Tumor neuroectodérmico primitivo periférico de riñón, reporte de caso

Introducción: El tumor neuroectodérmico primitivo periférico de riñón (PNETk) es una enfermedad rara muy agresivo que afecta mayormente a varones jóvenes. Reporte de caso: paciente varón de 19 años con cuadro clínico dolor abdominal, hematuria y masa palpable, en la tomografía se evidencia una enorme tumoración renal izquierda, Se le realiza nefrectomía radical convencional y se envía a estudio patológico más histoquímica resultando de PNETk. Luego paciente siguió su manejo por oncología para quimiterapia inicialmente. Conclusión: El PNETk que describimos representa el primer caso reportado en nuestro país, constituye una entidad clínica única por su rareza siendo un reto hacer diagnóstico y su comportamiento y manejo se sigue basando a reportes de casos debido a su poca frecuencia.

Introduction: Peripheral primitive neuroectodermal tumor of the kidney (PNETk) is a very aggressive rare disease that mainly affects young men. Case report: A 19-year-old male patient with symptoms of abdominal pain, hematuria and a palpable mass, the tomography shows a large left renal tumor. Conventional radical nephrectomy was performed and sent for pathology study plus histochemistry, resulting in PNETk. The patient then continued his oncology management for chemotherapy initially. Conclusion: The PNETk that we describe represents the first case reported in our country, it constitutes a unique clinical entity due to its rarity, being a challenge to make a diagnosis and its behavior and management is still based on case reports due to its infrequency.

Traumatismo de genitales externos masculinos por proyectil de arma de fuego. Reporte de casos / External male genital trauma caused by firearm projectile. Case report

RESUMEN Los traumatismos de genitales externos son lesiones producidos por agentes mecánicos externos y se observa en el 68,1% de todos los casos de traumas genitourinarios. Los traumas producidos por un mecanismo penetrante por proyectil de arma de fuego están incrementando en sucesos delictivos que ocurren en centros urbanos; estas lesiones comprometen el escroto en 78% y el pene en 28%. El manejo consiste en la exploración escrotal y del pene con reparación de la túnica albugínea, incluso orquiectomía si el testículo no es recuperable. La cirugía se realiza para evitar complicaciones como la disfunción sexual y miccional. Presentamos dos casos con el objetivo de dar a conocer el manejo actual de las lesiones genitales en nuestro centro, ante la ausencia de reportes o estudios previos en nuestro medio relacionados al traumatismo de genitales externos por proyectil de arma de fuego.

SUMMARY External genital trauma is caused by external mechanical agents and account for 68.1% of all genitourinary trauma. Firearm projectile trauma are increasing as a result of escalating delinquency in urban settings, these traumas involve the scrotum and penis in 78% and 28%, respectively. Management of these traumas require evaluation of the scrotum and penis; orchiectomy is needed if the testes are not recuperable. Surgical procedures are aimed at avoiding complications such as sexual and urinary dysfunction. We present two cases aimed at reporting the management of external genital trauma at our centre in absence of local reports of firearm projectile trauma.

Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature

We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.

Correlation of multicolor images and conventional color fundus photographs with foveal autofluorescence patterns in diabetic macular edema

Purpose: The aim of this study is to assess the ability of multicolour imaging (MCI) to detect foveal cysts in diabetic macular edema (DME) and compare it with conventional color fundus photography (CFP) and foveal autofluorescence (FAF) pattern. Methods: It was a retrospective review of 112 eyes of 84 DME patients with central foveal thickness ?250 ? who underwent MCI, CFP and shortwave autofluorescence imaging. MCI was performed with Sepctralis spectral domain optical coherence tomography (SDOCT) (Heidelberg Engineering, Germany). Results: 97 (86.6%) eyes had cystoid increased autofluorescence (cystoid iFAF), 9 (8%) had spot iFAF and 6 (5.35%) had irregular decreased FAF (dFAF). Among eyes with cystoid iFAF, OCT detected DME cysts in 93 (95.6%) eyes, MCI in 75 (77.3%) and CFP in 5 (5.15%) eyes. In all these eyes, the location of cysts on OCT and MCI corresponded with the location of cystoid iFAF, whereas none of the eyes with cyst seen on CFP correlated with the location of cystoid iFAF. Conclusion: MCI was superior to CFP in detecting DME cysts at fovea. It also correlated with hyperautofluorescence pattern in these eyes. MCI may have a potential role in diabetic retinopathy screening by segregating eyes with DME which would require treatment. Our findings need to be further validated in a larger and prospective study design.

Treatment outcomes of pachychoroid neovasculopathy with photodynamic therapy and anti-vascular endothelial growth factor

Purpose: To describe treatment outcomes of eyes with pachychoroid neovasculopathy (PNV) with PDT and anti-(vascular endothelial growth factor) VEGF therapy. Methods: Retrospective interventional case series. Records of six consecutive cases of PNV were reviewed. Four cases were treated with PDT+ inj ranibizumab. Two cases underwent only PDT. Final visual outcomes and functional outcome including macular status and choroidal thickness were assessed. Results: We analysed six eyes of six patients with PNV. There were four males and two females. Mean age of the patients was 56.5 years. Mean duration of follow up was 8.2 months. All patients received reduced fluence PDT. Four patients received ranibizumab along with PDT; mean BCVA at presentation was 0.41 log MAR units and mean BCVA at final follow up was 0.44 log MAR units. There was significant improvement at final follow up (P = 0.03). Mean subfoveal choroidal thickness (SFCT) at presentation was 445 microns and mean SFCT at final follow up was 293 microns. There was a significant reduction at final follow up (P = 0.02). Conclusion: PDT with or without ranibizumab appears to be an effective treatment modality for PNV.

Frequencies of regulatory subsets of CD4+ TH cells in peripheral blood in Mycobacterium Tuberculosis-Infected individuals and healthy contacts in a high-burden setting from Assam, Northeast India

Background: Mycobacterium tuberculosis (Mtb) adapts many strategies to persist and replicate inside human tissue. One such strategy is the manipulation of CD4+ TH cells for subset interconversion to regulatory subsets. The aim of the present study is to get an insight of dynamic changes of CD4+ TH cells to regulatory subsets, CD4+ CD25+ forkhead box P3 (Foxp3)+ T-cells and CD4+ CD25+ Foxp3+ programmed death molecule-1 (Foxp3+) T-cells, in peripheral blood in Mtb-infected individuals and healthy contacts in a high-burden setting from Assam, Northeast India. Materials and Methods: A case–control study was conducted in newly diagnosed active pulmonary tuberculosis (APTBs) patients and 2 sets of controls: (i) individuals infected with latent tuberculosis infection (LTBI) and (ii) healthy close tuberculosis healthy contacts (HCs). The frequencies of different subsets of CD4+ cells with regulatory markers were measured in peripheral blood in 3 groups of study participants. Results and Observations: Frequencies of CD4+ CD25+ Foxp3+ T-cells (1.84 ± 1.40 vs. 4.32 ± 1.82 vs. 11.30 ± 3.66), CD4+ CD25+ Foxp3+ PD1+ T-cells (0.37 ± 1.28 vs. 2.99 ± 3.69 vs. 14.54 ± 5.10) and ligand (PD-L1)-positive CD4+ TH cells (0.80 ± 0.45 vs. 2.28 ± 0.95 vs. 7.13 ± 2.02) were significantly increased from HCs to LTBIs to APTB patients, respectively (P < 0.0001). No significant changes in frequencies of total CD4+ cells were observed between APTBs (29.51 ± 11.93), LTBIs (29.23 ± 8.16) and HCs (28.16 ± 9.73) whereas the mean ratios of CD4+ to CD4+ CD25+ FoxP3+ were significantly decreased from 34.34 ± 47.56 in HCs to 7.96 ± 5.8 in LTBIs to 3.12 ± 2.58 in APTBs (P < 0.0001). Significant decrease in mean ratios of CD4+ CD25+ FoxP3+ to CD4+ CD25+ FoxP3+ PD1+ were also observed from 4.97 ± 1.09 in HCs to 1.44 ± 0.49 in LTBIs to 0.78 ± 0.72 in APTBs. Conclusion: CD4+ TH cells change dynamically to regulatory subsets depending on the status of infection and a shift of response towards excessive regulatory T-cells, and PD-1/PD-L1 production may help in the development of active infection in latently infected individuals. These immunological parameters may be used, as potential biomarkers to see the changing dynamics of Mtb infection.

Leprosy Case Detection Campaign (LCDC): An Approach to Accelerate Progress to Achieve Leprosy Free India

The Elimination of Leprosy at National level was achieved in the month of December, 2005, by India. Afterward it was observed that trend of two important indicators of NLEP i.e. Annual New Case Detection Rate (ANCDR) and Prevalence Rate (PR) are almost static since 2005–2006, whereas the percentage of Grade II disability (G2D) amongst new cases detected showed a rising trend, which indicated delayed detection of cases and quantum of cases lying undetected/ hidden in the community. Hence, in order to address the issues being faced by programme an innovative approach for hidden case detection i.e., Leprosy Case Detection Campaign (LCDC) was introduced by Central Leprosy Division (CLD), Directorate General of Health Services (Dte.GHS), Ministry of Health & Family Welfare (MoHFW), Govt of India. This novel concept is first of its kind in the world as it has various unique features i.e., institutional framework at various administrative levels for planning, implementation and concurrent review of LCDC, formulation and training of search teams, Micro plan preparation, IEC activities, supervision and monitoring by identified supervisors and report submission. The activity was piloted in the limited areas of 50 districts of 7 states during March-April 2016 and in September, 2016 it was expanded to 163 districts of 20 States/ UTs to cover around 360 million population. During 2017, it was implemented in 255 districts of 23 States/ UTs to cover population of around 390 million. These efforts have yielded the desired result which is evident from the fact that approximately 67000 new leprosy cases were detected during the LCDCs in these 2 years (2016-17 & 2017-18) and number of G2D cases per million population also declined by more than 25%, from 4.48 cases per million in 2014-15 to 3.34 cases per million in 2017-18. In addition to the above, the benefits achieved through LCDCs are generation of large number of trained manpower who can suspect, identify leprosy cases and can carry out focussed IEC regarding leprosy.

Acute macular neuroretinopathy after blunt ocular trauma: A rare association

Acute macular neuroretinopathy (AMN) is a deep retinal ischemic manifestation. It has been reported after the use of sympathomimetics, childbirth, bee sting, oral contraceptives, flu-like illness, intravenous contrast agents and bodily trauma not directly involving the eyes. We report a case of AMN following blunt ocular trauma. An 18-year-old male presented with an acute history of blurring of vision following blunt trauma to the right eye. Spectral domain optical coherence tomography (SD-OCT) showed hyperreflectivity of the outer nuclear layer with ellipsoid layer disruption. This report highlights AMN as a manifestation of blunt trauma, presence of which may be an indicator of poor visual prognosis.

Utility of multicolor optic disc photography in evaluation of glaucomatous optic disc in myopic eyes: A novel approach

Interpretation of optic disc cupping and neuroretinal rim is challenging in myopic eyes because of large, shallow, and tilted disc, myopic crescent, and macular degeneration. Color and red-free optic disc photographs do not reveal the cup/disc ratio often in myopic eyes. We report characteristics of multicolor optic disc photography in three myopic eyes. All eyes underwent multicolor imaging Spectralis SDOCT system (Heidelberg Engineering, Germany). Owing to use of three laser lights in a confocal design, multicolor optic disc photography was able to delineate the neuroretinal rim and optic cup more clearly than color and red-free optic disc photographs.