Rare Incidental Foreign Body in the Maxillary Sinus on Routine Radiographic Examination

Accidental entry of any foreign body into the paranasal sinus could be due to known causes or unknown causes with the patient being either symptomatic or sometimes asymptomatic. Such asymptomatic conditions make it difficult to detect the foreign body for an indefinite period which on a longer duration may lead to various complications later. Routine radiographic examination during dental checkup reports to serve a good purpose in these kinds of cases by accidental detection of such foreign bodies in the maxillofacial region leading to early diagnosis and timely management. The present paper highlights the importance of routine radiographs in detecting a rare type of foreign body (nasal stud) in the maxillary sinus in the asymptomatic patient.

A study of changes in Mean Ocular Perfusion Pressure and Intra-Ocular Pressure among pa?ents undergoing hemodialysis

Background:During hemodialysis there is decrease in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hence Mean Arterial Pressure (MAP) due to decrease in body fluid volume. Due to reduc?on in MAP there is decrease in Mean Ocular Perfusion Pressure (MOPP) and also there is increase in IOP during dialysis. Objec?ve:To study changes in MOPP and IOP among pa?ents undergoing hemodialysis Methods:An observa?onal study was carried out among 100 pa?ents undergoing hemodialysis Under asep?c condi?on, Proparacaine eye drops were ins?lled in both eyes, IOP was measured by Schiotz Indenta?on Tonometer 30 min before, during hemodialysis and 30 min a?er hemodialysis in supine posi?on. Tonometer was sterilized by Isopropyl alcohol and was washed with normal saline before using on next pa?ent. Systolic and diastolic blood pressure were measured by using sphygmomanometer 30 min before, during and 30 min a?er hemodialysis. Results:The varia?ons in the SBP, DBP and MAP before, during and a?er hemodialysis were not sta?s?cally significant (p>0.05). There was significant differences for IOP between before, during and a?er hemodialysis and same for MOPP except before and 30 min a?er hemodialysis (p < 0.0001). Conclusion:Significant fluctua?ons were seen from the present study in the intra-ocular pressure and mean ocular perfusion pressure during, before and a?er hemodialysis.

Psychoses of Epilepsy in Pregnancy: A Case Report

To discuss the unique relationship between psychosis and seizures in a young individual, who is also pregnant. Psychosis of epilepsy can present in multitude of ways, including pre-ictal, ictal, post-ictal, chronic interictal, and forced normalization psychosis.

Psychoses of Epilepsy in Pregnancy: A Case Report

To discuss the unique relationship between psychosis and seizures in a young individual, who is also pregnant. Psychosis of epilepsy can present in multitude of ways, including pre-ictal, ictal, post-ictal, chronic interictal, and forced normalization psychosis.

Variations of physiological parameters in newly detected hypothyroidism

Background: Emergence of hypothyroidism as a public health issue apart from a common clinical entity, has gained much attention nowadays. The non-specific features of hypothyroidism lead to incorrect diagnoses, inadequate treatment and complications in the future. The present study was designed to unravel the effects of hypothyroidism on physiological parameters and to highlight the importance of early diagnosis and treatment. This study was done to assess the effects of hypothyroidism on pulse rate, blood pressure and respiratory rate.Methods: This descriptive cross-sectional study was done in 60 hypothyroid patients of 18-45 years age, both males and females, who were either newly detected or on treatment for less than 6 months. Patients with history of other systemic diseases, pregnancy and hyperthyroidism were excluded. After obtaining written consent from the patients, clinical examination was done.Results: Student t-test and ANOVA were used for analysis. Physiological parameters like pulse rate, blood pressure and respiratory rate had variations in the patients and there were changes with age, gender and BMI even though they were not significant. These changes were attributed to increased arterial wall thickness and endothelial dysfunction in blood vessels.Conclusions: The patients showed changes in cardiovascular and respiratory profiles. The variations in systolic and diastolic blood pressures were significant with increase in age. Physiological parameters had variations with gender and BMI also. This proves the cardiovascular and respiratory morbidity in newly detected hypothyroidism, which emphasizes the importance of early diagnosis and treatment in them.

A comparative study of the resurfacing effect of microdermabrasion versus glycolic acid peel in the management of acne scars

Objective To compare the resurfacing effect of microdermabrasion versus glycolic acid peeling in the treatment of acne scars

Methods A total of 80 patients were selected randomly and divided into two groups A [treated with microdermabrasion] and B [treated with glycolic acid peeling]. Data were coded and analyzed

Results Of the 80 participants, 56 completed all 6 sessions. Among those 56 patients, 24 patients belonged to group A and 32 patients belonged to group B. In group A, good improvement was noted in 16.7 percent of the patients, 67 percent showed fair improvement, 12.5 percent showed poor improvement and 4.2 percent had no change after 6 sessions. In group B, 3 percent of the patients showed excellent improvement, 3 percent showed good improvement, 81.3 percent showed fair improvement, 6.25 percent showed poor improvement and no change was noted in 6.25 percent of the patients

Conclusion This study infers that superficial scars showed greater improvement with microdermabrasion while reduction in active acne lesions was much more with glycolic acid peel. However, no statistically significant differences were found between the outcomes of both therapeutic modalities

To assess the reduction in bone mineral density among children who completed steroid therapy for nephrotic syndrome

Introduction: Minimal Change Nephrotic Syndrome is the most common type of nephrotic syndrome accounting for 85% of cases. It is the most common primary or idiopathic type of nephrotic syndrome in children. It occurs between 1 to 12 years of age, but most commonly 2 to 6 years. Even though the majority of cases show remission of nephrotic syndrome, the hypocalcemia due to Glucocorticoids are very severe. It reduces the bone mineralization and reducing the bone mineral content and thereby reducing bone density. Aim of the study: To assess the reduction in bone mineral density among children who have completed the first course of steroid therapy for nephrotic syndrome by measuring biochemical markers of bone. Materials and methods: This study was done to find out the reduction in the Bone mineral density among children who completed steroid therapy for nephrotic syndrome, by using bone biochemical markers. This study also helped to assess the side- effect of Glucocorticoids on bone density and to prevent bone demineralization and pathological fractures in children. Results: The results showed there was a reduction in the serum calcium values among children with MCNS. This implied hypocalcemia among children due to GCs and the P value is significant <0.001. This represented the corrected calcium levels among the children after drug effect. It implied the D. Sampath Kumar, S. Prasanna, P. Sakthi Seethalakshmi. To assess the reduction in bone mineral density among children who completed steroid therapy for nephrotic syndrome. IAIM, 2018; 5(2): 94-104. Page 95 overall the corrected calcium levels at low levels with MEAN=8.34 mg%. The P value was <0.024 Significant. The total proteins were normal among children after completing the glucocorticoid therapy. The P value was <0.001 and was significant. Mean = 5.68. Standard Deviation (SD) = 0.28. The serum phosphorus was almost normal among remission MCNS Children and at higher levels among defaulters, SDNS and SRNS. Conclusion: Glucocorticoids is the drug of choice and standard therapy for Minimal Change Nephrotic Syndrome (MCNS), but the drug-induced hypocalcemia and hypovitaminosis D are assessed by our study. Added to the above, the disease itself characterized by hypocalcemia and hypovitaminosis D. So, all children should undergo this assessment to prevent growth failure and pathological fractures. Nutritional supplements are recommended for the quality of life among children.

Phytochemical, antioxidant and antibacterial potential of Elaeagnus kologa (Schlecht.) leaf

OBJECTIVE@#To screen different solvent extracts of Elaeagnus kologa (E. kologa) leaf to determine the phytochemicals, potent antioxidant and antibacterial activity to find out the possible source of applied pharmaceutical formulations.@*METHODS@#Solvent extracts of leaf material were prepared using the Soxhlet apparatus. A study was performed on antioxidant activity of methanolic extract of leaf by 1-1-diphenyl-2-picrylhydrazyl method. The phenolic and flavonoid content of all the fractions were determined using high performance liquid chromatography. Leaves were also subjected to protein and carbohydrate test.@*RESULTS@#The total phenols, flavonoids were found to be high in petroleum ether as compare to other solvent fraction. The IC50 value of methanolic extract of the sample was 62.20 μg/mL which showed significant antibacterial activity against Bacillus subtilis (Gram-positive).@*CONCLUSIONS@#The present study suggests that the methanolic extract of E. kologa leaf possesses antioxidant and antibacterial properties. Such properties may be of great use in mitigating the detrimental effects of oxidative stress and reducing susceptibility to bacterial infection. Notably, extracts of E. kologa leaf also contain proteins and carbohydrates which add to its nutritional value.

Phytochemical, antioxidant and antibacterial potential of Elaeagnus kologa (Schlecht.) leaf

Objective: To screen different solvent extracts of Elaeagnus kologa (E. kologa) leaf to determine the phytochemicals, potent antioxidant and antibacterial activity to find out the possible source of applied pharmaceutical formulations. Methods: Solvent extracts of leaf material were prepared using the Soxhlet apparatus. A study was performed on antioxidant activity of methanolic extract of leaf by 1-1-diphenyl-2-picrylhydrazyl method. The phenolic and flavonoid content of all the fractions were determined using high performance liquid chromatography. Leaves were also subjected to protein and carbohydrate test. Results: The total phenols, flavonoids were found to be high in petroleum ether as compare to other solvent fraction. The IC

Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly

Congenital anomalies that involve the distal segment of urogenital sinus [giving rise to female urethra and vagina] may lead to abnormal urethral development ranging from absent to markedly deficient urethra. The abnormal division may also cause a short and patulous urethra. Sphincteric defects are likely to be associated and when combined with the short urethral length is a cause for severe urinary incontinence. Urinary incontinence due to a congenital cause requiring repeated urethral reconstruction to relieve symptoms is presented. A 15 year old girl was referred for bothersome urinary incontinence due to a short, wide, patulous urethra with defective sphincteric mechanism as part of urogenital sinus developmental anomaly. She was initially managed by reconstruction of bladder neck and proximal urethra with sphincter augmentation using autologous pubovaginal sling. Persistent urinary incontinence demanded a second urethral reconstruction using tubularised anterior bladder flap [modified Tanagho]. Surgical reconstruction of the urethra achieved socially acceptable continence.

Recurrent Urovaginal Fistula: A Sequel of Missed Ureteral Involvement.

A 44-year-old multipara presented with continuous urinary leakage per vagina of 15 months duration despite abdominal vesicovaginal fistula repair. Intravenous urography revealed normal upper urinary tract. Methylene blue test was positive but no fistula was detected on cystoscopy. Failure to cystoscopically visualize the catheter, which was easily introduced through the vaginal end of fistulous tract warranted a fistulogram that simulated retrograde ureteropyelogram and showed contrast in the bladder confirming ureterovesicovaginal fistula. Patient underwent transvesical ureteroneocystostomy with closure of bladder communication and remains continent at six months follow-up. Recurrence of urovaginal fistulae after vesicovaginal fistula repair may be attributable to undiagnosed ureteral involvement despite normal upper tract imaging. Simple procedures like cystoscopic visualization of catheter along with fistulogram can clinch the diagnosis in such cases.

Multiple Developmental Urogenital Anomalies: A Therapeutic Challenge.

Case report: In cases of atretic lower vagina, drainage of hematocolpos per se is inadequate as recurrent hematocolpos from re-stenosis is common. Surgical reconstruction in these cases should be directed to relieve obstruction and ensure continued vaginal patency. A 14-year-old girl reported with primary amenorrhea and recurrence of cyclical lower abdominal pain due to re-stenosis following a primary intervention for hematocolpos. Evaluation identified an atretic lower vagina and multiple associated urinary tract anomalies like unascended right kidney, malrotated left duplex collection system, ureteric diverticula and bladder diverticulum with left ureter opening into it. Though associated Grade IV vesicoureteral reflux (VUR) posed a management dilemma, drainage of hematocolpos and restoration of vaginal continuity by pull through of the proximal vagina and approximating its edges to fourchette relieved the patient of pain, restored menstruation, resolved the VUR and obviated the need for extensive urinary reconstructive procedures. Conclusion: In case of atretic lower vagina, drainage of hematocolpos per se is inadequate as recurrent hematocolpos from re-stenosis is common and surgical reconstruction should be directed to relieve obstruction and ensure continued vaginal patency. Coexisting developmental urinary tract anomalies may not require immediate surgical intervention.

Trans-vaginal repair of gynecological supratrigonal vesicovaginal fistulae: a worthy option!

To determine the appropriateness of vaginal approach for gynecological supratrigonal vesicovaginal fistulae. Retrospective review of consecutive women with gynecological supratrigonal Vesico Vaginal Fistulae [VVF] repaired at the fistula unit of Urogynecology department between 1996 and 2011 was done.Out of 48 cases of supratrigonal VVF of gynecological origin identified; 34 [70.8%] cases were repaired vaginally and 14 [36.8%] abdominally with a mean follow-up period of 52.8 [2-132] months. Overall 95.8% were successfully cured at first attempt. The success rate of vaginal repair [94.8%] at first attempt was comparable to that of abdominal repair [100%] [P value = 0.8946]. Amongst two failed vaginal repairs, one was successfully cured by subsequent vaginal repair and other by abdominal repair. Three fourth gynecological supratrigonal VVF can be repaired vaginally in first attempt with success rate comparable to abdominal approach. On the basis of this study we postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible supratrigonal VVF of gynecological origin

Parvovirus B19 presenting with persistent pancytopenia in a patient of T-ALL post induction chemotherapy diagnosed on bone marrow examination.

Manifestations of parvovirus B19 vary even in the normal host from asymptomatic or subclinical infection to a spectrum of illness with symptoms during viremic and immune complex mediated stage of disease. We report the morphological findings of parvovirus B19 infection (confirmed on serology) in a patient of T-acute lymphoblastic lymphoma (T-ALL) who underwent induction phase of chemotherapy (MCP 842 protocol). Persistent pancytopenia in the bone marrow aspirate with mild increase in blasts was thought to be due to failure to achieve marrow remission. However, giant pronormoblasts with prominent intranuclear inclusions confirmed on trephine biopsy led to the suspicion of parvovirus B19 infection which was later confirmed on serology. This case is presented to report the rarely seen classical morphological feature of parvovirus infection on bone marrow examination which was incidentally the first investigation to diagnose the viremic phase of the infection, indicating that a high index of suspicion needs to be kept in mind while examining bone marrows of susceptible patients.

Virulence and cytotoxicity of seafood borne Aeromonas hydrophila

The present study was conducted to determine the virulence and cytotoxicity of Aeromonas hydrophila strains isolated from seafood samples collected from 5 major fish markets in Chennai, Tamil Nadu, India. Among 73 A. hydrophila strains isolated from fish and shrimp samples, 86.3 percent exhibited haemolysis, 78.1 percent produced slime, 98.63 percent produced protease and also demonstrated cytotoxicity on Vero cells. Cell shrinkage, detachment and rounding of Vero cells were recorded as cytotoxic changes. Only one strain did not show haemolysis, slime production, proteolytic activity and cytotoxicity on treatment with Vero cells. Positive correlation was observed between proteolytic activity and cytotoxicity irrespective of haemolytic activity of the strains. These results demonstrated the presence of wide spread, pathogenically characterized, cytotoxic seafood borne A. hydrophila in Chennai.

Regional brain metabolism in schizophrenia: The influence of antipsychotics.

BACKGROUND: Schizophrenia has been associated with a plethora of metabolic changes in the brain that vary with duration and type of psychoses. Additionally, it has been observed that antipsychotics can further alter cerebral glucose metabolism. These changes resulting from antipsychotics have been postulated to be reflective of the duration and mechanism of action of the medication. AIMS: We aimed to examine the influence of antipsychotics on brain metabolism in individuals with schizophrenia in a naturalistic setting. SETTINGS AND DESIGN: A cross-sectional study was carried out by the psychiatry department of a tertiary care hospital in collaboration with the Radiation Medicine Centre. MATERIALS AND METHODS: Eighteen male patients with schizophrenia in different phases of treatment underwent an 18F-deoxyglucose positron emission tomography scan in a resting state 12 hours after the last dose of antipsychotic. Statistical Analysis: The types and duration of treatment were then compared with the regional glucose uptake in 14 predetermined regions of interest. The relative Uptake Values were further compared using SPSS 11.0. RESULTS: An immediate increase followed by a decrease in cortical uptake was noted while the basal ganglia uptake remained high, albeit with a decreasing trend. Typical antipsychotics were associated with lower frontal cortical and higher basal ganglia and cerebellar uptake as compared to atypical antipsychotics. CONCLUSION: The differential influence of the type and duration of antipsychotic on glucose uptake suggests a possible trend towards long-term side effects with typical medications that were not noted on clinical examination. This however needs to be confirmed with larger, controlled studies.

Metastatic adenocarcinoma presenting as an inguinal hernia: a case report and review of literature.

A 61 year old man presented with an inguinal hernia with no other significant symptoms. Histopathological examination of the hernial sac revealed metastatic deposits of a mucin secreting adenocarcinoma which was confirmed by subsequent tumor marker levels. Patient was put on chemotherapy for disseminated adenocarcinoma and is tolerating it well. This case emphasizes the need to carefully examine all hernial sacs received for pathological examination.

Clear cell sarcoma of the kidney--a study of seven cases over a period of three years.

Clear cell sarcoma of the kidney (CCSK) can display diverse morphological patterns and mimic various other pediatric renal tumors. An accurate diagnosis of this tumour is important considering the therapeutic and prognostic implications. AIM: The present study was undertaken to describe the various histological patterns of CCSK. The histology of 7 cases and the available case files of CCSK accrued over a period of3 years were reviewed. Immunohistochemical (IHC) stains were performed in 3 cases. The histological patterns observed in this study were classical (observed in 4 cases), epithelioid trabecular, myxoid, palisading and hyaline sclerosis types. IHC revealed reactivity to vimentin and non-reactivity to cytokeratin, desmin, smooth muscle actin, neuron specific enolase (NSE) and S-100 protein. Since CCSK is essentially a histological diagnosis, the importance of an accurate diagnosis of CCSK by a pathologist cannot be overemphasized. This study describes the various histological patterns that can be observed in CCSK.

Chondroblastoma of bone--not a " benign disease": clinico-pathologic observations on sixty cases.

Chondroblastomas (CBL) account for less than 1% of all bone tumors. A 46 year review (1955-2000) of bone tumors yielded 60 cases of CBL. This paper reviews their histology, radiology, clinical presentation and emphasizes that this seemingly benign lesion is capable of aggressive behaviour. Histopathology slides and radiographs of sixty patients were studied and clinical details and follow-up were obtained. There were 44 males and 16 females, aged between 10 to 30 years. Long bones were involved in 81.4% of the cases, tibia being the commonest site. Symptoms comprised pain (60%), local swelling (25%) and joint symptoms (5%) or a combination of these. Radiologically, an oval sharply demarcated lytic lesion predominantly in the epiphysis was noted in 50% of the cases. On microscopy all lesions revealed chondroblasts having irregular grooved nuclei and osteoclasts with 80% of the tumors showing chondroid differentiation and calcification. Treatment comprised curetting (34 cases), wide excision (21 cases), radical excision (1 case) and was unknown in 4 cases. Follow-up ranging from 2 to 26 years was available in 83.3% of the patients; six (10%) had local recurrence (at 6 months, 8 months, 1 year, 2 years, 3 years and 5 years), two (3.3%) developed lung metastasis (synchronous in one and at 18 months in the other) and spontaneous malignant transformation occurred in one (1.4%) patient after 9 years; subsequent to three local recurrences. CBL, though seemingly benign, can behave in an aggressive manner. Since there are no reliable histological features to predict biologic behaviour, regular long term follow-up is recommended.