0001), miR‐16 (FC—0.348, p‐value‐0.0001), and miR‐326 (FC—0.334, p‐value‐0.0001). Target study for these miRNAs revealed an increased expression of transcription factors responsible for Th1 and Th17 differentiation (T‐bet, RORϒt, IL‐17, IL‐6, and IFN‐ϒ), T‐cell activation (NFκB, MYC, and PIK3R2), downregulation of FOX‐P3, and other regulatory downstream molecules like SHIP‐1, ETS‐1, IRAK‐1, TRAF‐6, and PTEN. Conclusion: The study for the first time highlights the plausible role of different miRNAs in deregulating the Th17/Treg‐cell imbalance in aAA, and comprehensively suggest the role of altered NF‐kB and mTOR pathways in aAA. The axis may be actively explored for development of newer therapeutic targets in aAA. [ABSTRACT FROM AUTHOR]

Grid-forming inverters (GFMs) have emerged as crucial components in modern power systems, facilitating the integration of renewable energy sources and enhancing grid stability. The significance of GFMs lies in their ability to autonomously establish grid voltage and frequency, enabling grids to form and improve system flexibility. Discussing control methods for grid-forming inverters is paramount due to their crucial role in shaping grid dynamics and ensuring reliable power delivery. This paper explores the fundamental and advanced control methods employed by GFMs, explaining their operational principles and performance characteristics. Basic control methods typically involve droop control, voltage and frequency regulation, and power-balancing techniques to maintain grid stability under varying operating conditions. Advanced control strategies encompass predictive control, model predictive control (MPC), and adaptive control, which influence advanced algorithms and real-time data for enhanced system responsiveness and efficiency. A detailed analysis and performance comparison of different control methods for GFM is presented, highlighting their strengths, limitations, and suitability for diverse grid environments. Through comprehensive studies, this research interprets the ability of various control strategies to mitigate grid disturbances, optimize power flow, and enhance overall system stability. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Leukemic stem cells (LSCs) are the transcriptionally low/silent cells which are resistant to the tyrosine kinase inhibitor. These have been found to play a pivotal role in disease relapse in chronic myeloid leukemia (CML) cases. The present study evaluated the correlation of absolute CML‐LSC count in the peripheral blood (PB) at diagnosis and achievement of major molecular response (MMR) at 12 months in patients of CML‐CP.This was a prospective, observational, non‐interventional single center study including newly diagnosed adult (>18 yrs) CML‐CP patients. Absolute CD26 + CML‐LSC quantification was done by multiparametric flow cytometry. Patients were treated with Imatinib treatment and subsequently monitored at 3‐month intervals for BCR::ABL transcript levels. MMR was defined as a BCR::ABL1 transcript level of less than 0.1% on international scale.A total of 89 patients were enrolled in the study out of which 40.5% achieved MMR at 12 months. There was a significant difference in the median absolute CML‐LSC count of the patients who achieved MMR at 12 months as compared to those who did not (58.5 vs 368.1 cells/μL; p value <0.001). Using a ROC analysis, a count of <165.69 CML LSC/μL was identified to have a sensitivity of 83.8% and specificity of 72.4%, in predicting the MMR at 12 months.Absolute CML‐LSC count at diagnosis in the PB predicts the MMR achievement at 12 months. An absolute count of less than 165 cells/μL is highly predictive of achieving MMR at 12 months. [ABSTRACT FROM AUTHOR]

Background: Hepatosplenic T-cell lymphoma (HSTCL) is a rare fatal T-cell neoplasm with unique clinical and laboratory features. There is, however, significant morphological and immunophenotypic heterogeneity which may lead to diagnostic dilemma.Aims and Objectives: The study was aimed to study the prevalence and clinic-pathological spectrum of this rare variant of T cell lymphoma in the Indian subcontinent.Material and Methods: A retrospective analysis of all consecutive cases of HSTCL diagnosed over a period of 6 years was carried out. The clinical and laboratory parameters of all these patient were reviewed and analysed.Results: A total of 12 cases of HSTCL were diagnosed during this period which accounted for 1.76% of all non-Hodgkin's lymphomas (NHLs) and 9.1% of all T-cell NHLs. The median (range) age of presentation was 23 (16-30) years.Leukocytosis, peripheral blood (PB) involvement, and a blastic morphology were noted in 41%, 67%, and 58% of the cases, respectively. FCI proved these cells to have a mature, dual-negative (CD4-/CD8-) T-cell phenotype with a gamma-delta T-cell receptor restriction. Frequent loss of CD5 expression (84%) was also noted. These patients invariably had a fatal outcome and majority died within a year of diagnosis.Conclusion: The incidence of leukocytosis and a blastoid morphology is quite frequent in HSTCL. Hence, a differential diagnosis of HSTCL should always be considered in young patients presenting with splenomegaly and exhibiting atypical lymphoid/blastoid cells in the PB or a marrow. An FCI can readily diagnose and differentiate them from an acute lymphoblastic leukemia/lymphoma. [ABSTRACT FROM AUTHOR]

Background: Recently, CD26 have been identified as one of the promising and specific marker for the identification of leukemic stem cells (LSCs) in chronic myeloid leukemia (CML). Methods: This was a prospective, observational validation study. Peripheral blood (PB) samples from suspected cases of CML and other hematolymphoid neoplasm were evaluated for the expression of CD26 on stem cells (SC) (CD45 dim/CD34+/CD38‐) fraction by flow cytometry (FCM) using a single tube four‐color antibodies cocktail: CD45‐V500 /CD26‐PE/CD34‐PerCPcy5.5/CD38‐APC‐H7. The diagnosis of CML was confirmed using cytogenetics and/or molecular studies. Additionally, 12 paired PB and bone marrow (BM) samples of CML cases were compared for the proportion of CD26+ LSCs. Results: Expression of CD26 on the SC fraction was invariably noted in all cases (116/116) of CML, irrespective of the disease phase and transcript type. None of other neoplasm (0/26), including the Ph + ALLs expressed CD26. Proportion of SCs expressing CD26 was variable with a median (range) proportion being 61.3% (7.6%–98.6%). Evaluation of paired PB and BM samples showed similar proportion of CD26 + LSCs (R2: 0.969). Conclusion: We confirmed that FCM evaluation of CD26 expression in the PB LSCs is a rapid and specific tool for CML diagnosis. Its utility as a marker for residual disease evaluation can also be explored in the future. [ABSTRACT FROM AUTHOR]

In this article, a novel ZAC-source single-phase ac–ac converter with high buck and boost voltage conversion capability is introduced. The proposed topology utilizes the ZAC-source network to regulate the frequency and magnitude of the output voltage. The proposed converter operates in buck mode when the duty cycle lies between 0 and 0.33, and boost mode when the duty cycle lies between 0.33 and 1. The switching control strategy is discussed and the proposed converter provides a feature to control the magnitude and frequency of the output voltage independently. Employment of capacitors in the outer closed loop results in a highly consistent operation characterized by inherent soft commutation capability, removal of the source shoot-through risk, and enhanced input current waveform quality. Due to these advantages, it can be applied to the adjustable speed drives and traction systems. The control code is executed in dSPACE 1006 embedded with field-programmable gate array (FPGA) dS5203 board and the performance of the proposed converter is tested experimentally. The obtained experimental results are provided which validates the theoretical analysis and performance of the proposed converter. [ABSTRACT FROM AUTHOR]

Background: About 50 different CALR frameshift mutations have been identified in BCR‐ABL1 negative MPN, all leading to the development of common new protein C terminus. Antibody targeting this terminal epitope can be useful to identify this driver mutation using immunohistochemistry. Materials and Methods: CALR mutation analysis was carried out in 51 JAK2V617F negative cases, PMF (n = 22) and ET (n = 29). PCR followed by fragment analysis was performed for molecular detection of CALR mutation. Bone marrow biopsy specimens of corresponding patients were subjected to IHC using mutation specific antibody CAL2. Staining pattern and intensity were observed. Staining of <2% of background nonmegakaryocytic (non‐ MK) cells were regarded as Pattern A, while staining of more than 2% of background nonmegakaryocytic (non‐MK) was regarded as pattern B. Results: CALR mutation was noted in 40.9% (9/22) and 41.4% (12/29) of JAK2V617F negative PMF and ET, respectively. All CALR mutated cases, irrespective of the mutation type, showed a positive IHC staining in the megakaryocytes with moderate to bright intensity. All CALR wild‐type cases were negative on IHC. (Concordance rate‐ 100%). Pattern A was noted in 40% cases, while pattern B was noted in 60% cases. Pattern A staining had significantly higher chances of having type 1 mutation as compared to pattern B. In contrast, pattern B had a nonsignificant trend toward higher bone marrow cellularity and marrow fibrosis. Conclusion: CAL2 IHC detects all types of CALR mutation. This can act as a sensitive, specific, rapid, and cost‐effective screening test for CALR mutation analysis. [ABSTRACT FROM AUTHOR]

Myelodysplastic syndromes (MDSs) are characteristically defined by the presence of specific karyotypic abnormalities, based on which they have been prognosticated. Translocation t(9;22)(q34;q11.2) (Philadelphia positive [Ph +ve]) and corresponding BCR-ABL fusion transcript is the defining parameter of chronic myeloid leukemia. It is also seen in a fair proportion of adult acute lymphoblastic leukemia. Occurrence of a Ph +ve MDS is very uncommon, and that too is seen mostly on progression to higher stage/acute leukemia. Even rarer is the de novo presence of Ph positivity in an MDS. A literature search through PubMed has shown only about forty cases of Ph +ve MDS among which less than half had shown Ph positivity at the time of initial diagnosis. Due to its rarity, this entity has not yet found its space in current WHO 2008 classification and is still under "yet to be validated phase" in current practice of hematological malignancies. The benefit of using a tyrosine kinase inhibitor in such a situation is also debatable. We report here two such cases of de novo Ph +ve MDS, diagnosed in last 1½ year at our institute along with brief literature review. [ABSTRACT FROM AUTHOR]

The pulse‐width modulation (PWM)‐controlled modern electric drives causes some serious problems such as the generation of common‐mode voltage (CMV) and high dv/dt. The CMV might cause high‐frequency leakage currents that flow through the possible path that is bearing of the motor. Thus, the flow of current through the motor bearing leads to its premature failure. One of the main challenges in developing PWM methods for control of motor drives is the problem of CMV and its reduction/elimination. In this study, a modulation technique based on space‐vector approach is developed to reduce the CMV in a three‐to‐seven‐phase direct matrix converter. CMV reduction becomes possible by selecting suitable zero‐voltage vectors for a specific duration and the use of a selected set of active vectors for the output voltage synthesis. The proposed space‐vector PWM (SVPWM) for the reduction of CMV is performed with a seven‐phase R–L load to show the viability of the proposed technique. The proposed SVPWM technique is implemented experimentally in dSPACE working in conjunction with field‐programmable gate array processor board using a system generator. Hardware results that validate the proposed control algorithm are discussed. [ABSTRACT FROM AUTHOR]

This paper proposes the modulation and control of a three-to-six-phase matrix converter with an asymmetrical six-phase output. The matrix converter (MC) outputs consist of two sets of three-phase spatially shifted by 300, where the two sets have two isolated neutrals. The space vector approach is considered for the modeling and subsequent modulation of the three-to-six phase MC. The intelligent selection of voltage space vectors is made to synthesize the reference voltages and to obtain a sinusoidal output. The dwell times of selected voltage space vectors are adjusted in such a way that the effect of the second and the third auxiliary plane vectors (i.e., x1-y1, and x2-y2) are nullified. To achieve the maximum output voltage gain and to ensure that no reactive power is drawn from the utility supply, the input side power factor is maintained at unity. Nevertheless, the source side power factor is controllable. The modulation technique is implemented in dSPACE working in conjunction with a FPGA. Hardware results that validate the proposed control algorithm are discussed. [ABSTRACT FROM AUTHOR]

The article present a case study of a 67‐year‐old woman with purpuric rashes over her limbs for a week's duration. It mentions a complete blood cell count revealed pancytopenia with hemoglobin; and also mentions based on the morphological and immunophenotypic findings, a final diagnosis of early T‐cell precursor acute lymphoblastic leukemia with Auer rods was favored over an mixed phenotype acute leukemia (MPAL), T/myeloid.

Filariasis is among the common parasitic infestations found in India, with Wuchereria bancrofti being the most common causative organism. Presentation ranges from clinically asymptomatic to profound elephantiasis. It is also detected incidentally in diagnostic samples such as body fluids, fine needle aspirates, peripheral blood smears, and other cytological smears. Its detection in bone marrow aspirates with an associated hematolymphoid neoplasm is rare, with only a few case reports. We report one such case of young male who presented with leukocytosis of 253 × 109/L with basophilia and massive splenomegaly. Bone marrow aspirate smears showed the presence of microfilariae along with other features of a myeloproliferative neoplasm (MPN). The present case is probably the first case of finding a microfilaria in a case of MPN. [ABSTRACT FROM AUTHOR]

Hairy cell leukemia (HCL) is a rare, low-grade mature B-cell neoplasm with a characteristic clinical, morphological, immunophenotypic, and more recently described molecular (BRAF p.V600E mutation) profile. It typically affects middle-aged to elderly male who present with pancytopenia and massive splenomegaly. Lymphadenopathy is usually not seen. Atypical presentations such as absence of splenomegaly and presence of lymphadenopathy and leukocytosis, a hypoplastic marrow masquerading as aplastic anemia, pose a diagnostic challenge to both clinician and pathologist. A diligent morphological examination to look for the presence of hairy cells along with flow cytometric immunophenotyping showing consistent bright expression of CD200, in addition to well-described characteristic immunophenotype, helps in correctly diagnosing the case. This can be further confirmed by the consistent presence of V600E point mutation in BRAF gene. The correct identification of HCL in these unusual clinical presentations is of utmost importance owing to a different treatment approach in these cases. We present here four such cases with atypical presentation. [ABSTRACT FROM AUTHOR]

In this study, common mode voltage (CMV) reduction using space vector pulse‐width modulation (SVPWM) technique is proposed for a three‐phase induction motor drive fed by a three‐to‐three phase indirect matrix converter (MC). The proposed SVPWM effectively reduces the peak of the CMV without affecting the output voltage gain. By adopting the proposed SVPWM there is no change in the dv/dt of CMV at the terminal of the machine when compared to the existing method. The proposed control is possible by proper placement of zero vectors in the rectifier stage and discarding zero voltage vectors in the inverter stage of the indirect MC. The control technique is implemented in MATLAB/Simulink environment. Hardware setup is developed and control algorithm is implemented using dSPACE working in conjunction with the FPGA interface board. The results of the proposed SVPWM are compared with the existing method of CMV elimination and the improvement is established. The simulation results obtained are verified with the experimental results. The obtained results confirm a reduction of CMV by 48% (peak) and validate the viability of the proposed scheme in a three‐phase induction motor drive system. [ABSTRACT FROM AUTHOR]

Erythropoiesis is a highly regulated process and undergoes several genotypic and phenotypic changes during differentiation. The phenotypic changes can be evaluated using a combination of cell surface markers expressed at different cellular stages of erythropoiesis using FACS. However, limited studies are available on the in-depth phenotypic characterization of progenitors from human adult hematopoietic stem and progenitor cells (HSPCs) to red blood cells. Therefore, using a set of designed marker panels, in the current study we have kinetically characterized the hematopoietic, erythroid progenitors, and terminally differentiated erythroblasts ex vivo. Furthermore, the progenitor stages were explored for expression of CD117, CD31, CD41a, CD133, and CD45, along with known key markers CD36, CD71, CD105, and GPA. Additionally, we used these marker panels to study the stage-specific phenotypic changes regulated by the epigenetic regulator; Nuclear receptor binding SET Domain protein 1 (NSD1) during erythropoiesis and to study ineffective erythropoiesis in myelodysplastic syndrome (MDS) and pure red cell aplasia (PRCA) patients. Our immunophenotyping strategy can be used to sort and study erythroid-primed hematopoietic and erythroid precursors at specified time points and to study diseases resulting from erythroid dyspoiesis. Overall, the current study explores the in-depth kinetics of phenotypic changes occurring during human erythropoiesis and applies this strategy to study normal and defective erythropoiesis. [ABSTRACT FROM AUTHOR]

The article present a case study of a 62‑year‑old male with complaints of urgency, frequency, and poor stream. Topics discussed include perrectal examination revealed hard and nodular prostate; mentions Computed tomography of the abdomen and thorax did not reveal any lymphadenopathy; and also mentions Magnetic resonance imaging brain revealed a heterogeneously enhancing space‑occupying lesion in the right basal ganglia region.

Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by immunological imbalance due to inappropriate activation of macrophage, T/NK cells resulting in hypercytokinemia and subsequent tissue damage. We present an interesting case of acute lymphoblastic leukemia (ALL) who presented to us with clinical and laboratory features of HLH. High index of suspicion for malignancy based on clinical history and bone marrow examination led us to reach at definitive diagnosis of ALL. [ABSTRACT FROM AUTHOR]

Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by immunological imbalance due to inappropriate activation of macrophage, T/NK cells resulting in hypercytokinemia and subsequent tissue damage. We present an interesting case of acute lymphoblastic leukemia (ALL) who presented to us with clinical and laboratory features of HLH. High index of suspicion for malignancy based on clinical history and bone marrow examination led us to reach at definitive diagnosis of ALL. [ABSTRACT FROM AUTHOR]

Introduction: MicroRNAs (miRNAs) play a critical role in orchestrating T cell differentiation and activation and may thus play a vital role in acquired aplastic anemia (aAA). The study aimed to evaluate the differential expression of selected miRNAs and their relevant target genes in bone marrow samples of aAA patients. Methods: Differential expression of 8 miRNAs viz; hsa‐miR‐126‐3p, miR‐145‐5p, miR‐155‐5p, miR‐150‐5p, miR‐146b‐5p, miR‐34a, miR‐29a, and miR‐29b was evaluated in the bone marrow mononuclear cells of aAA patients. TaqMan microRNA assay was performed for preparing the cDNA of specific miRNA, followed by expression analysis using qRT‐PCR. Data were normalized using two endogenous controls, RNU6B and RNU48. Delta‐delta CT method was used to calculate the fold change (FC) of miRNA expression in individual samples, and a FC of >1.5 was taken as significant. Target genes of these miRNAs were evaluated by qRT‐PCR. Results: Thirty five samples of aAA patients and 20 controls were evaluated. Irrespective of the disease severity, five miRNAs were found to be deregulated; miR‐126 (FC‐0.348; P‐value‐.0001) and miR‐145 (FC‐0.31; P‐value‐.0001) were downregulated, while miR‐155 (FC‐3.50; P‐value‐.0067), miR‐146 (FC‐3.13; P‐value‐.0105), and miR‐150 (FC‐5.78; P‐value‐.0001) were upregulated. Target gene study revealed an upregulation of PIK3R2, MYC, SOCS1, and TRAF‐6, and downregulation of MYB. Conclusion: This is the first study from the Indian subcontinent demonstrating the presence of altered miRNA expression in the bone marrow samples of aAA patients, suggesting their role in the pathogenesis of the disease. A comprehensive study focusing on the effect of these miRNA‐mRNA interactions is likely to open new avenues of management. [ABSTRACT FROM AUTHOR]

Speed control of synchronous machines using Field Oriented Control (FOC) classically uses Proportional Integral (PI) or Integral Proportional (IP) regulators that allow to achieve satisfactory goals on the dynamics of speed and torque. However, the performance deteriorates with loss of one or more phases in multiphase machines with IP regulator. This paper present comparison between the use of IP regulator and Fuzzy Logic Regulator (FLR) under same conditions applied to Five Phase Permanent Magnet Synchronous Machine (FPSM). First, modeling and performance of the FPSM are presented. In the beginning, the control is ensured in healthy mode with an IP regulator then in degraded mode when one then two phases are opened. The performances of the FLR are compared to IP ones. Better performance of FLR is established in terms of faster dynamics. [ABSTRACT FROM AUTHOR]

Leukemoid reaction and myeloproliferative syndrome are close mimickers and frequently pose a diagnostic dilemma, particularly when the leukocyte count is very high. Leukocyte alkaline phosphatase score frequently aids in diagnosis but may or may not be contributory, especially in differentiating chronic neutrophilic leukemia. Herein, we document a case of leukemoid reaction with extensive hyperleukocytosis in a 46-year-old female with poorly differentiated carcinoma. The tumor itself as well as the associated leukocytosis portends a poor prognosis. [ABSTRACT FROM AUTHOR]

Radioiodine (RI) has been widely used in treatment of hyperthyroidism and thyroid cancer. The development of acute or chronic leukemia is a very rare complication of RI therapy. Here, we report two cases of acute myeloid leukemia occurring after the completion of RI therapy for follicular thyroid carcinoma along with a brief review of literature. [ABSTRACT FROM AUTHOR]

Background: The outcome of acute myeloid leukemia (AML) in low-middle-income countries (LMIC) is dismal due to delayed clinical presentation and infection-related complications. We aimed to analyze the outcome of patients with AML and the factors associated with its prognosis. Methods: A retrospective observational study was conducted at a tertiary care university hospital in North India from January 2015 to December 2019. Results: A total of 137 AML patients (median age 32 year (3–66 years) received intensive chemotherapy during study period. The median delay from diagnosis to treatment was 45 days (6–177 days). Among the 352 febrile neutropenia (FN) episodes analyzed, 175 (49.7%) were culture positive; Gram-negative multi-drug resistant organism (MDRO) sepsis during induction being 57.4% with 34.5% infections due to carbapenem-resistant Enterobacteriaceae (CRE) leading to a mortality rate of 14.6%. The median EFS and OS were 12.0 ± 1.57 (95% CI 8.91–15.08) and 15.0 ± 2.44 (95% CI 10.21–19.78) months respectively. Multivariable analysis revealed significant difference in median OS between favorable vs high risk AML groups (20.0 (95% CI: 12.50–27.49) vs 9.0 (95% CI: 2.99–15.01) months; p = 0.002); time from diagnosis to treatment (< 30 days vs ≥ 30 days; not reached vs 9.0 (95% CI: 6.81–11.18) months; p = 0.001), performance status (1 vs 2 vs 3; not reached vs 12.0 (95% CI: 10.32–13.67) vs 4.0 (95% CI:2.77–5.22); p = 0.001), and attainment of complete remission vs induction failure (not reached vs 6.0 (95% CI: 3.78–8.21); p = 0.002). Conclusion: Patient-related factors like delayed treatment initiation and high incidence of MDRO-associated sepsis are critical determinants of AML outcome in LMIC. [ABSTRACT FROM AUTHOR]

Morphological variants of plasma cells have been described in cases of Plasma cell neoplasm. Presence of these atypical forms poses difficulty in morphological diagnosis and demands the use of ancillary techniques to ascertain the nature of these atypical cells. We hereby report a series of 6 such cases where the bone marrow examination showed plasma cells with atypical morphology, leading to varied differential diagnosis; however immunophenotyping by flow cytometry in adjunct to serum electrophoresis, immunofixation and free light chain assays confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of early T precursor‐acute lymphoblastic leukaemia (ETP‐ALL), study its clinicopathological features and devise a 'flow score' based on immunophenotypic profiles. Material Methods: This was a retrospective study where clinical and laboratory data of all consecutive T‐ALL cases were analysed to identify features differentiating ETP from non‐ETP‐ALL. The utility of a flow score based on the five commonly used markers in leukaemia panels for T‐ALL (CD34, CD8, CD5, CD13 and CD33) was evaluated to differentiate ETP from non‐ETP‐ALL. Results: Early T precursor‐acute lymphoblastic leukaemia constituted 24.2% (n = 29) of all T‐ALL cases. It was significantly more common in adults (30.2%) as compared to paediatric (17.5%) patients (P =.046). The median age of presentation was significantly higher than the non‐ETP group. (24 vs 19 years; P =.01). Patients with ETP‐ALL usually presented with organomegaly, lymphadenopathy, lower levels of haemoglobin, total leucocyte count, peripheral blood blast proportion and LDH levels as compared to non‐ETP‐ALL. The majority of ETP‐ALL cases had L2 morphology with a moderate amount of cytoplasm showing frequent blebbing. A flow score cut‐off value of ≥3 on ROC curve analysis had a sensitivity and specificity of 100% and 94.6% respectively. Conclusion: Early T precursor‐acute lymphoblastic leukaemia had unique clinical and laboratory features. The prevalence of this entity is more common in the adult population. A flow score based on a minimum of five widely used markers can confidently identify ETP‐ALL and should be included in the primary panel of markers used for flow cytometric analysis. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma (ES) is a highly malignant neoplasm of childhood and adolescence seen commonly in both axial and appendicular skeleton but uncommonly in acral region. Ewing's tumor in the hand is extraordinarily rare. Radiological features are variable and can mimic other common lesions. We present a case of 13 year old female, with complaints of pain and swelling in right hand, which on X-ray showed periosteal reaction, giving a sun burst appearance and provisional diagnosis of osteosarcoma was made. The patient was operated and histopathological diagnosis of ES was confirmed. Histopathological examination remains the mainstay of diagnosis, supported by immunochemistry and cytogenetic studies. Surgical extirpation with chemotherapy is the therapeutic regimen of choice. We intend to report this case, because it is very rare location and the radiological features can mimic other lesions which commonly occur in this location like chronic osteomyelitis so it can be easily missed especially at preliminary evaluations. [ABSTRACT FROM AUTHOR]

This study was conducted with the aim to assess the clinico-pathological profile, treatment outcomes and the challenges faced in Low Middle Income Countries (LMIC) during management of pediatric Burkitt lymphoma cases on intensive chemotherapy protocol. This was a single center retrospective analysis of pediatric Burkitt lymphoma cases (age <18 years) managed uniformly with Lymphomes Malins B (LMB) 96 chemotherapy protocol between January 2015 and September 2019. 40 cases were analyzed with a median age 11.5 years (range 4–18 years) and male: female ratio =4.7:1. Patients belonging to different LMB risk groups were: A-3 (7.5%), B-31 (77.5%), and C-06 (15%). 25 (62.5%) patients had abdominal disease at presentation. The survival analysis of different treatment risk groups showed statistically significant difference in mean Overall Survival (OS) between group A-100%, group B- 87%±6.1% and group C-44.4%±16.2%; (p value =.016). On multivariate analysis of prognostic factors affecting survival, CNS involvement (p value =.03) and median time from diagnosis to treatment initiation more than 30 days (p value =.04) were significantly associated with poor outcome. Incidence of culture positive febrile neutropenia episodes was 28.2% of which 69.2% infections were caused due to carbapenem resistant gram-negative organisms. In our study, although the outcomes in risk group A and B patients were comparable to LMB 96 treatment results, the outcome in risk group C was considerably poor primarily due to advanced disease at presentation and delayed diagnosis. The critical challenges that we faced in our cohort were delayed diagnosis, treatment cost affordability, poor nutritional status, and high infection related mortality. [ABSTRACT FROM AUTHOR]

Introduction: A prototype of good prognosis, t(8;21)‐positive AML, has diverse clinical and genetic features which affect its outcome. This study aimed at evaluating the clinico‐pathological spectrum of t(8;21)‐positive AML and ascertaining prognostic factors influencing its outcome in the Indian subcontinent. Methods: A retrospective analysis of 75 cases of t(8;21)‐positive AML diagnosed over a period of six years (2013‐2018) was carried out. Detailed clinical and laboratory data of the patients were collected from the electronic medical records and reviewed. Results: Median age was 19.5 years (range 5‐75 years) with a M:F of 1.7. Myeloid sarcoma was observed in 9.3% cases. There were 85% FAB AML‐M2, 8% AML‐M1, and 7% AML‐M4 subtypes. Prominent morphological characteristics included dyspoiesis in maturing myeloid cells (83%), long thin tapered Auer rods (58%), cytoplasmic vacuoles (58%), eosinophilia (50%), and mast cells (22%). Auer rods in maturing granulocytes (4% cases) were highly suggestive of the translocation. Additional cytogenetic abnormalities were present in 53% cases. Seventy‐one percent (25/35) achieved CR. The overall survival (OS) was 40%, with a median follow‐up of 27 months (range 4‐57 months). None of the hematological or cytogenetic factors correlated with OS, except for the presence of myeloid sarcoma which had a trend toward poor survival (P =.07). Conclusion: Outcome of t(8;21) AML is not influenced by any of the clinico‐pathological parameters, except for a myeloid sarcoma, which may herald a poor prognosis. Recognition of this distinct subtype of AML would facilitate further molecular screening for risk stratification in resource‐constrained settings. [ABSTRACT FROM AUTHOR]

Objective: The presence of specific chemotherapeutic protocols for hairy cell leukemia (HCL) makes it essential to discriminate this entity from other lymphoproliferative disorders. Hence, awareness of the variations in clinical presentations and immunophenotypic aberrancies is requisite to ensure diagnostic accuracy.Materials and Methods: A retrospective study was carried out to analyze the clinical-pathological profile of patients with HCL diagnosed over a period of 81 months (2010-September 2017) in our institute. Flow cytometry was performed in all the patients, and further, BRAFV600E mutation analysis was performed by real-time polymerase chain reaction in a limited number of samples.Result: A total of 353 lymphoproliferative disorders were assessed during the period, of which 16 (4.5%) were diagnosed as HCL, which included 15 cases of classical HCL and single case of HCL-v. Striking male predominance was noted with a median age of 52 (range 22-90 years). 47% patients presented with pancytopenia, while 20% cases had leukocytosis. Three patients presented with bleeding diathesis in the form of melena and purpuric spots. The absence of splenomegaly was observed in 20% patients (4/15) while 2 (13.3%) cases had lymphadenopathy. Hypocellular marrow was observed in 13% cases. Bright expression of CD20/CD22 along with CD25/CD103/CD123/CD11c was noted in all the patients of classical HCL. Aberrant expression of CD23 and CD5 was seen in 33% ( n =5) and 6.7% ( n =1) cases respectively. CD200 was positive in all the 5/15 cases tested. The case of HCL-v presented with very high leukocyte count and exhibited a CD103/CD11c+ and CD123/CD25- profile. BRAFV600E, mutation was present in all the four patients tested who included patients with a hypocellular marrow and absent splenomegaly.Conclusion: HCL has characteristic profiles, yet it may exhibit unusual clinical and immunophenotypic presentations. Perspicacious use of flow cytometry and BRAFV600E mutation analysis will aid in the diagnosis in unprecedented cases. [ABSTRACT FROM AUTHOR]

We have investigated the expression of RNA transcripts of hematopoiesis regulatory molecules, viz., macrophage inflammatory protein (MIP)-1α, tumor necrosis factor (TNF)-α, granulocyte colony-stimulating factor (G-CSF), stromal cell-derived factor (SDF)-1α, stem cell factor (SCF), and transforming growth factor (TGF)-β in lipopolysaccharide-induced bone marrow mesenchymal stem cells (BM-MSCs) and levels of their soluble forms in the culture supernatants of BM-MSCs and BM plasma of patients with acquired aplastic anemia (AA) (n=29) and controls (n=29). The BM-MSCs of AA patients as compared to controls had markedly lower expression of MIP-1α transcripts (p<0.001), higher expression of TNF-α (p<0.001), G-CSF (p<0.001), and SDF-1α (p<0.01) transcripts, and no difference in the expression of SCF and TGF-β transcripts. The culture supernatants of BM-MSCs and BM plasma of AA patients in comparison to controls also had lower levels of MIP-1α (p<0.01 and p<0.001, respectively) and higher levels of TNF-α (p<0.05 for both) and G-CSF (p<0.05 and p<0.001, respectively) but with no difference in the levels of SDF-1α and SCF. The levels of TGF-β were although similar in culture supernatants of BM-MSCs of both the groups, but they were significantly lower in BM plasma of the patients than controls (p<0.001). Our data shows that BM-MSCs of AA patients have altered expression of hematopoiesis regulatory molecules suggesting that they may have a role in the pathogenesis of the disease. [ABSTRACT FROM AUTHOR]

Therapy-related acute myeloid leukemia (t-AML) occurs as a late complication of cytotoxic chemotherapy, which is administered for a primary malignancy. Simultaneous occurrence of breast cancer and AML is very uncommon, with only seven cases reported till 2016.[[5]] Even uncommon is the concurrent presence of metastatic breast cancer and AML in marrow. The impact of therapy-related acute myeloid leukemia (AML) on outcome in 2853 adult patients with newly diagnosed AML. [Extracted from the article]

The article presents a case study of a 10-year-old male who was presented with highâ€'grade fever, loss of appetite and generalized weakness and was diagnosed with acute myeloid leukemia where numerous polymorphs showed presence of Auer rods. Topics include presence of submandibular lymph node noted from physical examination, smear examination showing blasts, some of which contained Auer rods, and presence of Auer rods associated with a good prognosis.

Summary: This paper presents a low switching frequency–based pulse width modulation technique for a 3 × 3 indirect matrix converter. The nontriplen lower‐order harmonics are considered for minimization using differential evolution–based metaheuristic technique. The mathematical equations are formulated while considering minimization of nontriplet lower‐order harmonics along with control of fundamental voltage. An objective function is constructed by considering all the constraints on the feasible region and then it is minimized by using differential evolution technique. It is observed that the solution in the entire modulation range exists along with multiple solutions. Various cases of switching angles are considered, and solution trajectories are reported in practically feasible range. This type of modulation and control scheme is extremely useful in high power applications such as unified power flow controller as it minimizes the switching losses in the converter. The theoretical findings are verified by simulation and hardware results. [ABSTRACT FROM AUTHOR]

A letter to the editor on hydatid disease of the intestine is presented.

A 35 year-old male presented with multiple asymptomatic, tense, cystic to firm, skin-colored nodules within the scrotal skin with a provisional clinical diagnosis of a sebaceous cysts of the scrotum. Fine needle aspiration cytology (FNAC) was performed and a diagnosis of idiopathic calcinosis of the scrotum was suggested as no epithelial cells were found around amorphous, basophilic, calcified material. Histopathological examination confirmed the diagnosis. We report this case for its rarity. [ABSTRACT FROM AUTHOR]