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Angiotensin-converting enzyme 2 (ACE2) is a key host protein by which severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) enters and multiplies within cells. The level of ACE2 expression in the lung is hypothesised to correlate with an increased risk of severe infection and complications in COrona VIrus Disease 2019 (COVID-19). To test this hypothesis, we compared the protein expression status of ACE2 by immunohistochemistry (IHC) in post-mortem lung samples of patients who died of severe COVID-19 and lung samples obtained from non-COVID-19 patients for other indications. IHC for CD61 and CD163 was performed for the assessment of platelet-rich microthrombi and macrophages, respectively. IHC for SARS-CoV-2 viral antigen was also performed. In a total of 55, 44 COVID-19 post-mortem lung samples were tested for ACE2, 36 for CD163, and 26 for CD61, compared to 15 non-covid 19 control lung sections. Quantification of immunostaining, random sampling, and correlation analysis were used to substantiate the morphologic findings. Our results show that ACE2 protein expression was significantly higher in COVID-19 post-mortem lung tissues than in controls, regardless of sample size. Histomorphology in COVID-19 lungs showed diffuse alveolar damage (DAD), acute bronchopneumonia, and acute lung injury with SARS-CoV-2 viral protein detected in a subset of cases. ACE2 expression levels were positively correlated with increased expression levels of CD61 and CD163. In conclusion, our results show significantly higher ACE2 protein expression in severe COVID-19 disease, correlating with increased macrophage infiltration and microthrombi, suggesting a pathobiological role in disease severity.

Background: Asterion is the junction of lambdoid, parietomastoid, and occipitomastoid sutures. In traditional anatomy teaching, it is believed that asterion sits over the transverse-sigmoid sinus junction (TSSJ). It is a significant surgical landmark for the placement of a burr hole in the retrosigmoid approach. Objective: The purpose of this study was to evaluate the asterion's accuracy as a TSSJ-specific external surgical landmark in the Indian population. Materials and Methods: 16 human dried skulls were obtained from the Department of Anatomy, AIIMS, New Delhi. The point of TSSJ was taken between the two lips and just posterior to the entry of the superior petrosal sinus. Asterion internally was localized with the help of a geometrical divider. The x- horizontal/ anterior and y- vertically superior (+)/ inferior (-) distances were measured from asterion (internally) to the TSSJ by a digital vernier caliper. Results: The mean horizontal distance (x) of the left side asterion & TSSJ was 10.3±1.0mm whereas the vertical distance (y) ranged between +2 to -4.3 mm. The mean horizontal distance (x) of the right side asterion & TSSJ was 13.5±1.4mm whereas the vertical distance (y) ranged between +3 to -4.2 mm. Conclusion: Asterion is not a reliable landmark for TSSJ in Indian skulls. The TSSJ with respect to asterion was found on average 10mm and 13.5mm anterior on the left and right side respectively, and mostly inferior (average 4.2mm) in 75% of the skulls. The TSSJ was closer to the asterion on the left side in comparison with the right side. However, further studies with a larger sample size will be needed to evaluate the population-specific relation of asterion with the TSSJ.

Rheumatic heart disease (RHD) is often considered as a disease of developing countries and India is the home of about 40% of RHD patients. Environment seems to play a major role in its causation. Since gene environment interactions can lead to alterations of various metabolic pathways, identification of altered metabolites can help in understanding the various pathways leading to RHD. Blood plasma samples from 51 RHD and 49 healthy controls were collected for the study. Untargeted metabolomics approach was used to identify the metabolites that are altered in RHD patients. Data showed 25 altered metabolites among RHD patients. These altered metabolites were those involved in Purine, Glutamine, Glutamate, Pyrimidine, Arginine, Proline and Linoleic metabolism. Thus, the present study illuminates metabolic alterations among RHD patients which can help in determining the potential therapeutic targets.

The entire world is under a devastating pandemic caused by COVID-19 with a high mortality rate. Knowledge of the viral structure, factors that help in its progression and spread, pathological findings, diagnostic methods and, treatment modalities helps in understanding the viral disease and also in treating the patients in a better way besides preventing the community spread of this deadly infection. The causative agent is a single- stranded RNA virus. The clinical spectrum varies in symptomatic and asymptomatic patients, who later become potential silent carriers, thus unknowingly spreading the virus. The virus constantly undergoes recombination, with reports of cross-species infections. Studies have indicated a strong immunological basis of COVID-19 infection. Not only does it weaken the immune system causing multi-organ involvement but also helps in its progression and spread to others.Multiple organs especially lungs, heart, kidney, gastrointestinal and hepatic system, brain and skin are affected varying in their severity. Similarly, persons with associated co-morbidities are likely to be affected more in terms of the number as well as in the severity. Real- time reverse transcription polymerase chain reaction confirms the presence of COVID-19 infection. Serological diagnosis helps in diagnosing an ongoing outbreak or retrospective infection. Furthermore, it also identifies individuals who have been infected or have recovered from the disease especially the asymptomatic. This helps in the development of an effective vaccine indicating the status of herd immunity in the community. Different treatment modalities are being tried and under trial. This review article thus highlights the global epidemiological status, characteristic of the virus, symptomatology of the patients, role of diagnostic tests available, organs affected including their morphological changes and the latest line of treatment of COVID-19.

Background Lactobacillus crispatus is a dominant member of the healthy female reproductive tract microbiota, contributing to mucosal homeostasis and pathogen exclusion. Numerous studies have highlighted the protective effects of L. crispatus against both intestinal and genital infections. In the present study, we build on this foundation to investigate the broader health-promoting properties of L. crispatus , focusing on its antimicrobial and metabolic functions; and its protective roles in hepatic and cardiometabolic disorders. Methods Three L. crispatus strains were selected from a panel of sixty isolates based on comprehensive genome mining analyses described in our previous publication. In the present study, we generated complete genome data for these three strains, and delineated biosynthetic pathways including their capacity for antimicrobial peptide production, lactic acid biosynthesis, short chain fatty acid synthesis and biogenic amine production. The antimicrobial activity of these isolates was assessed via agar well-diffusion assay and time-kill assay. Their ability to survive gastric pH and bile stress was evaluated through acid and bile salt tolerance assays. Further, to assess metabolic benefits, anti-steatotic and cardioprotective effects were examined in a preclinical diet-induced mouse model of cardiometabolic disorder. Results Complete genome analysis of L. crispatus strains revealed multiple antimicrobial peptide (AMP) biosynthetic gene clusters, including several novel loci associated with bacteriocins. Metabolic profiling identified pathways for bile salt metabolism, folate biosynthesis and short chain fatty acids production. Cell-free culture supernatants exhibited broad-spectrum antibacterial activity, particularly against Escherichia coli , Enterobacter hormaechei, Staphylococcus aureus and Staphylococcus haemolyticus . Further, the strains tolerated gastric pH 2 and physiological bile stress of 0.3% suggesting potential for oral administration. In vivo, oral administration of L. crispatus (10 8  CFU) daily for 2 weeks followed by twice-weekly for 12 weeks significantly reduced hepatic steatosis, improved insulin sensitivity and cardiac function in a diet-induced cardiometabolic disorder mouse model. This is the first report demonstrating the cardiometabolic protective potential of L. crispatus . Conclusions L. crispatus confers diverse health benefits through pathogen resistance functions and modulation of host metabolic pathways. These findings support its potential as a novel biotherapeutic for preventing and managing hepatic and cardiometabolic disorders, extending its therapeutic relevance beyond reproductive health.

Diphtheria is a life-threatening infectious disease caused by Corynebacterium diphtheriae. Although the disease is seen infrequently in the postvaccination era, sporadic cases continue to occur. Cardiac involvement, in the form of myocarditis, is the most serious manifestation of diphtheria and is the most common cause of mortality in these patients. The features of diphtheritic myocarditis on cardiac magnetic resonance imaging (MRI) have not been reported previously. In this brief report, we describe the cardiac MRI and histopathologic features on endomyocardial biopsy of a patient with acute heart failure who was later diagnosed to be a case of diphtheritic myocarditis.

Tufted angioma and kaposiform hemangioendothelioma are considered to represent two ends of the spectrum of benign vascular neoplasms that predominantly present during infancy or early childhood. We report a rare case of a 5-month-old infant with complicated vascular neoplasm involving the pericardial cavity and skin over cervical region, masquerading as infective pericarditis with cellulitis. The patient responded dramatically to therapy with oral prednisolone and sirolimus, with a significant reduction of size of skin lesions and complete resolution of pericardial effusion over 8 weeks. The report also highlights the importance of a multidisciplinary team in managing such complicated cases.

Cutaneous adnexal tumours (CATs) are one of the commonest clinical presentations in dermatology outpatients. They constitute a subset of skin tumours with a common clinical presentation and variable histological findings. Almost all of them clinically present as a subcutaneous nodule. Depending upon the site and distribution, the clinician can suspect the diagnosis. However, histopathological examination is the gold standard for the definitive diagnosis and proper subtyping of CATs. The present study is conducted to see the overall spectrum, incidence and distribution of CATs in a large cohort at the tertiary care centre with their clinical profile. This was a retrospective study in which all the CATs diagnosed over a period of 5 years (2015 to 2019) in a tertiary care hospital were studied. Clinical data were recorded from the histopathology requisition forms. Three hundred and ninety-five cases of CATs were retrieved. Approximately 90% of cases were benign and 10% were malignant. The age of presentation ranged from 8 months to 81 years with male preponderance in all the histological subtypes. The most common site was the head and neck followed by the extremities. Morphologically, the maximum cases showed a differentiation towards sweat glands (44%), followed by sebaceous (29%), follicular (26.5%) and apocrine differentiation (5.3%). Malignant tumours were common in the elderly age group with sebaceous carcinoma being the commonest. CATs comprise of a wide spectrum of tumours occurring in all age groups. Malignant CATs are rare and common in older age groups. Histopathological examination is the gold standard in distinguishing between the different subtypes.