Unilateral absence of pulmonary artery: a radiographically occult cause of life-threatening hemoptysis

Unilateral absence or agenesis of pulmonary artery (UAPA) is a rare congenital abnormality with an estimated prevelance of 1 in 2,00,000 adults. The entity occurs commonly in association with other congenital heart diseases like septal defects or patent ductus arteriosus. The condition usually runs a benign clinical course with patients usually presenting clinically in adulthood with history of recurrent respiratory tract infections. Two such patients presented with recurrent respiratory tract infections, breathlessness and hemoptysis. The chest radiograph of first patient was reported as normal in the referring hospital, while that of second patient showed volume loss in left lung. CT Pulmonary Angiography (CTPA) was then performed which demonstrated the absence of right and left pulmonary arteries respectively in the first and second patients. Pulmonary artery branches were reformed distally by multiple collaterals arising from systemic arteries. The entire spectrum, including embryology, imaging features and management of UAPA are discussed. UAPA remains a potential cause for life-threatening hemoptysis, due to extensive collateralization associated with the condition. It is important for radiologists to be aware of this uncommon entity in order to suspect it on a routine chest radiograph, diagnose it and map associated collaterals on CTPA and also embolize the bleeding collaterals.

Prevalence of ocular morbidity among tribal children in Jawadhi hills, southern India: A cross-sectional study

Purpose: Childhood blindness is second to cataract in terms of blind person years; population-based prevalence of ocular morbidity among tribal children has not been studied. We conducted this study to determine the prevalence of ocular morbidity in tribal children age 15 years or younger in Jawadhi hills, southern India. Methods: A population-based cross-sectional study was conducted in four tribal villages where all children below 15 years of age were invited to participate in the study. After appropriate consent/assent, an optometrist assessed uncorrected vision refraction and best-corrected visual acuity using suitable techniques. A comprehensive ophthalmic examination was also done by an ophthalmologist to determine the presence of ocular morbidity. Children requiring cycloplegic refraction or further treatment were referred to the base hospital. Results: Among 260 children examined, the prevalence of ocular morbidity was 10.8% [95% confidence interval (CI): 6.3–13.7]. Vitamin A deficiency (VAD) was the foremost morbidity: 4.6% (95% CI 1.6–6.3) followed by refractive error (2.7%). Three (10.7%) children had more than one ocular morbidity. Nearly 1 in 10 tribal children suffer from ocular morbidity and 1 in 57 had low vision. Conclusion: VAD is a public health problem in this tribal region which requires immediate intervention with prophylaxis and treatment. Uncorrected refractive errors in school-age children also need to be attended.

Pattern of Drug of Resistance in Previously Treated Pulmonary Tuberculosis with Line Probe Assay

Background: Tuberculosis is global health problem known since ancient times. Drug-resistant TB has been known from the time of anti-TB drugs were first introduced for the treatment of TB. The emergence of drug resistant tuberculosis particularly MDR TB has become significant health problem worldwide and an obstacle to effective tuberculosis control. Line Probe Assay (LPA) is a Nucleic Acid Amplification Test (NAAT) which provides rapid diagnosis of R and H resistance and yield results in 72 hours.Literature on drug resistant pattern in patients who are previously treated for tuberculosis and/or suspected MDR cases with Line Probe Assay method are not studied hence this study was carried out. Aims and objectives: To know the drug resistance pattern of Rifampicin and Isoniazid in previously treated pulmonary tuberculosis cases and correlating with the demographic characteristics of patients. Methods: This study was carried out in department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur in AFB smear positive patients of pulmonary tuberculosis who have previously taken treatment, before reporting at OPD/IPD. The exclusion criterion was new cases of pulmonary tuberculosis. Detailed history, examination and investigations were carried out. The diagnosis of active pulmonary TB was based sputum smear examination by Ziehl - Nelson staining method. Sputum smear positive cases were subjected to line probe assay to detect resistant pattern at RNTCP accredited laboratory (SMS Medical College and Hospital, Jaipur). Results: A total of 175 previously treated sputum smear AFB positive patients of pulmonary tuberculosis were taken in this study. Out of which 141(80%) were males and 34(20%) cases were females with male : female ratio 4:1 and maximum cases (43.4%) belonged to 31-45 age group with mean age 38 years. Majority of cases belonged to rural area and lower middle class group. More than 2/3rd cases were smokers (72%) among male. Out of 175 cases, 100(57.1%) cases were drug resistant, 75(42.8%) cases were drug sensitive. Line probe assay with regard to resistant pattern was highest in grade +3 sputum (100%) followed by grade +2(98%) and grade +1(96%), while least in scanty sputum positive cases (3%). Resistance to Isoniazid (H), Rifampicin(R) and Both (H+R) were seen in 27%, 14% and 59% respectively. Half of patients (56%) out of total resistance belonged to default category of previously treated pulmonary tuberculosis cases. Resistance to H (27 cases) were 62.5% in relapse, 33.3% in default and 11% in failure cases. Out of R resistance (14 cases), 63% and 37% were in relapse and default cases. Out of 59 cases of H+R resistance 65% belonged to failure category and 20% default and 15% relapse category. Conclusion: Line Probe Assay (LPA) provides accurate and rapid diagnosis of R and H resistance and is recommended for diagnosis of DR-TB in previously treated pulmonary tuberculosis patients.

true human tail in a neonate: Case report and literature review

A true human tail is a benign vestigial caudal cutaneous structure composed of adipose, connective tissue, muscle, vessels, nerves and mechanoreceptors. A true human tail can be distinguished from a pseudotail as the latter is commonly associated with underlying spinal dysraphism, which requires specialised management. True human tails are very rare, with fewer than 40 cases reported to date. We report a healthy one-day-old male newborn who was referred to the Bharath Hospital, Kottayam, Kerala, India, in 2014 with a cutaneous appendage arising from the lumbosacral region. Magnetic resonance imaging of the spine ruled out spinal dysraphism. The appendage was removed by simple surgical excision. Clinicians should emphasise use of 'true tail' and 'pseudotail' as specific disparate terms as the clinical, radiological and histological findings of these conditions differ significantly, along with management strategies and outcomes

Microscopical evaluation of leaf of Maytenus emarginata.

Microscopical investigation was carried out on leaves of Maytenus emarginata (Willd.) Ding Hou belongs to family celastraceae, is an evergreen tree that tolerates various types of stresses of the desert, locally known as “Kankero” in Hindi, “Thorny staff tree” in English. Literature survey revealed that not much work has been done on this plant, especially on leaves. So we have taken its detailed microscopical studies to prove its appropriate identification. Microscopical study provide information that the lamina is dorsiventaral and 380µm thick. The Lamina is amphistomatic, the stomata being distributed both on the adaxial and abaxial sides. Calcium oxalate crystals of druses are fairly abundant in the mesophyll tissue. The stomata are cyclocytic type. The venation is densely reticulate. The terminations are either simple or more commonly forked into deuse clusters. Powder Microscopy show that the sclereids are fiber like in shape and size. The sclereids are 500 µm long and 30 µm thick. Long or short, cylindrical mesophyll cells are common with powder. They have dense tannin contents. The cells have thin wall and the cells are up to 200 µm long and 60 µm wide. Calciumoxlate druses are quite abundant in the power. They are spherical bodies with spiny surface. The druses are 30 µm in diameters. The above studies provide useful information in regard to its correct identity, evaluation and help to differentiate from the closely related other species of Maytenus Emarginata (Willd.)Ding Hou

Effect of Lateral Preoptic Area Lesion on Sleep Wakefulness and Thermoregulation In Cold Acclimatized Rats.

Hypothalamic temperature (Thy) alteration is one of the important stimuli that brings about thermoregulatory measures including the changes in wakefulness and muscular activity. The role of the lateral preoptic area (lPOA) in thermoregulation and sleep is well documented. But it is not known whether the integrity of the lPOA is essential for bringing about the changes in sleep-wakefulness (S-W) and thermoregulation in cold ambient temperature (Ta). Neurotoxic lesion of the lPOA resulted in an increase in wake period and core body temperature (Tb) and no change in Thy. Unlike, normal animals, as reported earlier, there was further increase in Tb of the lPOA lesioned rats on acute cold exposure, but the Thy remained unaltered throughout the 28 days of continued cold exposure. The findings demonstrate that the lPOA lesioned rats have lost the ability to reset Thy which may be necessary for thermoregulation during cold exposure. Moreover, increased wake period lasted only 7 days in lesioned, compared to 14 days in normal animals. Less efficient restoration of Tb, and less prolonged wake period during continued cold exposure, are probably the result of the inability of the lPOA lesioned rats to lower Thy, which is necessary to bring about the thermoregulatory measures.

Cost of Illness Due to Typhoid Fever in Pemba, Zanzibar, East Africa.

The aim of this study was to estimate the economic burden of typhoid fever in Pemba, Zanzibar, East Africa. This study was an incidence-based cost-of-illness analysis from a societal perspective. It covered new episodes of blood culture-confirmed typhoid fever in patients presenting at the outpatient or inpatient departments of three district hospitals between May 2010 and December 2010. Cost of illness was the sum of direct costs and costs for productivity loss. Direct costs covered treatment, travel, and meals. Productivity costs were loss of income by patients and caregivers. The analysis included 17 episodes. The mean age of the patients, was 23 years (range=5-65, median=22). Thirty-five percent were inpatients, with a mean of 4.75 days of hospital stay (range=3-7, median=4.50). The mean cost for treatment alone during hospital care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH). The average societal cost was US$ 154.47 per typhoid episode. The major expenditure was productivity cost due to lost wages of US$ 128.02 (83%). Our results contribute to the further economic evaluation of typhoid fever vaccination in Zanzibar and other sub-Saharan African countries.

A comparative study of visual reaction time in table tennis players and healthy controls.

Visual reaction time is time required to response to visual stimuli. The present study was conducted to measure visual reaction time in 209 subjects, 50 table tennis (TT) players and 159 healthy controls. Methods: The visual reaction time was measured by the direct RT computerized software in healthy controls and table tennis players. Simple visual reaction time was measured. During the reaction time testing, visual stimuli were given for eighteen times and average reaction time was taken as the final reaction time. Results: The study shows that table tennis players had faster reaction time than healthy controls. On multivariate analysis, it was found that TT players had 74.121 sec (95% CI 98.8 and 49.4 sec) faster reaction time compared to non-TT players of same age and BMI. Also playing TT has a profound influence on visual reaction time than BMI. Conclusion: Our study concluded that persons involved in sports are having good reaction time as compared to controls. These results support the view that playing of table tennis is beneficial to eye-hand reaction time, improve the concentration and alertness

Hypothalamic temperature: A key regulator in homeostatic restoration of sleep during chronic cold exposure in rats.

Exposure to cold ambient temperature (Ta) affects sleep-wake (S-W) state. The vigilance states on the other hand influence thermal status of the animals. Simultaneous recording of body temperature (Tb) with S-W is crucial to understand the homeostatic relationship between the two. In the present study we recorded both Tb and hypothalamic temperature (Thy) along with S-W, during acute and chronic exposure to mild cold (Ta). Electrooculogram (EOG), electroencephalogram (EEG) and electromyogram (EMG) electrodes were chronically implanted in rats to assess S-W. A thermocouple, near the preoptic area, and radio transmitter in the peritoneum, were implanted, to record Thy and Tb respectively. After three days of baseline recordings of S-W, Thy and Tb at Ta of 26°C, the rats were exposed to mild cold Ta (18°C) for 28 days. All the parameters were recorded during cold exposure and also for five days after the termination of cold exposure. On the first day of cold exposure there was a decrease in slow wave sleep and paradoxical sleep, but they were restored by the 21st day of continued exposure. The Thy remained decreased throughout the cold exposure. Though the Tb showed a slight decrease on the first day of cold exposure, there was no appreciable change during the subsequent days. The Thy came back to near pre exposure level on termination of cod exposure. The decrease in Thy during mild cold exposure would have triggered cold defense mechanisms. Increase in wakefulness during acute cold exposure and non-shivering thermogenesis during chronic cold exposure are probably responsible for the maintenance of Tb. Decrease in Thy is probably the key trigger for initiating thermoregulatory measures to maintain Tb and homeostatic restoration of sleep.

Composite epithelial kidney tumor comprising of adeno and neuroendocrine carcinomatous components: An unusual variant of renal cell carcinoma.

Renal cell carcinomas accounts for an approximately 2% of human malignancies with atleast ten different histological subtypes recognized by the World Health Organization (WHO) 2004 classification. Composite carcinomas with dual divergent epithelial differentiation in kidneys are extremely uncommon. We report an unusual case of a 37-year-old female who presented with symptoms related to renal tumor for the last three years. Computed tomography scan revealed a large heterogenously contrast enhancing left kidney mass comprising of two distinct histological components of low grade adenocarcinomatous and carcinoid-like low grade neuroendocrine carcinomas with presence of hilar lymph nodal metastases of both the components. The component of adenocarcinoma was immunoreactive to E-cadherin, cytokeratins 7 and 19 with negativity for cluster of differentiation 10, cytokeratin 20, CD117, and vimentin; while the neuroendocrine component was immunoreactive for vimentin, chromogranin and synaptophysin with negativity for CD10, CD117, and cytokeratins 7, 19 and 20. MIB-1 labeling index in the both the components was 2-3%. The present case is the first of its kind to be reported in the kidney and emphasizes the diversity potential of kidney tumors.

Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: Report of the Indian Society of Gastroenterology Task Force.

Background Gastroesophageal reflux disease (GERD) and its complications are thought to be infrequent in India; there are no data from India on the prevalence of and risk factors for GERD. The Indian Society of Gastroenterology formed a task force aiming to study: (a) the frequency and profile of GERD in India, (b) factors including diet associated with GERD. Methods In this prospective, multi-center (12 centers) study, data were obtained using a questionnaire from 3224 subjects regarding the frequency, severity and duration of heartburn, regurgitation and other symptoms of GERD. Data were also obtained regarding their dietary habits, addictions, and lifestyle, and whether any of these were related or had been altered because of symptoms. Data were analyzed using univariate and multivariate methods. Results Two hundred and forty-five (7.6%) of 3224 subjects had heartburn and/or regurgitation at least once a week. On univariate analysis, older age (OR 1.012; 95% CI 1.003–1.021), consumption of non-vegetarian and fried foods, aerated drinks, tea/coffee were associated with GERD. Frequency of smoking was similar among subjects with or without GERD. Body mass index (BMI) was similar in subjects with and without GERD. On multivariate analysis, consumption of non-vegetarian food was independently associated with GERD symptoms. Overlap with symptoms of irritable bowel syndrome was not uncommon; 21% reported difficulty in passage of stool and 9% had mucus in stools. About 25% of patients had consulted a doctor previously for their gastrointestinal symptoms. Conclusion 7.6% of Indian subjects have significant GERD symptoms. Consumption of non-vegetarian foods was an independent predictor of GERD. BMI was comparable among subjects with or without GERD.

Field test results of the motherhood method to measure maternal mortality.

Background & objectives: Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Methods: Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by motherhood and aided by their peer memory. Such groups included all women who have given birth, including those whose babies died during the measurement period. Results: A total of 15161 births were elicited in the study period of two years. In the same period 49 maternal deaths, 713 infant deaths, 493 neonatal deaths and 679 perinatal deaths were also recorded. The maternal mortality ratio was 329 (95%CI:243-434)/100000 live birth, infant mortality rate was 48(44-51)/1000LB, neonatal mortality rate was 33(30-36)/1000LB, and perinatal mortality rate was 45(42-48)/1000 total birth. Interpretation & conclusions: The motherhood method estimated maternal, perinatal, neonatal and infant mortality rates and ratios. It has been field tested and validated against census data, and found to be efficient in terms of time and cost. Motherhood method can be applied in a time and cost-efficient manner to measure and monitor the progress in the reduction of maternal and child deaths. It can give current estimates of mortalities as well as averages over the past few years. It appears to be particularly well-suited to measuring and monitoring programmes in community and districts levels.

Maxillary zoster with corneal involvement.

A case, of maxillary zoster with corneal involvement in a young patient is described. Corneal involvement in maxillary zoster (Medline search) is rare.

Hypohidrotic ectodermal dysplasia--a case report.

A case presented here is that of a nine year old male patient with total anodontia. Findings of this case as regards to the orofacial, radiographic and other general manifestations were suggestive of hypohidrotic ectodermal dysplasia. The dental problems were best managed by prosthetic replacement of dentition taking into consideration a design which would provide adequate relief for the preservation of the ridges which were thin and underdeveloped to the absence of teeth.