Oncocytic adrenal cortical neoplasm of uncertain malignant potential – A rare case report

Adrenal oncocytic tumors are rarely encountered. Most of the oncocytic tumors are benign and rarely malignant. Here we report a case of a 10-year-old male child presented with abdominal mass whose Contrast-Enhanced Computed Tomography (CECT) shows well-circumscribed tumor. Right adrenalectomy was carried out. Histopathologically, it was diagnosed as adrenal cortical oncocytic neoplasm of uncertain malignant potential (AONUMP). This case highlights that although adrenal oncoytic tumors are rare, we should consider this as a differential diagnosis while evaluating the patient for adrenal masses. The case is presented in view of its rarity, and distinguishing gross and microscopy appearance, the diagnosis of which was further confirmed with immunohistochemistry markers.

Juvenile hyaline fibromatosis in siblings

Background: Juvenile Hyaline Fibromatosis is a rare autosomal recessive connective tissue disorder. Case Characteristics: Three year old girl with multiple facial nodules, gingival hypertrophy and multiple joint contractures. Her sibling, male child also had similar findings which was progressive and he died at 2 years. Outcome: Nodule biopsy showed extensively hyalinised dermis with PAS positivity. Message: Juvenile Hyaline Fibromatosis is a differential diagnosis for children presenting with multiple nodular lesions.

A randomized prospective comparative study of nerve stimulator and ultrasonogram in popliteal sciatic nerve block for ankle and foot surgeries.

Background: Regional blocks in the field of anaesthesia were done traditionally with paraesthesia technique. To overcome the demerits with paraesthesia technique, nerve locator was applied for nerve blocks. Later, the application of ultrasonogram for regional blocks got the real time imaging of the nerves and drug administration. This resulted in publications of numerous studies with variable results. Therefore we planned to compare ultrasonogram and nerve locator in popliteal sciatic nerve block in our population. Methods: A prospective, randomized, observer blinded study was planned to compare the nerve stimulator (Group N) and ultrasound (Group U) on duration of „block technique‟, number of needle reinsertions in popliteal sciatic nerve block for ankle and foot surgeries. We included all consented patients aged ≥18 years of both genders belonging to ASA I to III and excluded pregnant mothers, diabetes mellitus, neuropathy, chronic opioid use, positioning difficulty, coagulopathy, nerve block contraindications, local anaesthetic allergic patients. Results: The duration of block technique in Group U = 262.00 ± 108.36 Seconds and Group N = 715.16 ± 234.66 Seconds with statistically significant P value = 0.0001. The average number of needle reinsertions in Group N = 6.05 ± 2.31 and Group U = 2.46 ± 1.11 with statistically significant p value of 0.0001. Therefore the time taken to perform the block and the number of needle reinsertions in Group U is shorter than the Group N. Conclusion: The duration of block technique and number of needle reinsertions are better with ultrasound. Though the onset of motor and sensory blockade were better with ultrasound success rate is not significantly different.

Hemophagocytic lymphohistiocytosis with a leukemoid reaction in an infant with scrub typhus

A two-month-old male infant presented with a clinical picture suggestive of fever without focus. Treatment was initiated with broad spectrum intravenous antibiotics. The infant subsequently developed septic shock, hepatosplenomegaly and tachypnoea with oxygen dependency. There was laboratory evidence of anemia, thrombocytopenia and a leukemoid reaction. Infection induced hemophagocytic lymphohistiocytosis with a leukemoid reaction was suspected because of fever, splenomegaly and bicytopenia in conjunction with elevated serum triglycerides and ferritin. Empiric therapy with doxycycline caused a rapid resolution of the fever, and the diagnosis of scrub typhus was confirmed by a positive scrub IgM ELISA. HLH with a leukemoid reaction secondary to scrub typhus has not previously been reported in early infancy

Probiotic potential of lactic acid bacteria present in home made curd in southern India.

Background & objectives: The human gut microbiota play a significant role in nutritional processes. The concept of probiotics has led to widespread consumption of food preparations containing probiotic microbes such as curd and yogurt. Curd prepared at home is consumed every day in most homes in southern India. In this study the home-made curd was evaluated for lactic acid bacteria (LAB) with probiotic potential. Methods: Fifteen LAB (12 lactobacilli, 1 lactococcus, 2 Lleuconostoc) and one yeast isolated from home-made curd were evaluated for resistance to acid, pepsin, pancreatin and bile salts; antimicrobial resistance; intrinsic antimicrobial activity; adherence to Caco-2 epithelial cells; ability to block pathogen adherence to Caco-2 cells; ability to inhibit interleukin (IL)-8 secretion from HT-29 epithelial cells in response to Vibrio cholerae; and ability to induce anti-inflammatory cytokine expression in THP-1 monocyte cells. Results: Llactobacillus abundance in fermenting curd peaked sharply at 12 h. Nine of the strains survived exposure to acid (pH 3.0) for at least one hour, and all strains survived in the presence of pancreatin or bile salts for 3 h. None showed haemolytic activity. All were resistant to most antimicrobials tested, but were sensitive to imipenem. Most strains inhibited the growth of Salmonella Typhimurium while five inhibited growth of V. cholerae O139. Seven strains showed adherence to Caco-2 cells ranging from 20-104 per cent of adherence of an adherent strain of Escherichia coli, but all inhibited V. cholerae adherence to Caco-2 cells by 20-100 per cent. They inhibited interleukin-8 secretion from HT-29 cells, in response to V. cholerae, by 50-80 per cent. Two strains induced IL-10 and IL-12 messenger ribonucleic acid (mRNA) expression in THP-1 cells. Interpretation & conclusions: LAB in curd had properties consistent with probiotic potential, but these were not consistent across species. LAB abundance in curd increased rapidly at 12 h of fermentation at room temperature and declined thereafter.

Alcohol-related violence among the Australian aboriginal and Torres strait islanders of the northern territory: prioritizing an agenda for prevention- narrative review article

Alcohol - related violence among Australian Aboriginal and Torres Strait Islanders [also called as "Indigenous"] is a major public health concern in Northern Territory of Australia. There is dearth of epidemiological data that link three contributing epidemics: alcohol misuse, violence, and trauma in the Northern Territory. In this review, we aimed to concentrate on how these epidemics intersect among the Indigenous people in the Northern Territory. In our descriptive review, we have searched published papers, publicly available government and health department reports web sites reporting relevant data on these three risk factors in the Northern Territory. The high rate of family and domestic violence and assaults in the Australian Territory indicates an increased correlation with high risk alcohol use compared to unintentional injuries. Heavy drinking pattern and harmful use of alcohol among Indigenous people are more likely to be associated with the incidence of violent assaults and physical injuries in the Northern Territory. We are trying to emphasize our understanding of co-occurring risk factors on the alcohol - violence relationship and urging a need for interventional approaches to reduce the public health issues in the Northern Territory

Spontaneous septicaemia with multi-organ dysfunction--a new face for Pantoe agglomerans?

Pantoe agglomerans (P. agglomerans) is an unusual cause for sepsis in immunocompetent individuals, especially in the absence of characteristic risk factors. We report one such case occurring in a farmer, manifesting with severe illness. The severe nature of illness and the apparently spontaneous origin of septicemia underline the pathogenic potential of this organism. When coupled with the ubiquity of the organism, there is a definite possibility that this disease may become increasingly frequent in the near future, especially in agronomic countries like India. Further studies on the epidemiology and natural history of this disease are required.

Pulmonary nocardiosis due to Nocardia otitidiscaviarum in an immunocompetent host- a rare case report

Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients. We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever, cough with scanty sputum, hemoptysis, left sided chest pain and exertional dyspnea for two weeks. There was no past history of tuberculosis, diabetes mellitus or steroid therapy. Chest X-ray showed homogenous peripherally based opacity in the left upper zone. Bronchoscopy was done and brushing sent for culture, which showed colonies with features of Nocardia species after 48 hours. Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum. Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically. We report this case to emphasize the fact that among the Nocardia species, Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.