Small cell neuroendocrine carcinoma with primary orbital involvement – The unseen, and a review of literature

Neuroendocrine neoplasms are derived from the epithelial lineages mainly of respiratory tract, with predominant neuroendocrine differentiation. There are only a handful of documented cases of paranasal small cell neuroendocrine carcinomas (SNEC) with primary orbital involvement. Here, the authors describe a 33-year-old male patient with rapidly progressive swelling of the right lower lid with proptosis since 4 weeks. On contrast-MRI orbit, an ill-defined multilobulated mass measuring 3.6 × 3.1 cm with intense homogenous enhancement was seen in the right retrobulbar space involving the right ethmoid sinus. On incisional biopsy, a poorly differentiated mass containing numerous small round blue cells and scanty intervening stroma with prominent necrosis and apoptosis was seen. Immunohistochemistry was strongly positive for synaptophysin. He was diagnosed as a case of SNEC and received chemotherapy, with good response till date of 9 months of follow up. The authors present a literature review and describe challenges in management of a primary orbital SNEC.

Myopia, axial length, and optic coherence tomography characteristics of the macula in Indian children

Background: Myopia is a common condition affecting a significant proportion of the pediatric population in Asian countries. Aim and Objectives: This study was undertaken to investigate the associations of optical coherence tomography measurements of macular volume and macular thickness with refractive error and axial length in Indian children. Materials and Methods: The prospective observational study was carried out at MRA Medical College, Ambedkar Nagar, Uttar Pradesh. We enrolled 300 consecutive cases (190 cases and 110 controls) of pediatric age group (6–18 years) between January 2015 and December 2018. Pearson’s correlation was performed with refractive errors, axial length, macular thickness, and volume. Results: Children with myopia (SE ?0.5–?4.57 D) tended to have smaller total macular volume and thinner macular thickness as, compared to control. The correlation of macular thickness and macular volume was analyzed with spherical equivalent (SE) and axial length. Macular thickness had negative correlation with SE and positive with axial length, correlation coefficients being observed as (r = ?0.886 and 0.880, P ? 0.001). Total macular volume correlated negatively with SE, (r= ?0.771, P ?0.001) and positively with axial length (r = 0.764, P ?0.001). Conclusion: Increasing axial myopia was associated with increased macular volume and thickness. It establishes the importance of the fact that refractive error should be considered in the interpretation of macular thickness.

Acute pancreatitis masquerading as mesentric growth in COVID-19 patient: A case report

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It commonly affects the respiratory system, producing pneumonia-like symptoms. Among extrapulmonary manifestations, involvement of the gastrointestinal tract is common with symptoms of nausea, vomiting, diarrhea, and abdominal pain. Coronavirus acts by targeting the ACE-2 receptors in the alveoli of the lungs, but because these receptors are also present in other organs, such as the pancreas, it can affect the pancreas as well, thus causing acute pancreatitis. We here discuss a case of a 72-year-old hypertensive male with COVID-19 who presented with atypical presentation of acute abdominal pain and a few episodes of vomiting. Laboratory investigations were inconclusive. Imaging findings were suggestive of small bowel obstruction and perforation; thus, an exploratory laparotomy was done in which a mesenteric growth was found, reported as acute pancreatitis on histopathology. Therefore, attention should be paid to the pancreatic involvement and atypical presentations in COVID-19 patients.

A cross-sectional comparative study of functioning in patients with bipolar depression and patients with unipolar depression

Background: Bipolar affective disorder is an episodic illness in which patient suffers from unexpected change in affect like elated mood episode (mania) followed by either depressed mood with period of inter episode euthymia. The disease in comparison to unipolar depression starts in early thirties, more severe symptoms and with more detriment in functioning and wellbeing. Aim and Objectives: The present study asses the level of global functioning of bipolar depressive patients in different domains and data compared with unipolar depressive patients. Materials and Methods: This study was done at a tertiary center in India. The study included 30 patients with bipolar depression in study group and 30 patients with unipolar depression included in control group. In all the patients of both groups, relevant scales, that is, back depression inventory and global assessment of functioning (GAF) were applied. These data were statistically analyzed by SPSS software. Results: On Comparison of global assessment of functioning scores between both groups the GAF score in bipolar depressive patients (SD ± 50.03 [4.75]) had significantly lower score as compared to unipolar depressive patients (62.37 [SD ± 11.50]), also patients show significant negative correlation. (?0.559) of GAF score and total Beck Depression Inventory score in case group (bipolar depressive patients). Conclusion: These findings of greater impairment in global functioning may be interpreted by understanding that life of patients with bipolar depression also complicated by having episode or episodes of manic symptoms in addition to their depressive episodes while patients with unipolar depression are experiencing depressive episodes only.

Large orbital glial heterotopia- A rare entity

A 15-month-old child was brought to the ophthalmology outpatient department with his parents complaining of a large mass located on the nasal side of his right eye since birth. On examination, an irregular mass was seen to be located on the nasal side of his right orbit, obscuring the visual axis. On a contrast-enhanced computed tomography scan, a heterogenous lesion was seen to be located on the bridge of the nose and the medial aspect of the right orbit without any bony defect or communication with the brain or sinuses. In view of the possibility of developing amblyopia, the lesion was surgically removed. On histopathological examination, a diagnosis of extranasal glial heterotopia was made. To the best of our knowledge, this is the largest extranasal glial heterotopia in the orbit to be ever reported.

Family vitiligo impact scale: A scale to measure the quality-of-life of family members of patients with vitiligo

Background: Vitiligo places a significant psycho-social burden on caregivers and family members. Aims: The aim of the study was to develop and preliminarily validate a scale to measure the psychosocial impact of vitiligo on adult family members. Methods: Themes that emerged from qualitative interviews and a focus group discussion with family members were used to generate items for a preliminary scale, followed by pre-testing and scale development. The new scale was then tested with two comparator scales and a global question. Results: A preliminary scale with 32 items was pilot tested on 30 participants. Following this, the scale was condensed to 16 items in 12 domains that were administered to 159 participants. Scale scores ranged from 0 to 48 with a mean of 19.75 ± 12.41. The scale had excellent internal consistency with Cronbach’s alpha coefficient of 0.92 (0.70–0.95) and also showed good test-retest reliability at two weeks (r = 0.946). The scale showed criterion, convergent and known group validity. Limitations: It was conducted in a large teaching hospital which may have resulted in selection of patients with persistent or progressive disease and more worried family members. Vitiligo is highly stigmatized in our country and the performance of the scale may need to be evaluated in other communities and cultures as well where stigma is less oppressive. Conclusion: Family Vitiligo Impact Scale appears to be an easy-to-complete, reliable and valid instrument to measure the psychosocial impact of vitiligo in family members of patients. It may be useful as an outcome measure in both clinical and research settin

Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases

@#Introduction: Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables. Materials and methods: This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland – Altman plot. Results: Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6- 8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value <0.05). Female, compared to male, had significantly smaller (p<0.0001) and thinner graft (p<0.0001). There was a strong agreement between the literature and our observed graft diameter, but with an overestimated graft diameter in 18.5% of the cases. Conclusion: Among anthropometric parameter, only height and weight had moderate positive correlation with graft diameter. Males had longer and wider ST graft in contrast to age-matched female group.

Comparative clinical trial of intracameral ropivacaine vs. lignocaine in subjects undergoing phacoemulsification under augmented topical anesthesia

Purpose: To compare intracameral Ropivacaine to Lignocaine during phacoemulsification under augmented topical anesthesia, in terms of efficacy and safety. Methods: This prospective, randomized, double-masked clinical trial included subjects planned for phacoemulsification with posterior chamber intraocular lens implantation for visually significant uncomplicated senile cataract, under augmented topical anesthesia. Cases were randomized into two groups, Group A (Ropivacaine 0.1%) or Group B (Lignocaine 1.0%). The pain experienced by the patients during the surgery, mydriasis, post-op inflammation and endothelial cell change at six weeks after the procedure was evaluated. Surgeon's feedback was recorded to evaluate the cooperation of the patient during surgery. Results: A total of 210 subjects were screened and 184 were randomized to have 92 subjects in each group. There was no statistically significant difference seen on comparing Group A and B with respect to Age (P = 0.05), painful surgical steps (P = 0.85), visual analog scale scores (P = 0.65), surgeon's score (P = 0.11), postoperative inflammation (P = 0.90) and average ultrasound time during phacoemulsification (P = 0.10). Subjects in Group A fared better when compared to Group B with respect to endothelial cell loss (P = 0.0008), and augmentation in mydriasis (P < 0.001). Conclusion: Intracameral Ropivacaine and Lignocaine, both are equally effective in providing analgesia during phacoemulsification. However, intracameral Ropivacaine is superior to Lignocaine with regards to corneal endothelial cell safety, and augmenting mydriasis.

Smartphone photography for screening amblyogenic conditions in children

Purpose: To validate the smartphone photography as a screening tool for amblyogenic conditions in children. Methods: Children between 5 to 8 years attending eye out patient department (OPD) were photographed (by an optometrist) with a smartphone to capture their pupillary red reflexes followed by clinical examination by the principal investigator (PI). The PI on the basis of clinical examination identified children with significant amblyogenic conditions and, subsequently, two ophthalmologists independently categorized the photographs on the basis of color, symmetry, and shape of the pupillary reflex into normal or abnormal. The identification of amblyogenic conditions on clinical examination was compared to that on photography. Refractive errors <3D and anisometropia <2D were excluded. Sensitivity, specificity, positive predictive value, and negative predictive value of smartphone photography screening were determined. Results: In all, 250 children were screened. Clinically 23.6% were harboring amblyogenic conditions. The mean sensitivity and specificity of screening by smartphone were 94% and 91%, respectively. Conclusion: Smartphone photography is a reliable tool for detection of amblyogenic conditions in children.

Prospective evaluation of the quality of life of oral cancer patients undergoing post-operative radiotherapy in a Regional Cancer Centre of central India

Background: The assessment of the quality of life (QOL) has become an important aspect of oral cancer research. It has allowed the evaluation of the impacts of the disease as well as the treatment from the patient’s perspective. Objectives: The objective of this study is to assess the QOL of oral cancer patients undergoing post-operative radiotherapy (PORT) during treatment as well as after the completion of treatment. Materials and Methods: It is a hospital-based prospective observational study. It was carried out in Regional Cancer Centre, Dr. Bhim Rao Ambedkar Hospital, Raipur, India. A total of 108 oral cancer patients with cancer-free survival after surgery who satisfied the study criteria and got registered for PORT were included as study participants. The data with regard to their QOL were collected using the European Organization for Research and Treatment of Cancer QOL Core Questionnaire-C30 and the European Organization for Research and Treatment of Cancer Head and Neck Module (QLQ-H and N35) at three time-points, i.e., just before initiation, just after completion, and 6 months after completion of PORT. Mean, median, standard deviation, standard error, and 95% confidence intervals were calculated. Statistical significance was set at P < 0.05. The association between QOL at various time points was analyzed using Wilcoxon signed-rank test and Friedman’s ANOVA. Results: It was elicited that various scales of functional and symptomatic domains of QOL were significantly impaired at the end of RT and either restored to or improved from pre-RT level, at 6 months after completion of PORT. However, social functioning, nausea vomiting, appetite loss, dry mouth, and sticky saliva remained significantly deteriorated at the final assessment as compared to pre-RT level. Conclusions: This study concludes that QOL alters significantly over a short period of time from pre-RT to subsequent post-treatment period. However, it emphasizes the all-important need for psycho-social support in addition to disease cure for oral cancer patients during their treatment as well as a later period.

Intra- and Inter-observer Variability in Different Methods of Measuring Carpal Collapse

@#Introduction:Carpal collapse of wrist occurs in disorders like rheumatoid arthritis and Kienbock's disease. Three techniques have been described to measure carpal collapse. First, the carpal height ratio (CHR), measured by dividing carpal height by 3rd metacarpal length. Second, the revised carpal height ratio (RCH ratio), measured by dividing carpal height by length of capitate. Third, capitate radius distance (CR index), measured by shortest distance between distal edge of radius and the proximal edge of capitate. The index publications describe good reliability of all these but which method out of the three is best in terms of intra- and inter-observer variability is not known. The purpose of this study was to find out which method had the least inter- and intra-observer variability for determining carpal collapse. Materials and Methods: Fifty normal wrist postero-anterior radiographs were studied by three assessors who measured CHR, RCH ratio and CR index separately. The measurements were repeated after one month by all the three observers. The results were then statistically analysed. Results: The p-value was <0.001 in all the three assessors in CR index meaning that the intra-observer variability was least in CR index. For the inter-observer variability intra class coefficient of 0.9 indicated that the CR index has the least variability. Conclusion: CR index is the most reproducible method to measure carpal collapse. The method which provides accurate measurement of carpal collapse will allow better staging of carpal disorders.

RELATIONSHIP BETWEEN ISOKINETIC LEG STRENGTH AND KNEE FRONTAL PLANE PROJECTION ANGLE DURING SINGLE LEG SQUAT AMONG MALE JUNIOR ATHLETES

@#Background: Those with increased dynamic knee valgus are vulnerable to increased risk of non-contact knee injuries. However, studies on the top down kinetic chain of lower limb mechanics during dynamic motions such as single leg squat (SLS) among trained males were scarce. Objective: The objective of the study was to evaluate the relationship between isokinetic hip and knee strength and frontal plane projection angle (FPPA) of the knee joint during SLS. Methods: Thirty-two male junior athletes (twelve cyclists, ten runners and ten squash players) were screened for excessive dynamic knee valgus (DKV) prior to participation. Only those within the normal value of DKV were included. Their hip and knee isokinetic strength in sagittal plane were evaluated at 60º/s of angular velocity for both legs using dynamometer. Two dimensional knee FPPA was evaluated during SLS at 60º of knee flexion. Pearson correlation was evaluated between knee FPPA during SLS and isokinetic leg strength. Results: Correlations between knee FPPA and hip and knee isokinetic strength were not statistically significant except between knee flexion peak torque/body weight (r = -0.35, p = 0.05) and hamstring to quadriceps ratio (r = -0.39, p = 0.03) of non-dominant leg. Conclusions:Isokinetic hip and knee strength and knee FPPA during SLS was correlated only for non-dominant leg during SLS among male junior athletes. DKV during SLS may be reduced through strengthening the muscles around hip and knee joints.

A roadmap for achieving health equity in India: A proposed framework and assessment of the determinants of health equity

With the upcoming technical interventions in the health sector of India, India has been able to create a great scope for Medical Tourism in the country. People from different nations are coming to India to avail many critical treatments at an affordable price. Even after such great development, Health Equity has always been a great challenge for our country. Through Health Equity, we mean availing the standard health services by the under-privileged, marginalized group of people compared to the privileged segment of the community. The present study will help us to highlight on the prioritization of the allocation of the resources to the most eminent tier of the Health care structure. Also, this study will focus on the effectiveness of this component of the Health care structure of India and how this can help in throwing light on the disparity of the health care services through a proposed model.

Clinico-histopathological Concordance in Leprosy Patients - A Study of 200 Cases

As information about profile of leprosy from different geographical areas is important, this study was carried out to document the clinical profile of leprosy cases reporting to a medical college, a tertiary care settings in Rajkot, Gujarat. Further this study also aimed at analysing the concordance of clinical findings with bacteriological and histopathological characteristics. 200 leprosy patients who came to Dept. of D.V.L., P.D.U. G.M.C, Rajkot from October 2014 to September 2016 were included. Thorough history with routine investigations, slit skin smear, biopsy for H & E and Fite Faraco stain was undertaken. The most common age group was 21-30 years (31%) with male to female ratio 1.82:1. 15 (7.5%) of these cases were migrants. 71.5% were multibacillary patients. 8% were relapse cases. Only 3 (1.5%) belonged to paediatric age group. Clinically maximum patients (91, 45.5%) were of lepromatous leprosy followed by borderline tuberculoid leprosy (46, 23%). An overall 65% of these cases were positive for acid fast bacilli (AFB) in slit skin smears. 17% had Type II reactions whereas only 2% had Type I reactions. 36% of these patients had grade I and 12.5% had grade II deformity. The most common histopathological entity was borderline tuberculoid (25%) followed by lepromatous leprosy (24.5%). Maximum clinical concordance was seen in borderline lepromatous (72.72%. The histopathological diagnosis was consistent with clinical diagnosis in 116 cases (58%) which indicates the need for strengthening of skills and or more research into criteria or dynamics of disease spectrum in this area. A combined approach including clinical, bacteriological and histopathological examination would be desirable to reach at final diagnosis and classification in tertiary care/referral centres. Population based studies followed by intensification of anti-leprosy activities appear to be necessary in this area.

Sexually transmitted infections: Need for extragenital screening

Extragenital infections can occur concurrently with simultaneous urogenital infections. Extragenital sites are believed to serve as hidden reservoirs and play a critical role in their transmission. The etiological relationship of the most widespread Sexually transmitted diseases (STD) pathogen to reproductive tract has long been established, but the distribution to extragenital sites appears to be infrequent and its correlation with the sexual practice still requires to be investigated. Optimal-screening strategies for extragenital infections are largely unknown. However, there is a lack of data on clinical outcomes and optimal treatment regimens for rectal and pharyngeal extragenital infections. Further studies are needed in settings other than reproductive health and STD clinics, especially in primary care clinics and resource-limited settings.

Human leucocyte antigen Class I and II alleles associated with anti‑hepatitis C virus‑positive patients of North India.

Purpose: Humans are the only known natural hosts of hepatitis C virus (HCV). This study was undertaken to examine the frequencies of human leucocyte antigens (HLAs) Class I and Class II genotype profiles in anti‑HCV‑infected patients of Northern India. Materials and Methods: From a period of January 2013 to August 2014, 148 anti‑HCV‑positive patients of North India referred to the Department of Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospitals, New Delhi, for performing HLA typing were included in the study. Results: A*02, A*31 allele frequency decreased significantly in anti‑HCV‑positive patients. Frequencies for HLA‑B loci did not reach any statistical significance. Among the Class II alleles, HLA‑DRB1*03 and HLA‑DRB1*10 were significantly higher in the patient population, and HLA‑DRB1*15 was significantly decreased in the patient population as compared to the controls. Conclusion: HLA‑A*33 was significantly increased as compared to control population and showed geographic variation in HCV‑infected individuals of India.

Rhinoentomophthoromycosis: A rare case report.

Entomophthoromycosis is chronic granulomatous fungal infection with varied presentation as subcutaneous,mucocutaneous and visceral infections. The majority of the subcutaneous infection caused by entomophthoralean fungi involves Basidiobolus spp, C. coronatus, or C. incongruous. A case of rhinoentomophthoromycosis in an immunocompetent male involving maxillary sinus and nose is presented. The patient was clinically diagnosed as malignancy of nose but microscopy and histopathology of the aspirate clinched the diagnosis. The patient responded to antifungal therepy.