Septate gall bladder: a surgical surprise with review of literature

Septate gallbladder is a rare congenital anomaly, which can present a challenge for the surgeon who performs laparoscopic cholecystectomy. The common first line modality for screening in symptomatic gallbladder pathology is still ultrasonography. Preoperative diagnosis of this anomaly is not common. Pre- operative diagnosis and being acquainted with this anomaly decreases the possibility of injury to the biliary tract, the number of postoperative complications and the possible need for further surgical procedures. We present a case of septate gallbladder, which was diagnosed during the operative procedure. Despite the finding of a septate gallbladder, the performance of laparoscopic cholecystectomy was uneventful.

Diagnostic Approach to Malignant Pleural Effusion- An Experience in Tertiary Care Centre

Background: Pleural effusion may be due to benign or malignant causes. Patient with known malignancy raises the possibility of pleural involvement. In majority of cases, malignant pleural effusion is associated with high morbidity and mortality.Confirmation of malignancy by cytological or histological examination of pleural fluid is currently important modality in establishing the diagnosis. Aim And Objective -To diagnose malignant pleural effusion by cytological and histological examination of pleural fluid at our centre. Methods: Cross-sectional study including all the patients with pleural effusion done on 101 cases. Results: Most of the effusions are benign. Initial pleural fluid cytology was positive for malignancy in 40% of patients. Thoracoscopic pleural biopsy confirmed 75% positive cases for malignancy.Malignancy causing pleural effusion are mostly due to carcinoma of lungs and breast. Conclusion: Cytological and histopathological examination of pleural fluid are useful diagnostic tools in patients with pleural effusion.

Immunomarker Study in Primary Breast Carcinoma: A 3 Year Cross Sectional Study in Rural Population of Western Odisha

Background: Breast cancer is the second most common cancer in the world and,by far,the most frequent cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012. It is well established that there are at least 4 main molecular subtypes of breast cancer based on different patterns of gene expression, and they have a considerable impact on outcome. Objective of this study is to establish a comparative analysis of breast cancer by IHC assay in western Odisha and to correlate with reference to tumor sizes, histological grade and lymph node involvement. Methods: This study was conducted in VIMSAR, Burla, Odisha from July 2014 to August 2017 where 66 Cases of radical mastectomy received for routine histopathological evaluation from Dept of Surgery for histological typing and evaluation of IHC status by Dako EnvisionTM FLEX/HRP detection reagent. ER, PR, Her2neu and Ki67 were evaluated as per ASCO/CAP guidelines. The molecular subtypes were correlated with known prognostic markers as tumor size,histologic grade and lymph node status. Results: Triple negative and Her2neu 20.9% of cases were more aggressive and correlated with increased tumor size,higher grade and majority showed lymph node involvement at an early stage. Conclusion: After overall assessment it was seen that majority of cases were Luminal A type followed by triple negative and Her2neu positive cases indicating not only the latter are related to poor outcome but also showed its increased prevalence in this part of odisha possibly because of late presentation. Molecular typing help categorize and plan targeted therapy to patients.

Revised IAP Growth Charts for Height, Weight and Body Mass Index for 5- to 18-year-old Indian Children.

Justification: The need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old. Process: The Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children’s growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole’s LMS method. Objectives: To construct revised IAP growth charts for 5-18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years. Recommendations: The IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5-18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.

Salmonella Typhi Infections and Effect of Fluroquinolones and Third Generation Cephalosporins in Clinical Outcome.

Background: Enteric fever is a common public health problem in Nepal. The emerging fluoroquinolone resistance to Salmonella typhi is a major concern in every hospital and is a public health problem these days. Continuous antibiotic susceptibility patterns surveillance and standard treatment policies need to be established to control MDR typhoid. Objective: To detect the increasing pattern of fluoroquinolone resistant Salmonella typhi and to correlate its clinical response to third generation cephalosporins. Materials and Method: This is a cross- sectional prospective study conducted in the pediatric ward of Birendra Hospital, Kathmandu, from September 2009 to August 2010. Forty seven children aged between 3-14 years with the diagnosis of suspected, probable and confirmed cases of Enteric fever were enrolled in the study. Data was collected and statistical analysis was done using SPSS program. Result: Culture positive enteric fever was found in 21 cases (44.68%) and positive Widal test in 18 (38.29%). Among the culture positive cases, antibiotic sensitivity was highest for Ofloxacin (95.23%), followed by third generation Cephalosporins (Ceftriaxone, Cefixime) (90.47%). A significant number of isolates were resistant to Nalidixic acid (71.42%). All cases were successfully treated with parenteral antibiotics followed by oral third generation cephalosporins without any complications and/or mortality. Conclusion: There is an increasing trend to fluoroquinolone resistant Salmonella typhi. Third generation cephalosporin can be the appropriate antibiotic for treatment.of clinically suspected cases of Enteric fever and to minimize the risk of increasing emergence of MDR enteric fever including Nalidixic acid resistant Typhoid.(NARST).

Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants Under 2 months of Age.

Introduction: Hypoxemia is the most serious manifestation of any acute illness in infants less than two months and has shown to be a risk factor for mortality. Hypoxia can be detected using a pulse oxymeter or arterial blood gas analysis. However this facility is not available in most centers of Nepal. This study has correlated different signs and symptoms to predict hypoxia. Methodology: This hospital based prospective cross sectional study included 160 infant < 2 months, presenting to OPD or Emergency department with any acute illness A complete history was taken and weight, temperature, respiratory rate, heart rate and oxygen saturation was recorded. Presence or absence of nasal flaring, cyanosis, chest indrawing, head nodding, grunting, wheezing and crepitations on auscultation was recorded subsequently. Clinical signs of hypoxemic and non hypoxemic infants were compared and then analyzed. Results: 160 infants, 95 (59.4%) were male and 65 (40.6%) were female. Of the total population, 56(35%) were hypoxic where as 104(65%) were non hypoxic. Infants who presented with more than 3 symptoms, were lethargic, tachypneic or had chest indrawing had higher sensitivity(92.8%, 75%, 75% and 89.3 % respectively) where as infants with nasal flaring, grunting, head nodding or central cyanosis had high specificity (91.3%, 87.5%, 98% and 100%) respectively. Conclusion: Infants presenting with ≥ 3 symptoms, lethargy, respiratory rate of ≥ 70/minute or chest indrawing can be used for screening purpose to detect hypoxia and infants showing signs like grunting, head nodding, nasal flaring or central cyanosis should be considered hypoxic and treated with supplemental oxygen.

Obesity amongst affluent adolescent girls.

OBJECTIVE: To assess the prevalence and type of obesity in affluent schoolgirls aged 16 and 17 yr. METHODS: A cross-sectional study was conducted in 2002, in 4 randomly selected public schools of Delhi. All girls from randomly chosen classes were included. Weight, height and waist and hip circumferences were measured for all 414 schoolgirls and their socio-demographic profile was recorded. Body mass index [BMI] and waist hip ratio [WHR] were calculated for all the girls. BMI > 30 (i.e.--95th percentile) denotes obesity and BMI > 25 (i.e.--85th percentile) denotes overweight as according to International Obesity Task Force (IOTF) criteria. WC > 80 cm or WHR > 0.85 denote central obesity. RESULTS: Prevalence of obesity and overweight amongst the study subjects was 5.3% and 15.2% respectively (IOTF). Out of the 22 obese girls central obesity was present in 21 girls (95.4%) [WC > 80 cm] and 12 girls (54.5%) [WHR > 0.85]. CONCLUSION: There is significant prevalence of obesity in affluent schoolgirls in Delhi and more than half of them have central obesity.

Metaplastic carcinomas of the breast (light microscopic and immunohistochemical features).

Metaplastic carcinomas of the breast are uncommon tumors that contain other cellular components besides the glandular component. These carcinomas have a poor prognosis as compared to breast carcinomas without metaplasia. It is, therefore, important to recognise the metaplastic components. The study was conducted over a three year period. All breast carcinomas received during this period in the department of pathology were analysed for areas of metaplastic carcinomas. The light microscopic features, special stains as well as the immunohistochemical markers of metaplastic carcinomas are highlighted in this paper.

Giant cell pneumonitis induced by cobalt.

Cobalt alone and in combination with tungsten carbide known as hard metal is capable of causing lung damage. This may vary from development of pulmonary oedema to asthma and fibrosing alveolitis. We report a case of giant cell interstitial pneumonitis caused by exposure to cobalt dust which was not identified as the etiological agent initially and hence led to progression of the disease. The patient subsequently improved following cessation of exposure and treatment with oral corticosteriods, thereby stressing the importance of occupational history in all cases of interstitial pulmonary fibrosis.

Successful non-surgical embryo recovery from a goat.

Embryos from a Jamunapari goat were successfully recovered using non-surgical approach. The technique of Bessoudo et al [Theriogenology, 29 (1988) 221] was simplified and all the appliances used were fabricated indigenously. Fluid retrieval rate was 95%. Five excellent embryos (blastocysts) were recovered. The whole process of embryo collection was completed in 30 min.

Scleral rigidity in glaucoma, before and during topical antiglaucoma drug therapy.

A study of 30 subjects (10 normal and 20 having glaucoma) was done to find out the scleral rigidity in glaucoma cases as compared to normal. The effect of miotics, timolol (0.25%) and pilocarpine (2%) eye drops on the scleral rigidity in cases of glaucoma was observed.

Fibro osseous lesions of cranio facial bones.

In a review of all tumours and tumour like lesions of the craniofacial bones between the years 1963 and 1980, 19 cases were diagnosed as fibro osseous lesions. The mean age of occurrence was 23.8 years with a slight male predominance (1.6:1). The clinical and histological aspects of the various lesions, the problems in diagnosis and the impact of diagnosis on clinical behaviour are discussed.

Sickle haemoglobin, G-6PD deficiency and malaria in western Orissa.

Sixty cases of malaria were screened for sickle haemoglobin and G-6PD deficiency. Plasmodium vivax was detected in 40 (66%) and Plasmodium falciparum in 21 (35%) cases, with six of the latter having cerebral manifestation. Sickle Hb was found in 7 (11.5%) patients and G-6PD deficiency in 3 (5%) cases. Both patients with SS disease had vivax malaria, while of 5 with sickle cell trait 3 had only vivax, one only falciparum and one mixed infection. Amongst G-6PD deficient patients one had vivax and two falciparum malaria. One of the latter had both SC trait and G-6PD deficiency. Thus, adult persons with SS disease or SC trait were not found to be resistant to either vivax or falciparum malaria. A high frequency (5%) of G-6PD deficiency amongst malaria patients warrants a caution against indiscriminate use of 8-aminoquinoline drugs.

A protocol used for splitting mouse embryos into two halves.

8-16 cell embryos and early blastocysts were obtained from the oviducts and anterior portion of uterine horns of albino mice at 70 and 90 hr after LH injection respectively. Splitting of embryos was done by using two microtools attached to a micromanipulator unit (Research Instruments Ltd, UK). After bisection, each pair of the half embryos is transferred to a dish containing 2 ml of T-6 medium and cultured in CO2 incubator (at 39 degrees C, 95% RH and 5% CO2 in air mixture). Splitting of blastocysts as compared to 8-16 cell embryos was found difficult (35.48% vs 52.44%, respectively). 38.88% of bisected 8-16 cell embryos and 11.36% of bisected blastocysts developed on 48 hr culture. Information on splitting mouse embryos and their subsequent development in culture are significant in view of using the technique for commercial application and for research in developmental biology of animal embryos.

Survival of mouse embryos after being frozen in glycerol-sucrose mixture.

Random bred female albino mice (6-8 weeks old) were used as a source of embryos. 8- to 16 cell embryos were dehydrated in glycerol-sucrose mixture in 0.25 ml straws at room temperature. Straws were cooled at the rate of 5 degrees C/min to -7 degrees C. Seeding was induced by touching the out side of the straw at -7 degrees C. Straws were further cooled at 0.5 degree C/min down to -35 degrees C and then plunged into liquid N2. Thawing of straws was done by direct transfer into water at 35 degrees C. Frozen-thawed embryos were cultured in a CO2 incubator maintained at 39 degrees C. Out 190 embryos (8-16 cell) initially frozen, 169 (88.94%) were recovered on thawing. 158 (93.5%) out of 169 were apparently normal and used for culture. 75 (47.46%) developed to morulae/early blastocysts and 72 (45.56%) to expanded blastocysts on 24 and 48 hr culture respectively. In conclusion, the incorporation of sucrose in the freezing medium at a concentration of 0.25 M has led us to propose a freezing, thawing and transfer method without dilution of glycerol. The technique being quite simple is worth trying in farm animals where importance of this technique in non-surgical transfer of frozen-thawed embryos will be a boon.

Cryopreservation of mouse embryos at -196 degrees C by vitrification.

Embryos (8-16 cell) were obtained from random bred albino mice (6-8 weeks old) that were induced to superovulate by injections of 5 I.U. PMSG and 5 I.U. hCG given 48 hr apart. Embryos were exposed to intracellular cryoprotecting medium (glycerol 10%, 1-2 propanediol 20% in PBS) for 10 min and then transferred to extracellular vitrification medium (25% glycerol, 25% 1-2 propanediol in PBS). Vitrification medium containing embryos, and diluent (1 M sucrose) were loaded in a straw and immediately plunged into liquid N2. After thawing at 20 degrees C, the contents of the straw were mixed by shaking (1 step dilution) and emptied in a petri dish. After 3 washings in culture medium the embryos were kept in CO2 incubator for further development. In 3-step dilution procedure the dilution of cryoprotectants was done in 0.5 and 0.25 M sucrose before culture. Embryos in 3-step dilution of cryoprotectants exhibited high survival as compared to 1-step dilution (20.23% vs 6.55%).