Mucormycosis is an invasive fungal infection characterised by rapid filamentous growth, which leads to angioinvasion, thrombosis, and tissue necrosis. The high mortality rates (50–100%) associated with mucormycosis are reflective of not only the aggressive nature of the infection and the poor therapeutics currently employed, but also the failure of the human immune system to successfully clear the infection. Immune effector interaction with Mucorales is influenced by the developmental stage of the mucormycete spore. In a healthy immune environment, resting spores are resistant to phagocytic killing. Contrarily, swollen spores and hyphae are susceptible to damage and degradation by macrophages and neutrophils. Under the effects of immune suppression, the recruitment and efficacy of macrophage and neutrophil activity against mucormycetes is considerably reduced. Following penetration of the endothelial lining, Mucorales encounter platelets. Platelets adhere to both mucormycete spores and hyphae, and exhibit germination suppression and hyphal damage capacity in vitro. Dendritic cells are activated in response to Mucorales hyphae only, and induce adaptive immunity. It is crucial to further knowledge regarding our immune system’s failure to eradicate resting spores under intact immunity and inhibit fungal growth under immunocompromised conditions, in order to understand mucormycosis pathogenicity and enhance therapeutic strategies for mucormycosis.

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Innate and adaptive immunity to Mucorales

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

Study of histopathological patterns of endometrium in abnormal uterine bleeding

Congenital pulmonary airway malformation (CPAM) is a developmental malformation of the lower respiratory tract. We report the case of a male newborn diagnosed with cystic lung disease during prenatal ultrasound. A cesarean section was performed at the 32nd gestational week because of premature rupture of the membranes, and soon after the delivery the newborn developed respiratory failure and died. The aim of this study is to report an autopsy case because of its rarity, and to briefly discuss the CPAM subtypes and differential diagnosis of cystic lung diseases of childhood.

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Congenital pulmonary airway malformation.

Background: Abnormal uterine bleeding (AUB) interferes with the quality of life of an otherwise healthy woman. Until the pathology underlying menorrhagia is, accurately diagnosed, proper therapy is hardly possible. The objective of the study was to analyze different histopathological patterns of endometrium in AUB and observe the incidence of various pathologies in different age groups and their relation to parity.Methods: This two-year prospective studywas done in the department of pathology in atertiary care centre, which included 250 cases of clinically diagnosed AUB patients were evaluated. Histopathological examination of endometrial biopsies and hysterectomy specimens were done, followed by clinical correlation.Results: Out of 250 cases of AUB, Premenopausal bleeding was seen in 216 cases (86.4%) and 34 cases (13.6%) had postmenopausal bleeding. The commonest finding observed in the study was proliferative phase endometrium (37.2%), followed by secretory endometrium (34%) and endometrial hyperplasia (16%). Disordered proliferative endometrium was seen in 2.4% of patients. Endometrial carcinoma was seen in 4 (1.6%) cases. Endometrial hyperplasia was seen mostly in the age group 41-50 years (27 cases). Two cases of endometrial carcinomas were presented after age 60 years.Conclusions: Our study revealed the highest incidence of AUB in the perimenopausal age group (41-50 years). Hence a thorough histopathological workup and clinical correlation are mandatory in cases of abnormal uterine bleeding.

Histopathological spectrum of endometrium in abnormal uterine bleeding

Comparison of ROTEM Sigma to Standard Laboratory Tests and Development of an Algorithm for the Management of Coagulopathic Bleeding in a Tertiary Center

Background: Abnormal uterine bleeding is one of the commonest complaints in women and when it occurs without   organic lesions like tumor, inflammation, it is called as dysfunctional uterine bleeding. Aim of current study was to find out the histopathological pattern of endometrium in Abnormal Uterine Bleeding (AUB) also to study organic causes of AUB. Methods: Specimens received as endometrial curettage and hysterectomy specimens were studied followed by correlation of histopathology with age and clinical presentation. Results: The patients were mainly from the age group of 30-49 years (74.24%). The most common menstrual disorder was menorrhagia (46.86%). In dysfunctional uterine bleeding the most common histological pattern of endometrium includes proliferative endometrium (22.8%) followed by endometrial hyperplasia (19.40%), atrophic endometrium (7.16%), secretory endometrium (5.97%), irregular shedding [1.80%], irregular ripening (1.20%) and anovulatory endometrium (0.59%). Organic lesions encountered in AUB cases were leiomyoma (17.92%), endometrial polyp (1.79%), endometrial carcinoma (1.50%), endometriosis (0.59%) and choriocarcinoma (0.29%). Conclusion: It is important to know the histological pattern of the endometrium like proliferative endometrium, endometrial hyperplasia, atrophic endometrium, secretory endometrium, irregular ripening and shredding and organic lesions in patients diagnosed as AUB in different age groups since recognition of these conditions will help and will avoid further complications.

Histopathological study of endometrium in cases of abnormal uterine bleeding

Congenital pulmonary airway malformation (CPAM), previously known as congenital cystic adenomatoid malformation is a congenital disorder of the lung similar to bronchopulmonary sequestration. In CPAM, usually an entire lobe of lung is replaced by a non-working cystic piece of abnormal lung tissue. This abnormal tissue will never function as normal lung tissue. The underlying cause for CPAM is not known. It occurs in approximately 1 in every 30000 pregnancies. The association between CPAM and malignancy has been well documented. There is a small risk (0.7%) of malignant transformation within the cyst. So early diagnosis and surgical resection is important to prevent the grave complications. Herein, we are reporting two interesting cases of CPAM and one belonged to Type II and other belonged to Type III of Stocker's classification.

Congenital pulmonary airway malformation: A report of two cases.

Background: Mortality from trauma remains a major public health issue as it is the leading cause of death in persons aged 5 - 44 years. There is a dearth of information on polytrauma from developing countries such as ours. Hence, this topic was studied at our institute. The objective is to study the coagulation parameters in polytrauma patients at our institute and to correlate the findings with the prognosis. Methods: A prospective study was carried out in the department of pathology in a tertiary care center, during a period of 20 months from December 2012 to July 2014. All the polytrauma patients (injury severity score (ISS) >=  15) with injuries to head and neck, face, thorax, abdomen, extremities and external (skin) were included. Sampling was done within 20 min of arrival during primary survey of the patient. Screening tests like bleeding time (BT) and clotting time (CT) were carried out bedside. Other tests carried out were complete blood count (CBC), prothrombin time (PT), activated thromboplastin time (aPTT), thrombin time (TT) and D-dimer assay. Tests were carried out on fresh samples within 2 h of collection. Results: The incidence of coagulopathy was 59.86%. There was significant prolongation of PT, aPTT and TT in those patients who developed coagulopathy. PT was found to be a stronger predictor of mortality among polytrauma patients. Conclusion: A significant proportion of polytrauma patients were coagulopathic. Initial coagulation profile is very useful in predicting outcomes for major polytrauma patients. This study emphasizes the importance of early suspicion and basic screening for coagulopathy in polytrauma patients in developing countries. J Hematol. 2018;7(3):107-111 doi: https://doi.org/10.14740/jh432w

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The Study of Coagulation Parameters in Polytrauma Patients and Their Effects on Outcome

Background: Natural deaths represent a large proportion of sudden (unexpected and unattended) deaths. The term “sudden cardiac death” (SCD) refers to death from the abrupt cessation of cardiac function due to cardiac arrest. The objective of this study was to identify various causes, risk factors, age and sex distribution associated with sudden cardiac death in an Indian setting. Methods: Detail review of medical records and an autopsy study of all cases of sudden cardiac death that occurred instantaneously or within 24 hours of onset of symptoms in a tertiary care institution, between December 2010 and December 2015 was carried out. Results: In total, 124 cases of sudden death were studied during this period. Out of 124 cases, 109 cases (87.90%) showed pathology in heart and aorta. Atherosclerotic coronary heart disease was the most common cause of death (72.58%) followed by Hypertensive heart disease (4.83%), Hypertrophic cardiomyopathy (3.22%), Myocarditis (3.22%), Infective endocarditis (1.61%), Rheumatic heart disease (0.8%), Aortic dissection (0.8%), and syphilitic aortitis (0.8%). Conclusions: Sudden death is a source of concern and a detailed postmortem examination is mandatory to ascertain its cause. Presence of co-existing conditions like diabetes and hypertension contribute immensely to the risk of sudden death. Occurrence of sudden death at a younger age presents a formidable challenge. Prevention of development of risk factors of atherosclerosis at an early age can be an effective strategy to counter this ailment at all levels.

Pathology of heart, coronaries and aorta in autopsy cases with history of sudden death: an original article

Mucormycosis is a common fungal infection usually noted in immunocompromised individuals like diabetic and AIDS patients, patients receiving systemic corticosteroid therapy, cancer chemotherapy and organ transplant patients. It is very rare to affect healthy individual. Here we report a case of 50 years old immunocompetent female presented with cheek swelling with past history of nasal polypectomy. Clinically and radiologically diagnosis of maxillary carcinoma was made. After maxillary debridement surgery diagnosis of maxillary necrosis with mucormycosis was confirmed.

Gopal A. Pandit

Papers

Histopathological study of endometrium in cases of abnormal uterine bleeding

Congenital pulmonary airway malformation: A report of two cases.

The Study of Coagulation Parameters in Polytrauma Patients and Their Effects on Outcome

Pathology of heart, coronaries and aorta in autopsy cases with history of sudden death: an original article

Mucormycosis of Maxillary Sinus in Immunocompetent Patient Masquerading as Neoplasm: A Case Report