Septic arthritis is an emergent condition caused by an infection of the joint synovial fluid. If left untreated, it can lead to irreversible damage to the affected joint. Our study focused on providing a concise profile of the Iranian population and the diagnostic roles of synovial pan-PCR and culture. In an observational study, we evaluated the characteristics of all patients diagnosed with septic arthritis and admitted to a teaching center hospital complex. We extracted and analyzed the study of population's demographics and laboratory values. This study included 50 patients diagnosed with septic arthritis. 56% of our study population were male, and the mean age was 50.48. There were significant associations between synovial WBC counts and positive synovial culture results. Further comparison of the two diagnostic methods revealed higher pan-PCR accuracy than synovial culture. Pan-PCR may have higher diagnostic accuracy than synovial culture in hospitalized patients with septic arthritis.

CD58 and ADAM10 have been implicated in leukemia progression and chemoresistance; however, their specific roles in acute lymphoblastic leukemia (ALL) and chronic lymphocytic leukemia (CLL), particularly under chemotherapeutic pressure, remain insufficiently characterized. This study aimed to assess the expression of CD58, an immune adhesion molecule, and ADAM10, a metalloproteinase, in ALL and CLL patients undergoing chemotherapy, and to explore their potential involvement in immune evasion, niche-mediated survival, and chemoresistance mechanisms. Peripheral blood mononuclear cells (PBMCs) were isolated from 50 patients with ALL, 50 with CLL, and 30 healthy controls. Expression levels of CD58 and ADAM10 were analyzed by quantitative reverse transcription PCR (qRT-PCR) and flow cytometry. Chemotherapy regimens included vincristine (VCR), methotrexate (MTX), and doxorubicin (DOXO). ADAM10 mRNA expression was significantly upregulated in ALL patients treated with VCR+MTX (p<0.0001) and DOXO (p=0.001), with corresponding protein overexpression observed in both ALL (p<0.0001) and untreated CLL patients (p<0.0001). A significant difference in ADAM10 levels was noted between ALL and CLL cohorts (p=0.001). CD58 mRNA and protein expression were markedly increased in ALL patients receiving VCR+MTX (p<0.0001), whereas untreated CLL patients exhibited no significant alterations. CD58 and ADAM10 are differentially regulated in ALL under chemotherapy, supporting their roles in immune evasion and microenvironmental survival. The constitutive overexpression of ADAM10 in CLL suggests its involvement in chronic leukemic pathogenesis. These findings highlight CD58 and ADAM10 as potential therapeutic targets for overcoming chemoresistance in lymphoid malignancies.

Our study was mainly aimed at identifying the cause, clinical course of the disease, its most dreaded complication pseudomyxoma peritonei and spread to adjacent structures. We have used IHC techniques to know the origin of the tumor where both appendix and ovary were involved. We have listed out and discussed in detail 5 cases, each of which have a different clinical course and variation in staging, grading and prognosis. One of the cases had mucin deposit in the ovary for which IHC was done to confirm the origin of the tumor. Some of the findings were incidental and in others presence of mucin content in the appendix lumen raised clinical suspicion of spread to peritoneum and adjacent structures. Grading and staging is of prime importance as it determines the prognosis and management of the patient respectively. A ruptured or perforated appendix must warrant for an immediate suspicion of pseudomyxoma peritonei which when untreated can lead to mucinous neoplasms in adjacent organs like ovary and colon. Pseudomyxoma Peritonei (PMP) with simultaneous appendix and ovarian neoplasm should be treated as primary appendiceal tumour. Grading and staging of mucinous neoplasm of appendix and Pseudomyxoma Peritoneii needs a unified approach for standardized diagnostic reporting.

Cervical cancer is the second most common malignancy among women worldwide. The Receptor for Activated C Kinase 1 (RACK1) has a key role in regulating the pathways of cell signaling, angiogenesis, cell migration, invasion, and metastasis. This study investigated the association of polymorphisms rs1279736 and rs3756585 with cervical cancer. In this study, 100 LB pap-smear and paraffin block samples of cervical squamous carcinoma associated with Human papillomavirus (HPV) were selected along with 100 LB smear cytology samples from healthy women with normal pap smears, serving as the control group. Genomic DNA was extracted from the samples, and the polymorphisms rs1279736 and rs3756585 in the RACK1 genes were examined using the RFLP-PCR and ARMS-PCR methods, respectively. The rs1279736 polymorphism shows that the chance of cervical cancer in individuals with CA and AA genotypes is 3.772 and 1.852 times that of CC genotypes, respectively. This suggests that the A allele is involved in developing cervical cancer (P=0.005; OR=2.113). The rs3756585 polymorphism indicates that the chance of cervical cancer in TG and GG genotypes is 0.373 and 4.235 times that of TT genotypes, respectively. This also points towards the involvement of the G allele in the development of cervical cancer (P=0.032; OR=1.800). Also, there was no significant relationship between the genotype of polymorphisms, age, and subtype of papillomavirus 16 and 18 in patients. The present study was conducted for the first time. Our results showed that two polymorphisms are significantly associated with cervical cancer.

Use of fine needle aspiration cytology (FNAC) in the diagnosis of salivary gland neoplasms is controversial due to the diverse morphologic patterns and overlapping features between benign and malignant lesions. The Milan system has been introduced to report salivary gland cytopathology. The present study aimed to reclassify salivary gland lesions according to the Milan system for reporting salivary gland cytopathology (MSRSGC) to determine the risk of malignancy (ROM) and to estimate the diagnostic accuracy of the Milan system. In this retrospective cohort study, 136 salivary gland fine needle aspiration cytology samples taken from patients referred to Imam Khomeini and Amir-Aalam Hospital, Tehran, Iran, from 2016 to 2021, were retrieved along with the histopathological follow-up. Cytology smears were reviewed and reclassified based on MSRSGC. In addition, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. ROM for each category was 26.7% for non-diagnostic, 12.5% for non-neoplastic, 40% for atypia of undetermined significance (AUS), 0 for benign neoplasm, 0 for salivary gland neoplasm with uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 100% for malignant group. Sensitivity, specificity, PPV, and NPV in differentiating benign from malignant neoplasms based on MSRSGC were 75.9%, 100%, 100%, and 93.8%, respectively. Diagnostic accuracy was calculated as 94.8%. MSRSGC may be associated with a high accuracy in differentiation of benign from malignant salivary gland neoplasms, indicating its potential value as an effective classification system for reporting salivary gland cytology. The ROM for cytological categories except SUMP can be almost similar to that suggested by MSRSGC.

Background & Objective:Community-acquired Staphylococcus aureus bacteremia (CA-SAB) is associated with substantial morbidity, mortality, and healthcare costs. This study aimed to identify clinical and laboratory factors associated with in-hospital mortality among patients with CA-SAB.Methods:This retrospective cross-sectional study was conducted at a tertiary referral hospital in Tehran, Iran. Adult patients with positive blood cultures for S. aureus who met CA-SAB criteria were included. Demographic, clinical, and laboratory data were collected from medical records. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to assess associations with mortality.Results:A total of 114 patients with CA-SAB were included. No significant association was observed between underlying comorbidities and mortality. Although methicillin-resistant S. aureus (MRSA) infection was associated with a higher mortality rate, this difference was not statistically significant (P = .32). Multivariate analysis revealed that older age (odds ratio [OR], 1.053; 95% CI, 1.012–1.095; P = .01), elevated C-reactive protein (CRP) levels (OR, 1.016; 95% CI, 1.005–1.028; P < .01), and lower serum albumin levels (OR, 0.249; 95% CI, 0.097–0.642; P < .01) were independently associated with in-hospital mortality.Conclusion:Although age was not significant in univariate analysis, it emerged as a significant predictor after adjustment for other variables. Routine laboratory parameters such as CRP and albumin may serve as valuable prognostic indicators. Early identification of high-risk patients using these markers could inform timely interventions and improve outcomes in CA-SAB.

Breast cancer is the leading cause of cancer deaths among women worldwide. Fine needle aspiration cytology (FNAC) and breast sonography have played a pivotal role in the characterization of a breast lump. The main objective of this study was to analyze the correlation between the International Academy of Cytology (IAC) Yokohama for Reporting Breast Fine Needle Aspiration Biopsies (FNAB) and breast imaging reporting and data system (BIRADS) for sonography along with histopathological correlation. A total of 135 FNAC specimens were categorized according to the IAC Yokohama system and BIRADS reporting system and their correlation with histopathology wherever possible to calculate the risk of malignancy (ROM). According to IAC Yokohama categorization, the cases in categories I, II, III, IV, and V were 1,78,8,6 and 42, respectively. Akin to cytology, most of the cases were assigned BIRADS score two followed by score 6, with the Pearson's correlation coefficient between the IAC Yokohama system for reporting breast cytology and BIRADS scoring system of 1.957 with a P-value < 0.001 (strong correlation). The sensitivity, specificity, PPV, NPV, and DA of FNAC with category III assumed as malignant were 98.9%, 85%, 76.1%, 99.3%, and 89.5%, respectively. Histopathological correlation was available for 90 cases. The ROM for categories II, III, IV, and V was 5.6%,37.5%,100%, and 100%, respectively. IAC Yokohama system of reporting breast cytopathology and BIRADS serves as a common language of communication between pathologists and clinicians and aid in better stratification of the lesions. Both FNAC (minimally invasive) and ultrasound (non-invasive imaging technique) are diagnostic tools that complement each other for patient diagnosis and management.

Dear Editor, Mucosal melanoma of the head and neck (MMHN) region accounts for ~1.3% of all melanomas affecting the body (1). The conjunctiva is most frequently involved, followed by the upper aerodigestive tract. The oral and nasal cavities share almost 48% and 44% of the melanomas occurring in the upper aerodigestive tract. Paranasal sinuses harbor the bulk of the remainder of cases. Rarely are the pharynx and larynx involved (2). Nearly 80-90% of oral mucosal melanomas (OMM) arise from the keratinizing mucosa of the hard palate and maxillary gingiva. Buccal mucosa, mandibular gingiva, and the floor of the mouth are rather unusual sites (3). The amelanotic version of melanoma constitutes ~13% of all MMHN, which is more than its cutaneous incidence of 1.8-8.1% (4).Case 1The 42-year-old lady presented with an irregular blackish mucosal patch involving the inner surface of the upper lip (Figure 1A). Any pain or tenderness was absent. Only mere discomfort to the part led to its self-localization. Palpably, the mucosa appeared slightly thickened. Clinically, hemangioma and malignant melanoma surfaced as possible differentials. On histopathology: The thinned-out mucosa overlying diffuse sweeps of heavily pigmented tumor cells (Fig. 1B). These epithelioid tumor cells contained abundant cytoplasm, flocked with dense pigment granules that eventually obliterated their cellular details. Nuclei appeared vesicular with prominent nucleoli. Histomorphologically, the diagnosis of malignant melanoma was evident. Simultaneous positron emission tomography (PET) negated any further dissemination of the melanoma. Postoperatively, after a regimen of radiotherapy and chemotherapy the patient was followed up at 6 months interval without any relapse or recurrence.Case 2A 56-year-old man attended the otorhinolaryngology outpatient clinic with a rapidly enlarging left paranasal mass on his face. Computed tomography (CT) delineated a homogeneous solid tumor arising from the maxillary sinus, encroaching and compressing onto the nasal cavity (Fig. 1C). With a primary suspicion of sinonasal carcinoma or lymphoma, a punch biopsy was taken from the mass. Histologically, undifferentiated tumor cells appeared in diffuse sweeps undermining the ulcerated mucosa (Figure 1C, 1D). The polygonal tumor cells bore grossly irregular large nuclei, marked nuclear pleomorphism, frequent intranuclear cytoplasmic pseudoinclusions, vesicular chromatin, prominent nucleoli, and abundant pale eosinophilic cytoplasm (Fig. 1E). From such a dubious histomorphology sinonasal undifferentiated carcinoma, poorly differentiated squamous cell carcinoma (SCC), large B-cell lymphoma and amelanotic form of malignant melanoma posed as closest differentials. To their discrimination, a battery of immunohistochemical (IHC) markers were exercised. Cytokeratin (CK) 5/6, CD 45, and S100 were applied in the primary panel. The tumor cells expressed strong nucleocytoplasmic reactivity with S100, indicative of malignant melanoma (Figure 1F). While the other two reagents stained negatively (Figure 1I, 1J). HMB 45 was applied for confirmation. Tumor cells expressed strong cytoplasmic granular positivity, affirming it as amelanotic melanoma (Figure 1J). PET scan detected widespread dissemination to cervical lymph nodes, brain and lungs. The patient was immediately subjected to combination therapy. Despite this, he died of the disease after 4 months.

COVID-19 is a global pandemic that has caused an increase in hospitalization rates and high mortality. Secondary bacterial infections in hospitalized patients are one of the common complications of this viral disease. Due to the increased prevalence of antibiotic resistance, treating these patients is challenging. Therefore, this study aimed to evaluate the secondary bacterial infection and antimicrobial sensitivity test in hospitalized patients with COVID-19 in a tertiary hospital. In this retrospective descriptive study, all patients with COVID-19 who were admitted to Shahid Modares Hospital (Tehran-Iran) from October 2020 to March 2021 with positive culture results for bacterial infections, were assessed. The significance level was lower than 0.05. Ninety-seven patients with a mean age of 65.23 ± 16.72 years were assessed. The male patients accounted for 58.8% of the patients, while 41.2% were female. The ICU admitted patients with critical COVID-19 severity accounted for 59.8%, while 40.2% were hospitalized in the ward with a severe form of the disease. Age, length of hospitalization, and mortality rate were significantly higher in patients with ICU admission (all P-values<0.05). The most antibiotic-resistant bacteria were Klebsiella pneumoniae (32.98%). ICU admission showed a significantly higher rate in patients who were resistant to Cefotaxime, Ceftriaxone, Gentamicin, and Co-trimoxazole compared to the patients who were hospitalized in the ward (all P-values<0.05). Secondary bacterial infection in hospitalized patients with COVID-19 may lead to high mortality.

CD24 is a small, highly glycosylated membrane protein whose expression is associated with tumorigenesis and the progression of several types of cancer. Prostate adenocarcinoma is one of the most common cancers in men, and microscopic Gleason grading is an important factor affecting prognosis. This study aims to investigate the relationship between immunohistochemical expression of CD24 and its relationship with benign prostatic hyperplasia (BPH) and Gleason grade in prostate adenocarcinoma. This cross-sectional study was conducted on 163 patients, with an average age of 70.63±9.05 years, including 78 (47.9%) patients with prostate adenocarcinoma and 85 (52.1%) patients with benign prostatic hyperplasia., referred to Mostafa Khomeini Hospital in Tehran between 2018 and 2021, who underwent open prostatectomy or Trans Urethral Resection of Prostate (TURP). Immunohistochemical staining was used to evaluate CD24 expression, and Gleason grade was determined in the case of prostate adenocarcinoma. Data were analyzed with SPSS 22 and a P-value<0.05 was considered statistically significant. The percentage and intensity of CD24 staining in prostate adenocarcinoma patients was significantly higher than in BPH patients (P<0.05). Gleason score strongly correlated with the percentage and intensity of CD24 staining (P<0.05). The immunoreactive score, obtained by multiplying the CD24 expression percentage with staining intensity, was also significantly related to the Gleason score (P<0.05). CD24 expression can be considered as a factor in differentiating cases of prostate adenocarcinoma from benign prostatic hyperplasia. Also, a high level of this marker can indicate the progress of prostate cancer.