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Introduction: Fungal ball is a non-invasive sinus disease and the incidence of this disease has increased in recent years and also several case reports and case series have suggested a relationship with the accidental displacement of root into maxillary sinus. We report a case where fungal ball was removed along with the dental root fragment which was accidentally displaced into the maxillary sinus following traumatic dental extraction. A 32-years-oldCase Report: female patient presented to Maxillofacial Surgery Department with complaint of pain in the left orofacial region for one month. The patient had a history of traumatic extraction of posterior maxillary teeth 4 years back. On examination, no dental cause of pain was detected. On further evaluation, a foreign body within the left maxillary sinus was seen in the panoramic radiograph. Computed tomography images revealed displaced root in the left maxillary sinus with surrounding heterogenous soft tissue opacity. Following the detection of foreign body, patient underwent Functional Endoscopic Sinus Surgery (FESS) and the root was retrieved and the adjacent soft tissue specimen was sent for histopathological examination. The presence of fungus consistent with the Aspergillus species was confirmed. Conclusion: This article emphasizes the importance of atraumatic dental extraction, the association of fungal ball with displaced root and the utility of FESS in clearing the same.
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Endobronchial tuberculosis(EBTB)is a special form of TB which is associated with significant morbidity and potential mortality. EBTBis the infection of tracheobronchial tree, and continues to remain challenging for clinicians to diagnose. The incidence of EBTBhas been reported to be 5.8% to 30% in people with pulmonary TB. 60-year-old male, chronic smoker presented with complaints of dyspnea, cough with expectoration and sore throat for 2 weeks. General examination showed patient to have pallor and respiratory system examination showeddecreased breath sounds in left infraaxillary region and bilateral crepitations. Routine blood investigations done showed decreased hemoglobin levels, elevated total leukocyte count, ESR. Sputum AFB was negative. Mantoux-15mm induration. Chest X-ray showed homogenous opacities over the left lower zone and elevated right diaphragm. CT thorax done showed a subsegmental peripheral soft tissue density 4.3×2.2 cm in the inferior lingula segment. Bronchoscopy showed whitish plaques over the anterior tracheal wall near carina and over left main bronchus. Endobronchial tissue growth seen occluding the lingula bronchus. Biopsy was taken and histopathology showed a granulomatous lesion, BAL Gene Xpert was positive for MTB. Patient was started on 3 tablets ATT. Clinicians need to be vigilant in patients who are AFB smear negative, with symptoms; bronchoscopy should be considered in those selected cases.
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Background:Pulmonary artery hypertension (PAH) dreadful complication in bronchiectasis. The 6thworld symposium on pulmonary hypertension have taken mPAPof 20 mmHg as normal. Not much studies have been done based on the current cut off values, so we have incorporated values based on the new guidelines and made following observations. Methods: Thisstudy was designed as an observational cross-sectional study consisting of 27 patients, who were admitted in Pulmonary medicine department. Results:Out of 27 study subjects 15 were female抯 and 12 were males. It was found that 70.3% had less than 5 segments involved and 29.6% had more than 5 segments involved. Mean value of PAH was 34.48�.06 mmHg. Analysis showed a significant correlation (r=0.67) between number of segments involved and incidence of pulmonary hypertension. Conclusions: Itis essential to evaluate the cardiac status of bronchiectasis patients at the time of diagnosis as cardiac manifestations are one of the dreadful complications.
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The coronavirus disease 2019 (COVID-19) pandemic has emerged as a major threat to all healthcare systems across the globe, and it was declared a public health emergency of international concern by the World Health Organization (WHO). The novel coronavirus affects the respiratory system, producing symptoms such as fever, cough, dyspnea, and pneumonia. The association between COVID-19 and coagulation has been previously reported. Due to several inflammatory changes that occur in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections such as alterations in the levels of clotting factors, platelet activation leads to thrombus formation in coronary and cerebral vessels, leading to myocardial infarction and cerebrovascular accidents, respectively.Unfortunately, the progression of hypercoagulability in COVID-19 is rapid in patients with and without comorbidities. Hence, the proper monitoring of thrombotic complications in patients with COVID-19 is essential to avoid further complications. The implementation of guidelines for antithrombotic treatments based on the presentation of the disease is recommended. This review discusses the symptoms and mechanisms of upregulated coagulation in patients with COVID-19.
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The coronavirus disease 2019 (COVID-19) pandemic has emerged as a major threat to all healthcare systems across the globe, and it was declared a public health emergency of international concern by the World Health Organization (WHO). The novel coronavirus affects the respiratory system, producing symptoms such as fever, cough, dyspnea, and pneumonia. The association between COVID-19 and coagulation has been previously reported. Due to several inflammatory changes that occur in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections such as alterations in the levels of clotting factors, platelet activation leads to thrombus formation in coronary and cerebral vessels, leading to myocardial infarction and cerebrovascular accidents, respectively.Unfortunately, the progression of hypercoagulability in COVID-19 is rapid in patients with and without comorbidities. Hence, the proper monitoring of thrombotic complications in patients with COVID-19 is essential to avoid further complications. The implementation of guidelines for antithrombotic treatments based on the presentation of the disease is recommended. This review discusses the symptoms and mechanisms of upregulated coagulation in patients with COVID-19.
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OBJECTIVE@#To examine the role of carvacrol in modulating PI3K/AKT signaling involved in human breast cancer pathogenesis using in vitro experimental model MCF-7 cells.@*METHODS@#MTT and lactate dehydrogenase assays were performed with cells treated with different doses of carvacrol (0-250 p mol/L) at different time points (24 and 48 h). The nuclear morphology was assessed in MCF-7 cells with propidium iodide (PI) and acridine orange/ethidium bromide (AO/EB) staining and analyzed by fluorescence microscopy. Events like cell cycle arrest, apoptosis was observed by flow cytometric analysis and expressions of p-Rb, cyclin D1, cyclin-dependent kinase 4 (CDK4), CDK6, Bax, Bcl-2, PI3K/p-AKT was analyzed by immunoblot.@*RESULTS@#Carvacrol significantly reduced cell viability with the half maximal inhibitory concentration value of 200 µmol/L at 24 and 48 h (P<0.05). importantly, there was a significant increase in the accumulation of the G@*CONCLUSION@#Carvacrol significantly inhibited the breast cancer MCF-7 cell proliferation and induced apoptosis via suppressing PI3/AKT signaling pathway.
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Background: An alarming increase in Gestational diabetes mellitus (GDM) cases worldwide elevates concern regarding the consequences including fetal macrosomia, preeclampsia and many more. Plasma homocysteine levels which has direct impact on to endothelial function of blood vessels. The relationship of homocysteine and GDM is yet to be clarified.Methods: This single centre prospective observational study was conducted in Department of Obstetrics and Gynaecology of Thanjavur medical college hospital among 50 pregnant primi and multi gravida patients with normal pregnancy and gestational diabetes mellitus to assess the association and comparison of serum homocysteine levels in both groups.Results: The mean value of homocysteine in control group was 3.8 ± 0.95 and in gestational diabetes patients was 16.30±6.09. On comparison, found that there was hyperhomocysteinemia among GDM patients with normal pregnancy and results were statistically significant (T= -9.024 Df=48.000 <0.05).Conclusions: In this comparative and correlative study, we found that patients with gestational diabetes mellitus have higher serum homocysteine levels in comparison with normal pregnant women. Hyperhomocysteinemia is found to be an independent risk factor for gestational diabetes mellitus patients. Further investigations are needed to follow up for these patients in the postpartum period and later in their life.
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Background: According to the WHO, stroke is the second most important cause of death in elderly people with age >60 years and fifth leading cause in the age group of 15 to 59 years. Hyperhomocysteinemia has been linked to increased incidence of ischemic strokes. Thus, the aim of the present study was to assess serum homocysteine levels as an individual risk factor of stroke in young patients.Methods: This was a prospective, cross-sectional, single center study performed in 50 patients admitted in the Department of Medicine, Thanjavur Medical College and Hospital, Thanjavur, over a period of 7 months (i.e., from December 2013 to June 2014). Young patients, aged 1545 years, and diagnosed with stroke were included in the study. Serum homocysteine was measured by fluorescein polarization immunoassay (FPIA). Significant difference between the patients with normal and elevated mean serum homocysteine levels was identified by using unpaired t-test. P value ?0.05 was considered as statistically significant.Results: Majority of the stroke patients were male (78%). Similarly, male patients dominated the total number of patients with elevated serum homocysteine levels (75%). Thirty-two (64%) patients had an elevated serum homocysteine level. There was a significant difference between the patients with increased homocysteine levels as compared to patients with normal homocysteine levels (p value <0.05). Out of 32 patients with hyperhomocysteinemia, 27 (84.38%) patients had ischemic stroke, 4 (12.50%) had cortical vein thrombosis and 1 (3.12%) had hemorrhagic stroke.Conclusions: Findings of the present study confirm that hyperhomocysteinemia is associated with an increased incidence of stroke in young patients. As healthcare providers, we must stress on prevention of stroke, especially by identifying treatable risk factors.
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Background: There is no gold standard method for pancreatico-enteric reconstruction. In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice. In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out of 75 (6.6%) developed Grade ‘B’ POPF and three out of 75 (3.3%) developed Grade ‘C’ POPF. 20 out of 75 (26.6%) had grade ‘A’ DGE, five out of 75 (6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (Invagiantion) pancreatojejunostomy has accepatable early outcomes with clinically significant/relevant postoperative pancreatic fistula rates of Grade B (6.6%) and Grade C (4%), delayed gastric emptying (33.2%) and post pancreatic hemorrhage (5.3%) rates. The outcomes are comparable with Duct-to-mucosa PJ mentioned in literature.
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Background: The Drug utilization research (DUR) compares drug use between different countries and regions and is used to assess the rationality of prescribing pattern of the drug therapy. With this background we decided to evaluate antipsychotic drugs prescribing pattern in the psychiatric patients in a tertiary care hospital.Methods: The study was carried out at Department of Psychiatry, DSMCH. It was open label, cross - sectional, prescribed Documents based study. Duration of the study was one month (May-2017). Out-Patient number, age, sex, diagnosis, prescribed generic name, brand name, dose, route of administration, duration of therapy obtained from the Prescription register of Out - Patient Department of the Psychiatry.Results: The clinical experiences of the Psychiatrist I, II and III were 17 years, 35 years and 10 years respectively. The Psychiatrist I, II and III prescribed treatment for 36 (31.9%), 61 (54%) and 16 (14.2%) patients respectively. Among overall (n=113) patients (average age 38.9 years), male n=56 (49.6%) and female=57 (50.4%) were treated by all the three psychiatrists. The percentage of prescription of various drugs used were: Escitalopram (15.7%), Clonazepam (14.6%), Sertraline (8.7%), Risperidone (7.5%), Propranolol (6.7%), Olanzapine (6.3%), Quetiapine (5.9%), Trihexyphenidyl (5.5%), Amitriptyline (5.1%) and Other prescribed drugs, were between (0.4 to 2.8%).Conclusions: From this study, it can conclude that rational usage of drugs were followed in this study. All three prescribers (Psychiatrist I, II, and III) prescriptions were found to be rationale.
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Objective: To evaluate the anticancer activity of crude acetone and water leaf extracts of Tulbaghia violacea on a human oral cancer cell line (KB). Methods: The antioxidant activity of the leaf extracts was evaluated by using the DPPH assay while the anti-proliferative activity was assessed by using the MTT assay. The morphological characteristics of apoptotic cells were examined by using the dual acridine orange/ethidium bromide staining. Flow cytometry was used to evaluate the induction of multi-caspase activity and changes in the cell cycle. Results: The acetone and water extracts exhibited antioxidant activity in a concentration dependent manner. The extracts inhibited the growth of the KB cell line with IC50 values of 0.2 mg/mL and 1 mg/mL, respectively for acetone and water. Morphological changes such as cell shrinkage, rounding and formation of membrane blebs were observed in the treated cells. In acridine orange/ethidium bromide staining, the number of apoptotic cells increased as the concentration of the extracts increased. The activation of multi-caspase activity in KB cells treated with Tulbaghia violacea extracts was concentration dependent, leading to cell death by apoptosis and cell cycle arrest at the G2/M phase. Conclusions: The acetone and water extracts of Tulbaghia violacea appear to have anti-cancer activity against human oral cancer cells and need to be investigated further.
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Objective: To evaluate the anticancer activity of crude acetone and water leaf extracts of Tulbaghia violacea on a human oral cancer cell line (KB). Methods: The antioxidant activity of the leaf extracts was evaluated by using the DPPH assay while the anti-proliferative activity was assessed by using the MTT assay. The morphological characteristics of apoptotic cells were examined by using the dual acridine orange/ethidium bromide staining. Flow cytometry was used to evaluate the induction of multi-caspase activity and changes in the cell cycle. Results: The acetone and water extracts exhibited antioxidant activity in a concentration dependent manner. The extracts inhibited the growth of the KB cell line with IC50 values of 0.2 mg/mL and 1 mg/mL, respectively for acetone and water. Morphological changes such as cell shrinkage, rounding and formation of membrane blebs were observed in the treated cells. In acridine orange/ethidium bromide staining, the number of apoptotic cells increased as the concentration of the extracts increased. The activation of multi-caspase activity in KB cells treated with Tulbaghia violacea extracts was concentration dependent, leading to cell death by apoptosis and cell cycle arrest at the G2/M phase. Conclusions: The acetone and water extracts of Tulbaghia violacea appear to have anti-cancer activity against human oral cancer cells and need to be investigated further.
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Background: Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden in such patients. The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 25 years in urban women population in this region. Methods: A hospital based study was carried out in 316 women by calculating T-scores utilizing calcaneal QUS as diagnostic tool. Results: The result suggested that a substantial female population had oesteopenia and osteoporosis after the age of 45 years. The incidence of osteoporosis was (20.25%) and osteopenia (36.79%) with maximum number of both osteoporosis and osteopenic women recorded in the age group of (55-64 years). After the age of 65 years, there was an almost 100% incidence of either osteopenia or osteoporosis, indicating that it increases with age and in postmenopausal period, thereby suggesting lack of estrogenic activity might be responsible for this increasing trend. Religion, caste and diet had an influence on the outcome of osteopenic and osteoporosis score in present study, but still it has to be substantiated by conducting larger randomized clinical trials in future. Conclusions: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis.
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Biliary Tract Intraductal Papillary Mucinous Neoplasm (BT-IPMN) is a very rare entity, gradually emerging into attention as sporadic cases are being reported worldwide. In this brief report we discuss about such an entity from our part of the world, based on a case from our institution. A 47-year-old female was referred to our department with jaundice, intermittent fever with chills and rigor of 6 weeks duration. Initial evaluation revealed obstructive jaundice with distended gall bladder. Imaging with ultrasonogram (USG) and magnetic resonance imaging (MRI) showed hugely dilated intra and extrahepatic biliary radicles with multiple and diffuse soft tissue lesions fi lling the common bile duct (CBD) extending to the ductal system of left lobe of liver. A side viewing endoscopy demonstrated mucin extruding from a prominent ampulla of Vater. The patient was managed successfully by left hepatectomy with pancreaticoduodenectomy (HPD). Gross pathological examination of the specimen showed marked dilatation of intra and extra hepatic bile ducts with multiple polypoidal lesions and plenty of mucin fi lling the entire biliary ductal system. Histopathology revealed predominantly intraductal papillary mucinous adenocarcinoma at the hilum extending to left bile duct with diffuse dysplastic changes throughout the biliary tree. Thus the clinical, radiological and pathological features of this lesion clearly fi t into the diagnosis of BT-IPMN, which is slowly being established as a defi nite clinical entity with features much similar to its pancreatic counterpart.
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Improved antioxidant status helps to minimize the oxidative damage and thus can delay the risk of developing many chronic age related, free radical induced damage in diseases like diabetes, cancer, neurodegenerative diseases. We tried to evaluate the antioxidant potential of Costus igneus (CI) leaves in ethanol induced peroxidative damage in albino rats. Wistar albino rats of either sex were divided into four groups. Group I was control group and received normal saline, Group II received ethanol, Group III received test drug CI at 300 mg/kg and Group IV received CI at dose of 600 mg/kg. Study duration was 30 days. Antioxidants estimated at the end of 30 days. The levels of reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) significantly reduced and (malondialdehyde) MDA levels raised in ethanol treated group compared to control group. The levels of reduced glutathione, SOD and catalase enzyme recovered completely in a dose dependent manner. Results demonstrate CI significantly reversed the reduction of GSH, SOD and CAT and reduced significantly the levels of MDA, a biomarker of lipid peroxidation in a dose dependent manner, suggesting its ability to enhance the antioxidant defense to prevent alcohol induced oxidative stress injury.
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Diffuse unilateral subacute neuroretinitis [DUSN] can be a diagnostic dilemma photocoagulation of the subretinal worm is an effective treatment for eradication. Early laser photocoagulation has been advocated. We report a case of a middle aged man who presented with decreased vision and a sub retinal macular worm that required two laser sessions for complete eradication of the worm
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Humans , Male , Middle Aged , Retinitis/therapy , Helminths , Laser Coagulation , Retinitis/etiologyABSTRACT
Topiramate is a sulfamate-substituted monosaccharide used is the treatment of seizures, and prophylaxis of migraine. A number of ocular side-effects have been described with use of topiramate, like bilateral angle closure, acute myopia and macular striae. Ultrasound biomicroscopy [UBM] clinches the diagnosis after ruling out other causes of shallow tomography anterior chamber. Previous studies have not demonstrated internal limiting membrane folds presenting as macular striae. We report a case of topiramate-induced acute myopia with angle closure and macular striae in a young adult. This is the report wherein striae formation after low doses of topiramate and their resolution have been documented by Optical Coherence Tomography [OCT]
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Humans , Male , Adult , Fructose/analogs & derivatives , Anticonvulsants , Macula Lutea/pathology , Tomography, Optical CoherenceABSTRACT
Effective counselling and management of retinoblastoma families using genetic information is presently practised in many parts of the world. We studied histopathological, chromosomal and molecular-genetic data of two retinoblastoma patients from India. The two patients, one with bilateral and the other with unilateral retinoblastoma, underwent complete ophthalmic examination, cytogenetic study, retinoblastoma gene (RB1) mutational analysis and RB1 promoter region methylation screening. In the bilateral retinoblastoma patient deletion of chromosome region 13q14 in peripheral blood lymphocytes and a hemizygous novel 8-bp deletion in exon 4 of RB1 in tumour sample were observed. In the unilaterally affected patient CGA to TGA transition protein truncation mutations were observed in exons 8 and 14 of RB1.
Subject(s)
Child, Preschool , Chromosomes, Human, Pair 13/genetics , DNA/chemistry , DNA Methylation , DNA Mutational Analysis , DNA Primers , Exons , Female , Humans , Infant , Male , Mutation/genetics , Pedigree , Polymerase Chain Reaction , Promoter Regions, Genetic/genetics , Retinoblastoma/ethnology , Retinoblastoma Protein/genetics , Sequence DeletionABSTRACT
We report a 17 year old girl with prepancreatic and preduodenal portal vein. She presented with recurrent vomiting. Barium study revealed malrotation of the gut. Laparotomy confirmed malrotation of the gut with a prepancreatic and preduodenal portal vein. The patient is asymptomatic after gastrojejunostomy and vagotomy.