Segmental filiform-polyposis in a treated case of ulcerative colitis, colon: An unusual presentation raising a doubt of primary diagnosis?

Inflammatory bowel disease is broadly classified into Crohn's disease and ulcerative colitis. The standard criteria to distinguish between the two is the manner of the involvement of the bowel, with the former showing classical skip lesions and the latter having continuous involvement of the colon, most commonly affecting the rectum. However, some cases exhibit overlapping features. Herein, we report a treated case of ulcerative colitis presenting with patchy involvement of the colon in the form of peculiar segmental filiform polyposis spanned abruptly by an intervening normal mucosa. The clinico-radiologically suspicion of carcinoma colon with Crohn's colitis was considered. The clinicians and pathologists must be aware of such atypical presentations and should not be misled to change the diagnosis from ulcerative colitis to Crohn's colitis on the post-treatment resection specimens or endoscopic biopsies solely in view of the patchy filiform polyposis (FP), which poses a drastic impact on the patient's management.

Prevalence of osteoporosis in perimenopausal and postmenopausal women in Malwa region of Punjab

Background: Clinical sign of osteoporosis includes fragility fractures or a T-score that is <2.5 SD below the mean as determined by a dual-energy X-ray absorptiometry (DXA) scan of bone mineral density (BMD). People with T-scores of –2.5 have the highest risk of fracture. People with T-scores of –2.5 have the highest risk of fracture. However, maximum fractures are seen in patients with a T-score between –1 and –2.5 because of more people in this category. As there is very little knowledge of osteoporosis in perimenopausal and postmenopausal women in male region, this study will help us to know the current status of osteoporosis in these females. Aims and Objectives: The objective of the present study was to determine the prevalence of osteoporosis in 296 premenopausal, perimenopausal and postmenopausal women of more than 40 years of age attending midlife health clinic at a tertiary care center in Patiala, Punjab and to observe its correlation with age, menopausal status, body mass index, and dietary intake. Materials and Methods: A detailed medical, surgical, obstetrical, gynecological, and drug history were recorded in a pro forma designed for the study after taking the informed consent. Information about history of fracture on a trivial fall, family history suggestive of osteoporosis, socioeconomic status, educational status, and occupation was documented. Women having history of endocrinal disorders (hypo/hyperthyroidism, hypo/hypergonadism, and hypo/hypercalcemia), receiving therapeutic agents (thiazide diuretics, glucocorticoids, and osteoporosis treatment), having restricted mobility issues and with implants (at lumbar spine, hip, and lower limbs) were excluded from the study. Quantitative ultrasound (QUS) measurement of calcaneum was performed that T-score was generated based on the speed of sound and was used to classify the bone health status of the subjects. Results: Out of 296 women, 227 women had a low bone mass density, that is, <–1 SD. We divided all the participants into three groups as shown in Table 1. Group I (n = 69 [23.2%]) having normal BMD, that is, T score >–1 SD; Group II (n = 204 [69.2%]) included women with BMD between –1 and –2.5 SD (Osteopenia); and Group III (n = 23 [7.6%]) included women with BMD <–2.5 SD (Osteoporosis). Most women in perimenopausal (75%) and postmenopausal (64.6%) group were osteopenic (Group I). Out of all women with osteopenia (Group II, n = 204), 113 (52.1%) were postmenopausal and 82 (40.3%) were perimenopausal. All women with osteoporosis were postmenopausal. The difference between BMD categories and menopausal status was statistically significant (P = 0.014). In these women, the BMD was found to decrease with increase in the average number of years since menopause (YSM) (P = 0.06). Conclusion: Menopause is an important event in a woman’s life cycle which affects bone health with the prevalence of osteoporosis and osteopenia increasing with increasing YSM. QUS technology emerges as cost-effective screening tool for the early detection of osteoporosis for a large population in developing country like India.

Immunohistochemical evaluation of E-cadherin in oral epithelial dysplasia and squamous cell carcinoma

Aim: To evaluate the expression of E-cadherin (E-cad) in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Material and Method: Immunohistochemistry was used to detect E-cad expression in 20 cases each of normal oral mucosa, oral epithelial dysplasia and squamous cell carcinoma. Statistical Analysis Used: Inferential statistical methods for statistical analysis used were Chi-square test for comparison of the frequency between different severity of dysplasia and OSCC. Results: Upon assessing the expression of E-cad in OED and OSCC, increase in E-cad immunoreactivity was seen in early lesions. However, the expression of E-cad decreased significantly as the grade of dysplasia increased. Conclusion: We observed a significant decrease in E-cad expression from dysplasia to poorly differentiated squamous cell carcinoma suggesting that loss of expression of E-cad is closely related to carcinoma.

Role of Computed Tomography-guided Fine-needle Aspiration Cytology/Biopsy in Management of Lung Lesions: Experience of a Tertiary Care Oncology Hospital

Background: Fine-needle aspiration cytology (FNAC) and biopsy are routinely used methods for the diagnosis of lung lesions. In sampling of lung lesions, computed tomography (CT) is used to provide direction to the needle. The procedure is related with few complications. Methods: In this retrospective study, records of 247 patients who underwent CT-guided FNAC and/or biopsy at our tertiary care oncology-specific hospital during a calendar year (2015) were analyzed. The pretest coagulation profiles, predisposing emphysematous conditions on CT, and patient demographics were recorded. Lesion demographics included site, size, and depth. Postprocedure complications and diagnosis on cytology, histopathology, and immunohistochemistry (IHC) were tabulated. Results: Out of 247 patients, 160 (64.8%) were males. Most patients belonged to 51� years age group. Adenocarcinoma was the most common primary tumor of lung whereas carcinoma breast was the most common secondary diagnosed. Thirty (12.1%) patients developed complications after the procedure, with 29 of these having pneumothorax. Conclusions: Computed tomography-guided FNAC and/or biopsy is a safe and reliable tool to diagnose lung lesions.

An online cross-sectional study of the psychosocial impact of COVID-19 lockdown on general population of Haryana, India

Background: The coronavirus disease 2019 (COVID-19) pandemic has not only posed serious medical challenges but also significant psychological, social, and economic challenges acutely as well as in the long-term. There is evidence that this pandemic has caused intense psychological distress among people which is further likely to get compounded by administrative decision of nationwide lockdown. Aim: To determine the psychosocial impact of lockdown due to COVID-19 pandemic on the general population of Haryana, India. Method: It was an online cross-sectional study conducted on the general population of Haryana from 15th April to 5th May 2020 using a snowball sampling technique. A pre-tested, self-designed questionnaire comprising three sections, viz. sociodemographic characteristics, general life during lockdown, and psychological impact, was prepared using google forms and the link was sent to the participants through social media. Results: A total of 640 participants responded to the survey within the stipulated time. The most common depressive symptoms were insomnia (56%) followed by hopelessness (45%) and irritability (36%). Hypochondriacal preoccupation and obsessional ruminations were present in 87% and 23% of the respondents respectively. Twenty seven per cent of the people experienced autonomic symptoms of anxiety. Fear of death due to COVID (68.4%) and excessive COVID-related information being circulated through news and social media (26.2%) generated maximum stress. They coped with this stress by engaging themselves with television (TV)/social media (57%) and physical exercises (48.4%). Social life followed by professional life was the most affected facet of life. Lockdown had adversely affected the family bond in one per cent of the participants. Conclusion: The study concludes that lockdown due to COVID-19 pandemic had an adverse psychosocial impact on the general population of Haryana resulting in a magnitude of psychological issues.

Seroprevalence of brucellosis in Western Rajasthan: A study from a tertiary care centre

Brucellosis is a significant bacterial zoonotic disease with a high seroprevalence in low-to-middle-income countries where there is a significant contact of humans with animals. This prospective study was conducted to observe the seroprevalence of brucellosis in 75 symptomatic patients with pyrexia of unknown origin (PUO) and 75 high-risk individuals (10 veterinarians, 15 milkmen and 50 healthy contacts of symptomatic patients) with possible exposure to brucellosis. Serum samples collected from these patients and individuals were subjected to rose Bengal test (RBT) and ELISA for the detection of IgM and IgG antibodies. RBT was positive in 50 samples (40 PUO and 10 high risk), of which 25 (33.3%) PUO cases had detectable IgM antibodies, whereas IgG antibodies were detected in 20 patients. None of samples from high-risk individuals was reactive for IgM/IgG antibodies by ELISA. The overall seroprevalence in this study was 16.7% (33.3% in PUO patients). Being a predominantly livestock rearing area, brucellosis is a significant health-care problem in this part of India with this entity being linked to 33% of PUO cases.

Response of arbuscular mycorrhizal fungi along with Trichoderma viride and Pseudomonas fluorescens on the growth, biochemical attributes and vase life of Chrysanthemum indicum

Aim: The present study aimed to investigate the effects of two dominant arbuscular mycorrhizal (AM) fungi along with Trichoderma viride and Pseudomonas fluorescens on the growth and vase life of Chrysanthemum indicum ('Garden Mum'- Kathleen Dark Red). Methodology: An experiment was conducted to evaluate the effect of G. mosseae (G) and A. laevis (A) along with T. viride (T) and Pseudomonas fluorescens (P) on the growth and vase life of C. indicum L. under polyhouse conditions. The experiment was laid in a randomized block design with five replicates. Results: AM fungi along with other bioinoculants showed maximum root colonization leading to increased water absorption and various important nutrients, especially phosphorous, thereby enhancing the growth and different biochemical attributes. For the vase life experiment, bioinoculants treated plants showed better result with minimum peroxidase activity, thereby delaying flower senescence. Interpretation: AMF inoculation should be recommended at nursery level as biofertilizers are cost effective and also a substitute for chemical fertilizers

Uterine tumor resembling ovarian sex cord tumor: Histomorphological features

Uterine tumors resembling ovarian sex cord tumors are rare neoplasms with varied histological and immunophenotypic profile, uncertain histiogenesis and biological behavior. A critical evaluation of histological features is essential for diagnosis and management of these cases.

Anti-emetic trials in oncology: What should be done next.

Weinstein C, Jordan K, Green SA, Camacho E, Khanani S, Beckford-Brathwaite E, Vallejos W, Liang LW, Noga SJ, Rapoport BL. (Merck & Co., Kenilworth, New Jersey, USA; Department of Hematology/Oncology, Martin Luther University HalleWittenberg, Halle, Germany; Department of Hematology and Medical Oncology, Comprehensive Cancer Center at the Desert Regional Medical Center, Palm Springs, California; Department of Hematology/Oncology, Reliant Medical Group, Worcester, Massachusetts; Department of Oncology, Weinberg Cancer Institute, Baltimore, Maryland, USA; Department of Medical Oncology, Medical Oncology Center of Rosebank, Johannesburg, South Africa). Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy: Results of a randomized, double-blind phase III trial. Ann Oncol 2016;27:172–8.

Urolithiasis: Phytotherapy as an adjunct therapy.

Role of herbal drugs and medicinal plant extracts in the successful treatment of urolithiasis, classified as the third most common urinary tract diseases is well documented. Ayurvedic plants and their components mediate antilithogenic effects by altering ionic composition of urine, being diuretic, antioxidant or having antimicrobial activity. Therapeutic peptides and proteins have unique place in pharmaceutical biotechnology due to their critical roles in cell biology. The innovation in antilithiatic proteins is that they are anionic, rich in acidic amino acids which make oxalate unavailable by interacting with calcium and have EF Hand domain which is a characteristic feature of various calcium binding protein like calgranulin, osteopontin. The review provides a background on the pathogenesis of urolithiasis and medical treatments. It focusses on the present research evaluating the scientific basis of antilithiatic potential of various plants and role of plant proteins as therapeutic agents thus opening new vista in the management of urolithiasis. Further investigations are required to fully decipher the mode of action of the potent biomolecules so as to exploit their preventive and therapeutic potential.

Experience with treatment of pulmonary alveolar proteinosis from a tertiary care centre in north India.

Background. Pulmonary alveolar proteinosis (PAP) is a disorder characterised by accumulation of lipids and proteins in the alveoli, with the resultant symptoms ranging from indolent subclinical disease to progressive respiratory failure. Methods. We retrospectively studied five patients with PAP managed at our center between January 2007 and April 2010, with whole lung lavage (WLL) and/or subcutaneous granulocyte macrophage-colony stimulating factor (GM-CSF) therapy. Patients undergoing WLL under general anaesthesia were supplemented with three months of GM-CSF therapy. Pre- and post-lavage symptom assessment was performed with a 10-point, symptom-based visual analogue scale. Results. Their mean age was 37.6±7.0 years; there were four males. Diagnosis of PAP [idiopathic (n=3); secondary to Nocardia (n=1)] was established by surgical lung biopsy in four patients who presented with respiratory failure. Three patients with idiopathic PAP (n=3) were treated with a combination of GM-CSF and WLL; one patient with secondary PAP was treated with antibiotics alone. In another patient transbronchial lung biopsy was used to diagnose PAP and GM-CSF alone was administered. All patients were followed up for a median period of two years (range 0.5-3 years). Significant improvement was achieved in all the patients with therapeutic WLL and/or GM-CSF. Conclusions. Whole lung lavage appeared to be an effective and safe therapy in patients with PAP. Efficacy of simultaneous administration of GM-CSF and WLL in the treatment of PAP merits further study.

Cytoprotective role of the aqueous extract of Terminalia chebula on renal epithelial cells

PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as "harad" which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84% at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.

Initial experience of endobronchial silicon stents from a tertiary care centre in north India.

Background. Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. Methods. Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. Results. Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign postintubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. Conclusions. Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

Clinico-pathological profile in deaths due to burns.

Burn injuries occur universally and have plagued mankind since antiquity till the present day. Burns represent an extremely stressful experience for both the burn victims as well as their families. An extensive burn profoundly affects the patient's physique, psyche, financial situation and family. Patients with extensive burns frequently die, and for those with lesser injury, physical recovery is slow and painful. In addition to their dramatic physical effects, burn injuries frequently cause deleterious psychological complications. In all societies including developed or developing countries, burns constitute, a medical and psychological problem, but also have severe economic and social consequences not only to them, but also to their family and society ingeneral.24% cases were not hospitalized. 40% cases died within 24 hours of sustaining burns. 38% cases were unconscious before death. 66% cases had given dying declaration Mechanical injuries were present in 10% cases. 84% cases of total cases were alleged cases of accident. The major cause of death was Septicemic shock in 56% cases.

Immune responses to mycobacterial antigens in sarcoidosis: A systematic review.

From the time sarcoidosis has been described, there has always been a viewpoint that the disease is in some way related to tuberculosis (TB). Sarcoidosis is a granulomatous disease, which is likely a result of continued presentation of a poorly degradable antigen. Mycobacterium tuberculosis has been a very strong contender for this antigen. Besides the molecular studies demonstrating mycobacterial deoxyribonucleic acid (DNA) in the sarcoid tissue, assessment of immune responses against mycobacterial antigens provides a useful tool to study the role of mycobacteria in the pathogenesis of sarcoidosis. We reviewed the studies focussing on T-cell and B-cell responses to tubercular antigens in patients with sarcoidosis. Pooled data from various studies does provide a suggestive, though not unequivocal evidence in favour of mycobacteria as a cause of sarcoidosis. These findings not only reinforce the possible pathogenic role of mycobacterial antigens in sarcoidosis, but at the same time also limit the clinical utility of molecular and serological studies based on mycobacterial antigens in the differential diagnosis of TB from sarcoidosis, particularly in a country with high endemicity for TB.

Medical thoracoscopy for undiagnosed pleural effusions: Experience from a tertiary care hospital in north India.

Background and Aims. Medical thoracoscopy, also called pleuroscopy, has received renewed interest in the recent past for diagnostic as well as therapeutic uses. In this study, we describe our experience with thoracoscopy for undiagnosed pleural effusions. Methods. In a retrospective analysis of thoracoscopic procedures we performed between January 2007 and December 2008, yield of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions, defined as pleural effusions with adenosine deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy on three occasions was evaluated. Complications of thoracoscopy were also analysed. Results. Overall diagnostic yield of thoracoscopic pleural biopsy was 74.3% in patients with undiagnosed pleural effusions. Pleural malignancy was diagnosed in 48.6% of patients. There was only one case of mesothelioma and the rest were due to pleural metastasis. Lung cancer and breast cancer were the most common sites of primary malignancy. Tuberculosis was diagnosed with pleural biopsy in 22.8% of patients. We had low complication rate after thoracoscopy. Only two cases of empyema were observed. Conclusion. Medical thoracoscopy is a safe procedure and has good diagnostic yield in patients with undiagnosed pleural effusions.