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BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality. Risk stratification and initiation of dual or triple combination therapy has a better clinical response, especially in high-risk patients. Unfortunately, prostacyclin analogues are not marketed in India; hence, the use of these medications is limited. We report the benefits and difficulties of using iloprost inhalation in patients with advanced PAH in India. METHODS In this prospective observational study, we included patients with group 1 PAH. Inhaled iloprost was initiated as an add-on therapy for patients who had clinical, echocardiographic or laboratory deterioration on dual oral medications. Patients with clinical instability were excluded. All patients underwent thorough clinical evaluation, detailed echocardiogram and laboratory investigations. Patients were started on inhaled iloprost 2.5 ?g six times daily and closely followed up. The dose was escalated if necessary. On follow-up, clinical echocardiographic and laboratory evaluation was done on all patients. RESULTS Fourteen patients (11 women) with a median age of 32 years (2–66 years) with group 1 PAH were started on inhaled iloprost as an add-on therapy. Improvement in clinical parameters, WHO functional class, echocardiographic-derived right ventricular function, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were observed in 10 of 14 patients. A median increase of 31% (4.2, 106%) in the distance travelled during 6-minute walk test, a median increase of 45% (–20, 120%) in right ventricular fractional area change, a median increase of 27% (–16.7, 60%) in tricuspid annular peak systolic excursion and a median decrease of 36.7% (–69.6, 17.2%) in NT-pro-BNP levels were observed after initiation of medication. Three patients had progression of symptoms and were then referred for lung/heart–lung transplant. One patient developed progression of symptoms after an excellent initial response and transitioned to subcutaneous treprostinil. Improvement in clinical, echocardiographic and laboratory features allowed us to successfully perform surgical Potts shunt in 2 patients. The medications were well tolerated with minimal and transient side-effects. There were no deaths. CONCLUSION Inhaled iloprost can be used with acceptable benefits and minimal side-effects in patients with PAH.
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Diabetes care is challenging, and the increasing number of available therapeutic options has made it even more complex. Moreover, with an increasing prevalence across the world, it needs to be managed right from the primary care level to a quaternary care hospital. This calls for an easy-to-use algorithm that can be used by a general practitioner, who is often the first contact of a patient to manage diabetes in many countries. There are multiple models to assist in choice of pharmacotherapy, and these have evolved over time. We propose a user-friendly collaborative choice, as an aid to clinical decision-making. This alliterative framework supplements and strengthens existing guidance, by creating a comprehensive, yet simple, thought process for the diabetes care professional.
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Objective: To report our experience of tracheobronchial foreign body removal in childrenusing flexible bronchoscopy as the primary mode. Methods: Hospital records oftracheobronchial foreign body extractions between January, 2006 and January, 2018 werereviewed. Clinical presentations, radiological findings, location and types of tracheobronchialforeign bodies, types of bronchoscopes, complications and outcome of the procedures wereanalyzed. Results: 283 extractions in children with median (range) age of 18 (5-168) monthswere reviewed. Extraction by flexible bronchoscope, using wire baskets or grasping forceps,was successful in 260 cases. No major complications were encountered. Mean (SD) time forthe procedure was 31 (6.3) minutes. Conclusions: Airway foreign bodies can safely beremoved by flexible bronchoscopy with minimal complications. This procedure can beconsidered the primary mode for removal of airway foreign bodies by a trained andexperienced person
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Background: Intrathoracic and intra-abdominal tumors at inaccessible sites pose difficulty in diagnosis. Ultrasonography and computed tomography guided fine needle aspiration cytology has an important role in the diagnosis and distinguishing them as benign and malignant lesions. Image guided FNA has proved to be safe, quick, reliable and cost-effective method for obtaining tissue for cytopathological examination. The objective was to describe the pattern of intra-abdominal and intra thoracic masses on FNAC.Methods: This cross-sectional study was done in the postgraduate Department of pathology Government, Medical college Jammu i.e. 1st September 2017 to 30th September,2018 for a period of one year under image guided FNAC. Air dried and wet fixed smears were stained with may Grunwald Giemsa (MGG) and Papinacolau (PAP) stains respectively. Acid fast bacilli stain was done on additional smears in case of suspected tubercular lesions.Results: A total of 60 patients were subjected to ultrasonography and CT guided intra-abdominal and intra thoracic FNACs in a period of one year. FNAC was performed from various anatomical sites of which intra-abdominal lesions were 40 (liver:21 cases, gallbladder:8 cases, ovary: 3 cases, lymph nodes 3 cases, pancreas: 2 cases, omentum 2 cases, GIT 1 case). Intrathoracic lesions were twenty (20); out of which lung cases were eighteen (18) and two (2) were mediastinal aspirations.Conclusions: Percutaneous fine needle aspiration cytology under image guidance well described the pattern of deep-seated lesions.
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Background: Delayed umbilical cord clamping is an effective strategy and particularly relevant for infants living in low-resource settings with less access to iron-rich foods and thus are at greater risk of anaemia. Objective: To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on haematological parameters (serum ferritin & hemoglobin) at birth and at 72 hours in term neonates. Methods: This was an Open Label Randomized Controlled Trial conducted at Suvidha Mother and Child Nursing Home Talab Tillo Jammu over a period of 6 months. A total of 68 babies born at > 37 weeks of gestation were randomized in three groups, group I UCM alone (n=28) , Group II DCC alone (n=23) and Group III both UCC and DCC (n=17) using simple randomization technique . In milking group, Umbilical cord was milked 4 times towards the baby at a speed of 10 cm / sec . In Delayed Cord Clamping group cord was clamped and cut 2-3 cm distance from the umbilical stump after 3 minutes of birth. In Group III both procedures were done simultaneously. Statistical analysis: ANOVAwas used to compare mean difference of outcome between three intervention arms. Two tailed Pvalue of <0.05 was taken as significant. SPSS version 20.0 was used for data analysis Results: The baseline characteristics were mostly comparable in the all the groups. Maximum increase in Haemoglobin and PCV was seen in group II i.e delayed cord clamping . Mean haemoglobin and heamatocrit (PCV) levels at 72 hours of life neonates in group II (17.7g% and 55.4 ) and group III (17.3g% and 54) were comparable . Conclusion: Both the interventions i.e Delayed cord clamping performed alone or in combination with umbilical cord milking had comparable effect on hematological status in term neonates
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A 6 year old female child presented with movement disorder, cognition impairment, insomnia and restlessness. She was diagnosed with NMDA receptor autoimmune encephalitis triggered by Mycoplasma pneumoniae and was treated successfully with high dose steroids, Intravenous immunoglobulin and Clarithromycin. A 6 year old Female child of Indian origin presented with visual hallucinations, intermittent jerky movements of left leg and left arm, agitation, screaming episodes and insomnia. On examination she had cognition impairment with truncal ataxia. MRI Brain was Normal. EEG showed epileptiform activity over right hemisphere. Mycoplasma antibody titre was strongly seropositive .Serum and CSF NMDA Receptor antibody was positive. MRI STIR was negative. After appropriate investigations, she was diagnosed with NMDA Receptor autoimmune encephalitis triggered by Mycoplasma pneumoniae and was treated successfully with high dose steroids, Intravenous immunoglobulin and Clarithromycin. NMDA Receptor encephalitis is the most common cause of autoimmune encephalitis in children. 6% to 50% of patients with anti-NMDAR encephalitis have been found to have an associated underlying tumor. Mycoplasma pneumoniae are the main presumed infectious pathogens associated with majority of the autoimmune encephalitis. It is suggested that early onset encephalitis is a direct type extrapulmonary manifestation involving cytokines and late onset encephalitis is of the indirect type involving autoimmunity.Mycoplasma infection affecting children can lead to neurological complications like autoimmune encephalitis. Further studies in this area can help to lighten the etiology of autoimmune disorders.
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Optic disc pit (ODP) is small, gray‑white, oval depression found at the optic nerve head. It is a congenital defect that occurs due to imperfect closure of superior edge of the embryonic fissure. Cleft lip and palate are also congenital midline abnormalities occurring due to defect in the fusion of frontonasal prominence, maxillary prominence and mandibular prominence. There is only one case report describing the occurrence of ODP in a young patient with cleft lip and palate who also had basal encephalocele. We describe a 52‑year‑old patient with congenital cleft lip and palate with bilateral ODP with maculopathy but without any other midline abnormality.
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About fifty percent of all Non-Hodgkin's lymphomas are primary extranodal non-Hodgkin's lymphomas (NHL). Primary non Hodgkin's lymphoma of the breast is rare. Bilateral involvement of the breasts is even more rare. We present a case of a 40 year old woman presenting with bilateral breast lumps diagnosed on Fine Needle Aspiration Cytology[FNAC] as primary non hodgkin's lymphoma[PNHL].
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We present a rare case of invasive mole presenting as pain abdomen and bleeding per vaginum with subsequent hemoperitoneum. Emergency hysterectomy confirmed the presence of molar pregnancy perforating through the fundus.
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Metaplastic carcinoma of breast is a rare neoplasm. Although it is a tumor of ductal type, the predominent component may have an appearance other than the glandular pattern and usually runs an aggressive course.