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   2022| July-August  | Volume 42 | Issue 4  
    Online since August 1, 2022

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Assessment of bone marrow iron stores using Gale's grading and its correlation with iron deficiency anemia
Ishani Gupta, Bhavneet Kour, Roopali Jandial, Subhash Bhardwaj
July-August 2022, 42(4):160-165
Background: Iron deficiency anemia (IDA) is a very common condition worldwide, especially in low- and middle-income countries. The most accurate method to evaluate iron status is the measurement of bone marrow iron content by potassium ferrocyanide (Prussian blue)-stained aspirate. Microscopic examination of Prussian blue-stained bone marrow aspirate has been considered the “gold standard” for determining iron-depleted states. Aim: The aim of this study was to assess and classify the iron status in the bone marrow by both Gale's and intensive method, thereby differentiating iron store deficiency from functional deficiency. Methods: The present study was carried out in the Department of Pathology, Government Medical College and Hospital, Jammu, over a period of 1 year. A total of 135 cases of anemia with hemoglobin <10 g/dl were included in the study. Bone marrow aspiration was done; iron assessment was done by both Gale's and intensive method. Iron status assessed by the intensive method was categorized as normal, functional iron deficiency, iron stores deficiency, or combined functional iron and iron stores deficiency. Results: A total of 135 cases were included in the study, out of which 47% (64/135) were male and 53% (71/135) were female. Gale's study revealed hypoferrimic state in only 40 cases out of 135 (29.6%). According to the intensive method, out of these 40 cases, only nine cases were truly deficient cases that too had combined deficiency, two cases had iron store deficiency, 25 cases had functional iron deficiency, and four cases had normal iron stores. In the present study, according to the intensive method, maximum number of cases had functional iron deficiency (54%, 73/135). There were 1.4% (2/135) pure iron-deficient cases and 11.1% (15/135) revealed combined deficiency. Conclusion: Differentiation between IDA and functional iron deficiency is important for accurate diagnosis and treatment of the patient. Although intensive method of grading iron requires more expertise, it has proved to be superior and has more precision in diagnosing iron-deficient cases.
  3,723 194 -
Gut microbiome profiling in nonalcoholic fatty liver disease and healthy individuals in Indonesian population
Nuíman A S Daud, Nasrul Hadi Akram, Najdah Hidayah, Sri Jayanti, Irda Handayani, Muhammad Nasrum Massi
July-August 2022, 42(4):166-174
Background: The gut microbiome is thought to produce metabolites that are widely investigated to play a role in various disease pathophysiologies. Aim: This study aims to identify the differences in gut microbiome diversity and profile between nonalcoholic fatty liver disease (NAFLD) and healthy individuals. Methods: This was a cross-sectional study. We collected 21 fecal specimens from NAFLD subjects and 13 controls. The gut microbiota from all samples were profiled by using 16s ribosomal RNA next-generation sequencing. Statistical analysis was done using SPSS version 25.0 software. Results: NAFLD subjects had a greater body mass index. Hypertension, diabetes, and dyslipidemia were found in 19%, 28.6%, and 81%, respectively, in NAFLD subjects. There was a lower diversity of gut microbiota in NAFLD compared to the control group. At the phylum level, Firmicutes was found more in the control than the NAFLD group (42.24% vs. 54.01%, P = 0.037). At the genus level, the percentage of Enterobacter was more abundant in the NAFLD group compared to the control group (0.517% vs. 0%, P = 0.001). At the genus level, there was a negative correlation between Bifidobacterium and NAFLD fibrosis score (NFS) (r = −0.532, P = 0.013). Conclusion: The diversity of the gut microbiota in NAFLD group was less than in control group. Firmicutes was found to be less prevalent in NAFLD patients compared to control. Enterobacter was found to be more abundant in NAFLD patients. The amount of Bifidobacterium was inversely correlated to the severity of NAFLD based on NFS.
  2,058 193 -
“Ewing's Sarcoma of Calcaneum” an uncommon tumor in an unusual site with skip metastasis: An enigma
Pranita Mohanty, Anima Hota, T Govardhan, Satya S Mohapatra
July-August 2022, 42(4):180-182
Ewing's sarcoma (EWS) is an uncommon primary malignant tumor of the bone, mostly affects 5–25 years of age with male predominance. Diaphysis of the long bone is usual site of origin with occasional extraskeletal extension. However, it is extremely rare (3%–5%) in the small bones of the hand and feet, hence often misinterpreted as osteomyelitis, aneurysmal bone cyst, giant cell tumor, cartilagenous tumor and osteosarcoma; delaying definitive treatment. Metastasis of calcaneal EWS is common, and prognosis is dismal. Multimodality treatment approach is the standard care rendered for it. Herein, we report such a case of EWS in a 12-year-old girl child at an unusual site of calcaneum with skip metastasis for which the diagnosis and treatment was deferred by 5 months. Only after histopathology and immunohistochemistry confirmation, the definitive chemotherapy was provided and surgery was scheduled after five cycles of chemotherapy. The patient is now on chemotherapy and followed up till today.
  1,505 132 -
Coronavirus Disease-2019 and the kidneys: A tragedy of reciprocal damage and management challenges
Eman Sobh, Ahmed Salama Al-Adl, Mohamed F Awadallah, Khloud Gamal Abdelsalam, Sohaila Sabry Awad, Amal M Surrati, Hani A Alhadrami
July-August 2022, 42(4):153-159
Coronavirus disease 2019 (COVID-19) has been reported to affect nearly all body systems. Kidney affection has been observed in several studies. The effect of COVID-19 on renal function is beyond that occurring in pneumonia or severe respiratory distress cases. Renal affection is attributed to several factors, including the mechanism of viral injury. Patients with preexisting kidney injury are at increased risk of infection. Early detection and management are crucial to avoid morbidity and mortality, prevent the spread and contamination of hemodialysis Units. Early detection and treatment of kidney involvement in COVID-19 are vital to avoid increased morbidity and mortality. Proper selection of drugs and fluid management is vital in cases with kidney involvement. This review aims to discuss the clinical and pathophysiological affection of the kidney in COVID-19.
  1,457 169 -
Risk and predictors of patients receiving neoadjuvant chemotherapy followed by radical cystectomy or transurethral resection alone for muscle-invasive bladder cancer: A single-institute experience
Pei-Jhang Chiang, Kai-Hsiung Ko, En Meng, Tai-Lung Cha, Guang-Haun Sun, Dah-Shyong Yu, Chien-Chang Kao
July-August 2022, 42(4):175-179
Background: Upper urinary tract urothelial carcinoma and muscle-invasive bladder cancer (MIBC) incidence rates are high in Taiwan. Our patients with MIBC are commonly managed with a radical cystectomy (RC); however, recurrence rates remain high. Aim: We aimed to establish a protocol regarding neoadjuvant chemotherapy (NAC) followed by RC or transurethral resection (TUR) alone from 2008 to 2013. We outline the efficacy and prognosis of NAC followed by RC. Methods: This was a retrospective study. The clinical data of 38 patients who underwent NAC from 2008 to 2013 at a single institution were retrospectively reviewed. Patients were divided into Group 1 (NAC with RC) and Group 2 (NAC with TUR alone). Age, sex, tumor size, prechemotherapy characteristics, and oncological outcomes were analyzed. Results: Group 1 had worse chemotherapy responses than Group 2 (48% vs. 71%, P = 0.0002). There were no significant differences in the 3-year progression-free survival and overall survival (OS) between the groups. High-risk patients were defined as having a tumor size >5 cm, concurrent hydronephrosis, and adverse pathological features. High-risk Group 1 patients had a better 3-year OS than high-risk Group 2 patients (13/17, 76%; and 3/5, 63%; respectively). Conclusion: In high-risk patients or patients with poor chemotherapy responses, NAC followed by RC with pelvic lymph node dissection resulted in a significantly increased 3-year OS. NAC with TUR alone was suitable only for low-risk patients with good chemotherapy responses.
  1,344 155 -
Successful treatment of early-onset Morganella morganii sepsis in an extremely low birth weight infant
Chia-Ning Chang, Shyi-Jou Chen, Chih-Chien Wang, Wen-Tsung Lo
July-August 2022, 42(4):194-196
Morganella morganii is a rare cause of neonatal infections, and early-onset neonatal sepsis caused by M. morganii is serious and even fatal. We describe an extremely low birth weight female infant with early-onset M. morganii sepsis to highlight the importance of awareness of this potentially fatal organism.
  1,322 115 -
Combination use of laryngoscope, jaw thrust, and trachway for improving difficult tracheal intubation in obese
Wei-Chieh Chiu, Zhi-Fu Wu, Meng-Fu Lai, Hou-Chuan Lai
July-August 2022, 42(4):197-198
  1,094 89 -
Myoepithelial carcinoma of mandible: A rare case with literature review
Rituparna Biswas, Anirban Halder, Mimi Gangopadhyay, Tshering Doma Bhutia, Dipanwita Biswas
July-August 2022, 42(4):183-186
Primary salivary gland carcinomas of intraosseous origin of the mandible are uncommon neoplasms. Myoepithelial carcinoma (MC) happens to be the rarest. Detailed descriptions of its clinical course are hence not available. Herein, we report a case of MC affecting the mandibular central arch in a bizarre way in a 15-year-old adolescent girl who was treated effectively with definitive radiotherapy (RT) along with concurrent chemotherapy in view of unresectability. To the author's best knowledge, this is the fifth reported case of MC affecting the mandible and the first case to be treated by radical RT. Our study sheds light on the fact that RT can be an effective alternative to surgery where it is not feasible.
  1,082 95 -
Bilateral fractures of the femoral neck
Tse-Pu Huang, Tsu-Te Yeh, Chia-Chun Wu, Chun-Chi Hung
July-August 2022, 42(4):191-193
Bilateral fractures of the femoral neck are rare and are usually associated with underlying bone diseases, previous metabolic diseases, high-energy trauma, electroshock, or seizure attack. Low-energy trauma, such as a fall, related bilateral fractures of the femoral neck are rare. We report a case of a 74-year-old woman with displaced bilateral femoral neck fractures following a fall. After admission, we performed bilateral cemented bipolar hemiarthroplasty and restored functional outcome postoperatively. Osteoporosis was confirmed by X-ray bone densitometry at the postoperative outpatient department follow-up.
  910 101 -
Malignant extragastrointestinal stromal tumor: A challenging diagnosis due to unusual presentation
Abhay Vilas Deshmukh, Swati Dhanraj Hagone, Vitaladevuni Balasubramanyam Shivkumar, Nitin M Gangane
July-August 2022, 42(4):187-190
Gastrointestinal stromal tumors are the most common mesenchymal tumors of gastrointestinal tract which comprise <1% of all primary gastrointestinal malignancies. These tumors show mutations in the KIT gene or platelet-derived growth factor receptor-A gene and usually stains positively for CD117. Very few cases of extragastrointestinal GIST (EGIST) have been reported in literature which originate from omentum and mesentery as per our knowledge. Here, we report a case of EGIST arising from omentum with no connection to gastrointestinal tract organs in a 60-year-old woman who presented with abdominal pain for 2–3 months. Intraoperative findings showed the presence of multiple globular masses and nodules in the peritoneal cavity. Microscopically, the spindled tumor cells were arranged in interlacing fashion. Immunohistochemistry showed positivity for CD117 and negativity for smooth muscle actin (SMA). Thus, EGIST should always be considered as a differential diagnosis for nodular mesenteric masses.
  885 105 -