A case of an uncorrected double outlet right ventricle with ventricular septal defect in pregnancy

Congenital Heart Diseases (CHD) lead to various changes in the normal mechanisms of hemodynamics. Pregnancy in women with CHDs is rare. Double Outlet Right Ventricle (DORV) is a rare disorder, in which both the aorta and the pulmonary artery arise from the right ventricle. We present a case of a thirty-year-old pregnant woman who presented to us with 22 weeks of amenorrhea. She had DORV with VSD, which was undiagnosed till she came to our hospital. Double Outlet Right Ventricle (DORV) is a rare congenital heart disease. Pregnancy in a patient with DORV needs early diagnosis and a stepwise multidisciplinary approach for successful outcomes.

A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India

Background: Recurrent and clinically unresponsive dermatophytosis is being increasingly encountered in our country. It runs a protracted course with exacerbations and remissions. However, there is little information regarding the extent of the problem and the characteristics of recurrent dermatophytosis in published literature. Aims: We sought to determine the prevalence, risk factors and clinical patterns of recurrent dermatophytosis in our institution. We also investigated the causative dermatophyte species and antifungal susceptibility patterns in these species. Methods: One hundred and fifty patients with recurrent dermatophytosis attending the outpatient department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India were enrolled in the study conducted from January 2015 to December 2015. A detailed history was obtained in all patients, who were then subjected to a clinical examination and investigations including a wet preparation for direct microscopic examination, fungal culture and antifungal susceptibility tests. Results: Recurrent dermatophytosis was seen in 9.3% of all patients with dermatophytosis in our study. Trichophyton mentagrophytes was the most common species identified (36 patients, 40%) samples followed by T. rubrum (29 patients, 32.2%). In-vitro antifungal susceptibility testing showed that the range of minimum inhibitory concentrations (MIC) on was lowest for itraconazole (0.015–1), followed by terbinafine (0.015–16), fluconazole (0.03–32) and griseofulvin (0.5–128) in increasing order. Limitation: A limitation of this study was the absence of a suitable control group (eg. patients with first episode of typical tinea). Conclusion: Recurrence of dermatophytosis was not explainable on the basis of a high (MIC) alone. Misuse of topical corticosteroids, a high number of familial contacts, poor compliance to treatment over periods of years, and various host factors, seem to have all contributed to this outbreak of dermatophytosis in India.

Changing trends in Cesarean delivery.

The study conducted in retrospective manner in 150 bedded Government Victoria Hospital Maternity Hospital affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh. The rates and indications of primary and repeat Cesarean section rate was compared with 2004 and 2009 Cesarean rates. In our study, the Cesarean section rate was 25.66%. There is an increase in the CS rate over last decade from 16.14% in 2004, 20.33% in 2009 to 25.66% in 2014. The main contribution to this rise in CS is due to increase in numbers of repeat sections. CS become increasingly the procedure of choice in high risk pregnancies to prevent perinatal morbidity and mortality. This has become possible due to improved patient care, availability of effective antibiotics, blood transfusion services safer anesthesia, improved surgical technique and sophisticated neonatal care services.

IgG/IgA pemphigus reactive with desmoglein 1 with additional undetermined reactivity with epidermal basement membrane zone.

IgG/IgA pemphigus is an extremely rare subset of pemphigus, showing anti-keratinocyte cell surface antibodies of both IgG and IgA classes. Herein, we describe a unique case of IgG/IgA pemphigus with clinical features of edematous erythema and peripheral vesiculopustules. Histopathology showed the presence of subcorneal pustules and acantholytic blisters in the mid-epidermis with neutrophilic infiltration and eosinophilic spongiosis. Direct immunofluorescence of perilesional skin showed both IgG and IgA deposits to keratinocyte cell surfaces and unusual granular deposits of IgG, IgM, and C3 along basement membrane zone. On enzyme linked immunosorbent assay , the auto-antibodies were found to be reactive to desmoglein 1 antigen. Various clinical, histopathological, and immunological findings in our case overlapped with the features of IgA pemphigus, pemphigus herpetiformis, and pemphigus foliaceus. These findings indicate that IgG/IgA pemphigus may be a transitional form between IgA pemphigus and pemphigus herpetiformis, and thus provides insight into the pathogenicity of this rare disorder.

Cytomegalovirus pneumonia in adult acute lymphoblastic leukemia.

Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunosuppressed patients. Though acute lymphoblastic leukemia (ALL) is an immunosuppressed state, CMV disease has been reported infrequently. We present a patient of adult B lineage ALL who was on maintenance chemotherapy and developed CMV pneumonia. Patient was managed with intravenous ganciclovir and had successful outcome. However, three weeks later patient had a relapse of ALL and died shortly after high dose chemotherapy.

Effect of antioxidants (vitamin C, E and turmeric extract) on methimazole induced hypothyroidism in rats.

The study was to investigate the protective effect of antioxidants against methimazole (MMI) induced hypothyroidism in rats. Male Wistar rats were fed MMI, MMI plus vitamin C, MMI plus vitamin E and MMI plus turmeric extract (TE) supplemented diet. At the end of the experiments, thyroid weights, thyroxine (T4), triiodothyronine (T3) and cholesterol levels were determined. It was observed that MMI treated rats showed increase in thyroid weights, very low levels of circulating T4, T3 and increased levels of total cholesterol as compared to controls (P< 0.001). However, rats which received Vit. C, Vit. E or TE along with MMI showed reduced weights (38-55% less) in thyroid glands (P < 0.01), less suppressed T4 and T3 levels (2-6% and 7-35% respectively) and less increase in total cholesterol levels (19-52%) which are statistically significant. The data suggest the positive effect of antioxidants on thyroid gland which could be due to direct involvement of antioxidants on thyroid gland.

Echocardiography in patients with cerebral infarction.

Fifty consecutive patients of cerebral infarction underwent a detailed evaluation for the presence of cardiac disease, by means of a standard questionnaire, clinical examination, a 12 lead electrocardiogram, and a 2-D echo and colour Doppler examination. Only 9 patients had a normal echocardiogram, while as many as 27 (54%) demonstrated potential cardio-embolic abnormalities. Clinical and ECG evidence of pre-existent cardiac disease had been demonstrable in only 13 (26%) patients.