Two Unusual Presentations of Gestational Trophoblastic Neoplasia: Cutaneous Metastasis and a Large Solitary Lung Lesion

Gestational trophoblastic tumors, an uncommon group of pregnancy-related neoplasms, should be considered in any premenopausal patient presenting with metastatic disease from an unknown primary. A raised hCG and exclusion of pregnancy are often the only requirement in this situation. Although a potentially curable condition, a late diagnosis and the extent of the metastatic disease often determine the prognosis. Here we describe two young women with metastatic GTN, the first presenting with a very unusual finger metastasis and the second with a rare large solitary lung lesion with brain metastasis.

The Impact of the COVID-19 Pandemic on Health-Care Delivery System for Other Diseases and Antimicrobial Resistance Threat in India

India’s health‑care delivery is challenged with different inequalities and the dual burden of communicable and noncommunicable diseases. Lockdown posed negative effects on the growth and economy of the country; simultaneously, some positive effects, like increased health consciousness and adoption of hygienic practices, were also there. Health‑care delivery system faced tremendous challenges in diagnostics, therapeutics, infrastructure for inpatient care, and protection of health‑care manpower. During this period, people chose to self medicate which in turn increased the threat of emergence of antimicrobial resistance. Due to shifting priority to COVID from other diseases, resources were shifted to COVID, affecting the management of other acute and chronic diseases. The launching of COVID‑19 vaccination campaign showed some hope. However, despite the vaccination drive, strengthening infrastructure, and surveillance system, the devastating second wave could not be avoided due to the conglomeration of the crowd for pilgrimage, election campaign, and tourism in an unrestricted manner. It may be concluded that the fourth wave may be short lasting due to increased herd immunity.

Histoplasmosis masquerading as tuberculosis: A report of three cases in immunocompetent children

The most common cause of granulomatous lymphadenitis in countries like ours is mycobactrium tuberculosis followed by atypical mycobacterial infection, fungal infections, parasitic infection, cat scratch disease, lymphogranuloma venereum (inguinal lymphadenopathy), and leprosy Here, we present three cases of lymphadenopathy due to histoplasmosis in immunocompetent children. Two of them presented with fever, lymphadenopathy, initially diagnosed as granulomatous lymphadenitis consistent with tuberculosis on FNAC and were put on antitubercular drugs. However, their condition gradually became worse. As the patients continued to deteriorate, subsequent lymph node biopsies were done and diagnosed as histoplasmosis. Third case presented with acute loss of vision with hepatosplenomegaly and lymphadenopathy. Initially considered as acute leukemia, but eventually established as histoplasmosis. Histoplasmosis should be considered as one of the possible causes of granulomatous lymphadenitis in children.

Disaster and Mental Health Preparedness in India: A Scoping Review

Background: Disaster and mental health preparedness are inseparable domains highlighted during all the major disasters in India. To build Disaster-Mental health Preparedness (Disaster MHP), one has to understand the existing strategies, systemic efforts, and ground-level implementation. In this scoping review, we have analyzed the mental health preparedness efforts during major disasters in India. Methodology: We followed the Peters MDJ et al framework for scoping review named ‘Guidance for conducting systematic scoping reviews. This included the searching relevant articles on PubMed and google Scholar, and concept-context of the review. Results: The review identified major efforts taken during ten disasters in past 40 years and mapping of the potential areas for development of sustainable efforts towards Disaster MHP. Conclusion: This is the first systematic scoping review from India that provides insight into strength and sustainability of disaster mental health preparedness in India. The mapping of the review focuses on the models emerged from Bhopal, Odisha, Tamilnadu and NIMHANS for the future infrastructure, capacity building, and environment required for Disaster-MHP in India.

Evaluating the Importance of Long-term Follow up in a Dietitian Led Weight Management Service in the Community.

Background: According to current reports, 26% of adults in the United Kingdom are obese, Royal College of Physicians [1]. This highlights a need for practical, affordable and scalable intervention strategies that induce and effectively maintain clinically significant levels of weight loss. The Drop in to Stay on Track (DIST) service offers patients post weight loss intervention (WLI) support for weight maintenance and lifestyle changes. The purpose of the investigation was to evaluate a current community based dietitian led weight maintenance service to determine whether long term support and monitoring assist with weight maintenance/ weight loss post intervention. Methods: Over a period of a year, patients (n=44) attended an initial dietitian developed and led WLI. Upon competition patients were invited to attend the DIST service for long term support. Weights were collected pre and post WLI as well as at each time the patient utilized the DIST service. Weight changes were analysed using SPSS 20 statistical software and compared with DIST attendance frequency. Results: The majority (84%) of participants had either maintained (10%) or lost (74%) weight at their last recorded DIST session. Table 1 highlights the various statistically significant weight decreases from WLI referral. Discussion: It is clear from the findings of numerous studies that preventing weight regain is extremely challenging Perri et al. [2]. Recent reviews suggest that weight maintenance efforts should be long in duration with a focus on relapse prevention and problem solving to combat regain Brantley et al. [3]. Our findings from our evaluation suggest long term support and monitoring is beneficial for weight maintenance/weight loss post weight management intervention and further research is required to analyse greater numbers. Conclusion: Extended care is a necessary and effective method to optimise both continuous weight loss and long term weight maintenance.

A young male with paraplegia, massive cervical adenopathy and nondiagnostic biopsy specimens.

An 18-year-old man presenting with paraplegia due to spinal epidural infiltration at D6-D7 underwent laminectomy and spinal decompression followed by near-complete resolution of neurological symptoms; but this resolution was followed by progressively enlarging cervical lymph nodes. Leucocytosis, an elevated erythrocyte sedimentation rate, a marked polyclonal hypergammaglobulinemia and a moderate hepatosplenomegaly were found. The diagnosis of sinus histiocytosis with massive lymphadenopathy (SHML), also known as Rosai-Dorfman disease was established histologically by lymph node biopsy about 2 years after presentation.

Isolation, identification and characterization of secretory proteins of IVMFC embryos and blood circulation of estrus and early pregnant goat.

The aim of the present study was to isolate, identify and characterize the secretory proteins of IVM oocytes and IVMFC embryos to evaluate its immunogenecity. and identify of such proteins if any, in blood circulation of estrus and early pregnant goats. Oocytes were matured in TCM-199 with 1 microg/ml, estradiol-17beta; 0.5 microg/ml, FSH; 100 IU/ml, LH and 10% FCS on granulosa cell monolayer. After 18 hr of maturation, oocytes were further cultured in maturation medium containing 3 mg/ml polyvinyl alcohol (PVA) without serum and BSA for 12 hr and medium was collected. The IVF embryos of 4-8 cell stage were cultured in medium containing PVA without serum and BSA. Embryo culture medium was collected after 24 hr of culture and was pooled. The proteins were analyzed on SDS-PAGE (12.5%). Four secretory proteins of oocytes with approximately molecular weight of 45, 55, 65 and 95 kDa and three secretory proteins of embryos 45, 55 and 65 kDa were obtained on SDS-PAGE in silver staining. The protein profile of midluteal, estrus and early pregnant goat serum was similar and no variation was observed among the proteins on SDS-PAGE. Two secretory proteins of 55 and 65 kDa of both IVM oocytes and IVMFC embryos were observed on Western analysis. None of such proteins was observed in midluteal, estrus and early pregnant goat serum on western blotting. It can be concluded that IVM oocytes and IVMFC embryos secrete proteins in medium and two of them can develop antibody. The proteins secreted from embryos till morula stage was similar to that of oocytes. None of these oocyte/embryo released proteins were observed in blood circulation of estrus and early pregnant goats.

Primary neurological manifestations of lung cancer--a retrospective analysis of 8 patients.

Neurological manifestations are reported in 5 to 10% of cases of lung cancer. We present a series of 216 consecutive patients of lung cancer of which 8 patients presented first with neurological manifestations without overt respiratory symptoms. The present study aimed to identify the number of patients of lung cancer presenting with primary neurological symptoms, the nature of the presentations, and the outcome of these patients among 216 patients who presented over a 2 year period in the Institute of Postgraduate Medical Education and Research, Kolkata. Out of 8 patients, 3 patients presented with seizures, 3 patients with hemiparesis and 2 patients with paraparesis. Thus, 3.7% (8/216) of patients in our series presented with a neurological manifestation. We concluded that primary neurological manifestations are rare in lung cancer. The lungs should be the first site of evaluation in a case of a cerebral metastasis with an unknown primary.

ANCA-negative limited Wegener's granulomatosis.

A 26-year-old man presented with epistaxis, nasal obstruction and a subcutaneous swelling over the left malar region with radiological evidence of a mass in the right nasal cavity. Histology of the lesions showed necrotizing granuloma with evidence of vasculitis. There was no other systemic involvement and the patient was ANCA-negative. Excellent response to systemic steroid and cyclophosphamide therapy was noted.

Venous obstruction after permanent pacing.

In a 10-year prospective study of 6,256 patients (5,812 males, 444 females) with permanent pacemaker, 25 had presented with features of venous obstruction such as pain, swelling or dilated superficial veins of face, upper limb(s) or upper chest wall without congestive heart failure. When subjected to contrast venography, 22 (0.35%) of the cases demonstrated subclavian and/or superior vena cava thrombotic/fibrotic obstruction. Each patient had non-progressive dilated veins over upper chest wall which developed after an average period of six months of implantation and none had embolic events or cephalad propagation of thrombus. Nine patients had subclavian, eight superior vena cava and five had both the vein obstructions. Seven patients of venous obstruction were treated with heparin followed by oral anticoagulants and three patients with oral anticoagulants alone. Three of seven patients got relief of obstruction with combined therapy group (heparin followed by oral anticoagulants) only. Two patients with superior vena cava obstruction needed epicardial pacing during subsequent lead revision. Therefore, before revision of permanent pacemaker leads in patients with signs of venous obstruction, venography can be useful to assess the obstruction and to determine the route of new lead insertion.

Effect of isoproturon on male reproductive system: clinical, histological and histoenzyonological studies in rats.

Isoproturon, a nonhalogenated substituted phenylurea herbicide, was evaluated for its cumulative toxic effects on testicular histomorphology., steroid hormone biosynthesis-related enzymes, spermatogenesis and sperm cells in adult albino rats. The compound, suspended in refined groundnut oil, was administered (po) to rats for 10 weeks @ 0,200, 400 and 800 mg/kg/day for 6 days/week. Isoproturon, at 800 mg/kg dose, decreased epididymal sperm count and percentage of motile sperms and increased the percentage of morphologically abnormal sperm cells. At the same dose, diameter of seminiferous tubules was reduced, number of tubules per microscopic field was increased and the percentage of tubules with evidence of spermatogenesis decreased. However, the percentage of damaged tubules was increased with 400 and 800 mg/kg doses. Histoenzymological observations revealed dose-related reduction in the activities of glucose-6-phosphate dehydrogenase and delta 5-3 beta-hydroxy steroid dehydrogenase. Activity of 17 beta-hydroxy steroid dehydrogenase was not affected appreciably. Overall findings suggest that isoproturon, at high dose, impairs androgen biosynthetic process, affects spermatogenesis and induces maturational anomalies of sperm cells in rat.

Subacute toxicity of urea herbicide, isoproturon, in male rats.

Isoproturon, a substituted phenylurea herbicide, was evaluated for its cumulative toxic effect on growth, organ weight and histomorphology of different organs in adult male rats. The compound (200, 400 and 800 mg/kg/day for 6 days/week), suspended in refined groundnut oil, was administered to rats p.o. for 7 and 10 weeks. There were no definite signs and symptoms of toxicity in treated rats but the herbicide significantly decreased the weekly body weight of rats at 800 mg/kg dose. Isoproturon, in all the three doses, increased the weight of liver in a dose-dependent manner. At 800 mg/kg dose, isoproturon increased the weight of kidney and heart, and decreased the weight of epididymis. Histopathological alterations in the organs were dose-dependent. Salient microscopic changes induced by isoproturon were hepatocellular degenerative changes and focal necrosis in liver, glomerular and tubular degeneration in kidney and haemosiderosis in spleen. Testis showed degeneration and desquamation of cells of germinal layers. Tubular lumens of testis and epididymis exhibited reduced number of spermatids and spermatozoa, respectively, indicating retardation of spermatogenesis.

Klebsiella pneumonia with lung abscess in a male child.

An unusual presentation of Klebsiella pneumonia with lung abscess in a male child with no apparent predisposing factor is described.