Epistaxis: the cause found beyond the nose

Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.

Prediction of efficacy of gonadotropin releasing hormone agonist trigger for final oocyte maturation through post-trigger 12-hour luteinizing hormone, follicle stimulating hormone and progesterone levels in COS: a prospective study

Background: Circulating levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone (P4) in serum after administration of gonadotropin releasing hormone agonist (GnRHa) trigger for final oocyte maturation are found to be predictive of oocyte maturity. This prospective study was conducted at a tertiary care centre to evaluate relationship between serum LH, FSH and P4 levels at 12-h post-trigger and oocyte maturity rate and to predict which hormone has maximum sensitivity and specificity for appropriate oocyte maturation.Methods: Women at risk of ovarian hyper-stimulation syndrome who underwent either autologous or donor IVF cycle treated with flexible GnRH antagonist protocol were taken as participants of the study. GnRHa as trigger for final oocyte maturation was given. After 12 hours of agonist trigger, blood sample was drawn to assess LH, FSH and P4 levels in serum. Continuous variables were expressed as mean±SD. Independent sample t test was used for continuous variables which were normally distributed and Mann-Whitney U test for data not normally distributed. Main outcome measures were number of oocytes retrieved, oocyte maturity rate, fertilization rate, cleavage rate and grade of embryos.Results: There was a statistically significant reduction in number of retrieved oocytes, maturity rate, fertilization rate and grade 1 embryos with a concentration of serum LH and P4 less than the cut off value (p < 0.05).Conclusions: Serum LH and P4 level less than the cut off value at 12-hour post-trigger with GnRHa is associated with a dramatically less oocyte maturity rate and fertilization rate.

Genetics of fruit yield and its component traits under different fruiting habit backgrounds in chilli (Capsicum annuum L.)

The six basic generations (two parents, F1, F2 and backcrosses) of 14 crosses developed from nine parents differing in fruits node−1 and fruit orientation were evaluated to decipher the genetics of three quantitative traits (average fruit weight, fruits plant−1 and green fruit yield plant−1) during the rainly season of 2016 and 2017. The magnitude and direction of the additive genetic effects [a], dominance genetic effects [d], magnitudes of additive genetic variance (σ2 A) and dominance genetic variance (σ2 D) varied with the genetic background of the crosses and traits. In the genetic background of crosses involving parents differing in fruit node−1, the inheritance of average fruit weight, fruits plant−1 and fruit yield plant−1 were controlled by the genes with both additive and ambidirectional dominant effects. On the contrary, genes with only additive effects controlled the inheritance of average fruit weight, fruits plant−1 and fruit yield plant−1 in most genetic backgrounds of crosses involving parents differing in fruit orientation and those differing in both fruits node−1 and fruit orientation. Further, the genes controlling the inheritance of all the traits are dispersed among the parents used in the investigation. These results are discussed in relation to strategies to be used in breeding chilli.

Response of central nervous system aspergillosis to voriconazole.

Fungal infections of the central nervous system (CNS) usually present as subacute meningitis. Other manifestations include mass effect and focal neurological deficits. Cerebrospinal fluid (CSF) examination and biopsy of the lesion are helpful in disclosing the organism involved. Aspergillosis presents as brain abscess or granuloma with predominant neutrophils in CSF. Voriconazole is a broad spectrum triazole antifungal agent. It can be given orally and has lesser adverse effects We report a 69-years-old diabetic male, with aspergilloma of para-nasal sinus invading the CNS, who responded well to voriconazole treatment. He discontinued the medication by himself as it was costly. Within a month of stopping the medication, he developed features of subacute meningitis. However he showed clinical improvement after the medication was restarted. The case is reported for the clinical evidence of antifungal activity of voriconazole against aspergillosis.

Non-Hodgkin's lymphoma of the brainstem with atrial septal mass.

Simultaneous occurrence of cardiac and central nervous system tumors have been rarely reported. A 23 years male presented to us with right cerebello-pontine (CP) angle symptoms and signs. Cranial imaging showed a mass lesion in the right pons infiltrating into the right and middle cerebellar peduncles. There was also a cardiac-atrial septal mass. The brainstem lesion was found to be a non-Hodgkin's lymphoma where as the cardiac lesion was not accessible. Central nervous system lymphomas are reported rarely and the prognosis is poor. The chances of the cardiac lesion in this patient also being a lymphoma are high, as it was a infiltrative cardiac mass, infiltrating the atrial septum.

Rapidly progressive (crescentric) glomerulonephritis in erythema nodosum leprosum: case report

A autora faz a introduçäo do trabalho uma abordagem sobre o tabagismo como importante fator associado a doenças respiratórias, cardiovasculares e a alguns cânceres. Lembra também sobre as implicaçöes do tabagismo na gravidez e descreve alguns estudos sobre fumante passivo e refere algumas informaçöes epidemiológicas. Propöe-se a: 1- Estudar a prevalência de tabagismo entre estudantes da Universidade de Säo Paulo, campus de Ribeiräo Preto, em 1988. 2- Analisar a tendência desta prevalência no perído de 1980-1988. 3. Analisar a relaçäo entre escolhas das marcas e o custo das mesmas. Foi feito um levantamento em 1988, com questionário padronizado e com a mesma metodologia utilizada em 1980, 1981 e 1986. As principais conclusöes foram: 1- A prevalência do tabagismo nas diferentes unidades da USP, em dezembro de 1988 foi: FMRP, 11,9% EERP, 21,2%, FFRP, 8,7; FORP, 8,9%; e prevalência de extabagista foi respectimente: 6,8%; 9,3%; 7,5% e 6,5%. 2- As mulheres fumam tanto quanto os homens em 1988 entre os alunos inqueridos. 3- Até 1986, há tendência geral de declínio em todas as escolas; em 1988, esta tendência näo tem significado estatístico. 4- A tendência segundo o gênero alterou-se no período estudado, em 1980 e 1981 os homens fumam mais que as mulheres e em 1986 e 1988, homens e mulheres fumam igualmente. Foram levantadas e discutidas várias hipóteses no sentido de tentar explicar esta tendência geral de declínio e as mudanças ocorridas neste período quanto a prevalência nos dois gêneros

Gonadal involvement in leprosy - study of gynaecomastia, testicular and epidedymal involvement and therapeutic efficacy of indegenous drugs

Sessenta pacientes masculinos de hanseniase (idade media = 27,2+ ou - 5,04 anos), selecionados aleatoriamente, foram estudados quanto ao envolvimento gonadal e a eficacia terapeutica de duas drogas nativas. Destes pacientes 34 eram casados, com dura‡ao media da doen‡a de 4,17 + ou - 3,27 anos. Somente os pacientes com hanseniase virchowiana e dimorfa desenvolveram altera‡oes testiculares e de epididimos. Dor e/ou sensibilidade testicular (virchowianos = 62,5 por cento dimorfos = 30,0 por cento) foi a sintomatologia mais comum. Fun‡ao sexual alterada foi observada em 34 (56,6 por cento) casos, enquanto 11 pacientes apresentaram padrao sexual de distribui‡ao pilosa alterado e ginecomastia. O espermograna revelou azoospermia em 19 (35 por cento) dos casos e oligospermia em 16 (26,6 por cento) pacientes. Os achados histopatologicos das biopsia testicular revelaram evidencia de lesoes especificas nao relacionadas ao tamanho do testiculo, aos achados do semen e as manifesta‡oes clinicas. As altera‡oes histopatologicas mostraram grande variabilidade, nao tendo sido possivel classifica-las em vasculares, intersticiais ou obstrutivas: acredita-se que as altera‡oes encontradas sejam devidas ao estado alterado das gonadas na hanseniase. A eficacia das prepara‡oes terapeuticas nativas Speman e Tentex forte (Himalava) foi avaliada de um ponto de vista objetivo em 34 pacientes. Melhora subjetiva foi observada em 82,3 por cento dos casos, enquanto objetivamente o espermograma melhorou em 87,5 por cento dos casos com oligospermia. As drogas nao apresentaram efeitos colaterais e foram bem toleradas.