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Autoimmune haemolytic anaemia (AIHA) is caused by autoantibodies that react with self-red blood cells (RBCs) and cause them to be destroyed with or without complement mediated mechanism. Its clinical presentation is heterogeneous, ranging from asymptomatic to severe forms with fatal outcomes, also it can be either idiopathic or secondary to a coexisting disorder. We report an elderly gentleman on haemodialysis, who presented with severe haemolytic anaemia after one month of first dose of ChAd Ox 1 nCoV-19 vaccine (viral vector vaccine) for SARS- CoV – 2, who also had asymptomatic COVID 19 infection around 6 months prior to vaccination. This is the first reported case of AIHA following COVISHIELD vaccine and till now there are no other reported cases from India.
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Background: The incidence of lymphoproliferative disorders has increased in many parts of the world. Newer subtypes have been identified by the new WHO classification. Accurate subtyping of lymphomas is crucial for prompt treatment. Objective of the study was to assess the clinicopathological pattern of lymphoproliferative diseases diagnosed in Rajagiri hospital over a period of 3 years.Methods: A retrospective study on all patients who were diagnosed with lymphoma in Rajagiri hospital during January 2016 to December 2018 was conducted and the data were reviewed and analyzed.Results: A total of 151 patients were included in the study. Majority of the subjects (63%) were males. The predominant age group affected was 61-80 years. Mean age group was 58.46 years (SD=19.05 years). Most common presenting symptom was painless lymphadenopathy. B symptoms were seen in 18% of subjects and was found to be more commonly associated with B cell Non-Hodgkin lymphoma. Most common lymph node involved was cervical lymph node, while the most common extra nodal site was bone marrow. Most common lymphoproliferative disorder was Diffuse large B cell Lymphoma. Lymph node involvement was found in 74% of patients, while hepatomegaly and splenomegaly were seen in 11% and 18.5% of patients. 20% of patients had secondary bone marrow involvement. 8 patients developed recurrent lesions involving other organs.Conclusions: Clinicopathologic patterns of lymphoproliferative disorders vary across various regions. A proper understanding of demographical distribution of lymphomas is very essential, as it can provide valuable clues for accurate diagnosis and treatment.
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Introduction: Cervical cancer is the fourth most frequent cancer in women with an estimated 570,000 new cases in 2018representing 6.6% of all female malignancies. Apparently 90% of deaths from cervical cancer occurred in low- and middleincome countries; the annual death rate was more than 26,600.Aim: This study aims to assess the clinical profiles, overall survival, and disease-free survival (DFS) of carcinoma cervix andto assess the factors that determine the treatment outcome.Materials and Methods: Atotal of 298 patients who met the inclusion criteria of newly diagnosed patients with histopathologicallyconfirmed cervical carcinoma were included in the study. The clinical profile, status of presentation, staging, compliance withtreatment and follow-up, as well as the response to the treatment in terms of OS and DFS of the treated patients and itscontributing factors were the outcome measures.Results: Two hundred and forty-five (82.2%) of 298 patients of the study population completed the scheduled radical treatment. Themost common presentation was Stage 2B with 125 (41.9%) patients followed by 3B with 87 (29.2%) patients and 4A with 12 (4%).The common histology was squamous cell carcinoma (90.6 %). Mean duration of treatment time in concurrent chemoradiotherapy +brachy was 10.93 weeks and external beam radiotherapy + brachy was 10.63 weeks. The median follow-up duration was 4.8 years.The overall survival rate was 97.1% and the mean disease-free survival period rate was 93.4%. In the treatment group, 17 (6.9%)patients showed recurrence, 4 (1.6%) deaths of the total of 20 recurrences, and 8 deaths in the study population.Conclusion: Similar outcome in the treatment group in terms of overall survival and DFS compared to other studies, withstatistical significance in factors contributed to the recurrence. Although treatment defaulters and follow-up defaulters werereaching a good number of the study group, for which care and provision of awareness measures should be taken.
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Introduction: Cancer outcomes continue to improve dueto earlier detection and newer targeted therapies, withanthracycline chemotherapy playing a major role in themodern era of cancer treatment. Anthracyclines are listedamong the World Health Organization (WHO) model list ofessential medicines. Study aimed to evaluate the incidenceof the subclinical cardiac dysfunction associated withAnthracyclines based regimen in patients with breast cancerat a tertiary care center.Material and Methods: 110 patients with breast cancerpatients receiving Anthracycline-based chemo regimenwere enrolled in the study. All enrolled patients with breastcancer underwent baseline cardiac assessment and periodicmonitoring of cardiac function by noninvasive diagnostictoolsResults: The incidence of Anthracycline-induced cardiacabnormalities in this study was 38.1%. The incidence ofsubclinical cardiac dysfunction was more than overt cardiacdysfunction. The overt cardiac abnormality was observed in13.6% and subclinical cardiac dysfunction was observed in24.5% of our patients.Conclusion: Early identification of patients with subclinicalcardiac dysfunction aids in early intervention and preventionof further deterioration of cardiac dysfunction.
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Introduction: The management of ovarian tumors remains a common clinical gynecologic problem. The early and definitediagnosis of ovarian malignancy is of grave clinical importance. Recently, the role of color and spectral Doppler in the diagnosisof ovarian malignancy has been a subject of enormous debate.Aim: The purpose of the study was to evaluate the efficiency of color flow Doppler and its parameters with pulsatility index (PI)and resistive index (RI), to discriminate the benign and malignant ovarian masses.Methods: In 24 months period selected 100 patients, in whom adnexal mass was detected by ultrasound and had further evaluatedby Color flow Doppler at the radiology department. PI was calculated from the reproducible spectral waveforms generated fromflow central to peripheral within the mass or adjacent to the mass. The resistive index was calculated as the mean of threeconsecutive waveforms with the lowest RI. Each lesion was categorized on the basis of gray scale morphology as benign,borderline, and malignant. Other parameters such as a wall and septal thickness and echogenicity also were recorded. Theseimage-guided indices were further confirmed with histopathological findings to differentiate benign and malignant ovarian tumors.Results: Of the 100 patients 85 were benign, two were borderline, and 13 were a malignant ovarian mass with mean age 35.2,45.0, and 48.3, respectively. The threshold of PI >1 and RI >0.4 was diagnosed as benign. PI <0.8 and RI <0.4 were low andused as predictors of ovarian malignancy. Similarly, other parameters were calculated to discriminate the lesion.Conclusion: The study showed a high positive predictive value of high impedance flow in benign and predominant low impedanceflow in the malignant lesion. In the present study, fairly good specificity and sensitivity with PI <1 and the resistive index <0.4were achieved in ovarian malignancy. Color Doppler study was the diagnostic modality of choice for the patients with adnexalmass to establish the diagnosis of malignant ovarian tumors.
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Gynaecomastia is a common pathological condition of breast seen in men. This is defined as benign enlargement of breast tissue in males. It was first described by Palus Aegineta (AD 635-690). Herewith we are presenting cases of 14 year old twins attending the surgical O.P.D with bilateral enlarged breasts and pain. A diagnosis of pubertal gynaecomastia was made with no evidence of malignancy by histopathological examinations and mammography. One boy with 5 x 6 cm of right breast and 2 x3 cm of left breast was treated by subcutaneous mastectomy. Other boy had only enlargement of nipple and areola. He was reassured and sent home without surgical intervention. A rare case of idiopathic gynaecomastia in pubertal twins is described here.
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Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications.
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Gastric retentive floating drug delivery system (GFDDS) is enabled the prolonged continuous input of the drug to the upper parts of the gastrointestinal (GI) tract and improves the bioavailability of medications with narrow absorption window. The design of the delivery system is based on the controlled release formulation with floating and swelling features in order to prolong the gastric retention time of the drug delivery systems. In the present study norfloxacin as candidate, guar gum, sodium CMC, HPMC15 KM is studied along with other excipients like PVP K30 (binder), sodium bicarbonate microcrystalline cellulose were used in different concentrations to get the desired controlled release profile over a period of 12 hrs. All the formulations were evaluated for buoyancy lag time, duration of buoyancy, dimensional stability, drug content and in vitro drug release profile. Based on the in vitro studies carried out for the optimized formulation by dissolution the performance of the developed formulation promises to be efficient in controlling the drug release rate with the guar gum , a natural polymer.
ABSTRACT
Gastric retentive floating drug delivery system (GFDDS) is enabled the prolonged continuous input of the drug to the upper parts of the gastrointestinal (GI) tract and improves the bioavailability of medications with narrow absorption window. The design of the delivery system is based on the controlled release formulation with floating and swelling features in order to prolong the gastric retention time of the drug delivery systems. In the present study norfloxacin as candidate, guar gum, sodium CMC, HPMC15 KM is studied along with other excipients like PVP K30 (binder), sodium bicarbonate microcrystalline cellulose were used in different concentrations to get the desired controlled release profile over a period of 12 hrs. All the formulations were evaluated for buoyancy lag time, duration of buoyancy, dimensional stability, drug content and in vitro drug release profile. Based on the in vitro studies carried out for the optimized formulation by dissolution the performance of the developed formulation promises to be efficient in controlling the drug release rate with the guar gum , a natural polymer.
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We assessed 513 children (2-6 y = 252; 7-12 y = 261) who visited the pediatric outpatient of a rural medical college hospital, for sleep problems using ‘BEARS’ tool. Sleep problems detected in the BEARS domains for preschool (2-6 years, n=252) and school children (7-12 years, n=261) were as follows: bedtime problems (33.3% vs 14.9%, P<0.001), excessive daytime sleepiness (32.5% vs 1.9%, P<0.001), awakening during night (25% vs 11.87%, P<0.001), regularity and duration of sleep (19.84% vs 4.98%, P<0.001), and sleep disordered breathing (4.8% vs 5%, P=0.1). We conclude that sleep problems are common among rural Indian children and should be routinely screened for during health visits.