The paradigmatic shift in the clinical profile of dengue patients: a prospective observational study from a tertiary care center in north India

Background: Dengue a vector-borne viral disease transmitted by mosquito and has several complications causing fatalities and a bad impact on society. The paucity of studies in Uttar Pradesh and lack of epidemiological data necessitated to take up this prospective study. Thus, the current study looked into the causes of heavy prevalence, urban v/s rural ratio, gender difference, various complications to formulate a strategy to limit the severity of the disease by early diagnosis and rapid intervention. The fever caused by dengue is characterized by body ache, petechial rashes, myalgia, and nausea and vomiting. There can be varied manifestations of dengue involving the lung, pleura, peritoneum, pericardium, and complications of liver, kidney, brain, muscle, eye, and other organs. The disease is characterized by thrombocytopenia, dehydration, bleeding tendencies, shock, and multiorgan dysfunction. Current estimates reports about 40% (2.5-3 billion) of the world population are at risk. Purpose: The study is aimed at detecting clinical signs and symptoms of patients with dengue fever presenting to TMU teaching hospital between January 2019 to December 2019. Material and Methods: A prospective observational study was undertaken in serologically confirmed cases of dengue. The disease was analyzed for its clinical profile, required investigations were done and evaluated. Results: In the present study the clinical outcome was: 1) Dengue fever without warning sign was (29.46%). 2) Dengue fever with a warning sign (57.87%). 3) Severe dengue fever (12.12%). Mortality noted in the present study was 1.8%. Bleeding manifestations were noted in 8.2% of patients. Thrombocytopenia (<100,000) was noted in (85.85%) patients. Fever was the presenting complaint in the majority of the patients (99.3%). Fever was followed by myalgia (91.9%), headache (58.8%), arthralgia (28.2%). Conclusions: Patients of dengue presented with fever, headache, myalgia, nausea, vomiting. Bleeding manifestations were looked for. Lab findings like leucopenia and deranged liver function test were more than other studies.

A rare case of benign fibrous histiocytoma of the cornea

Fibrous histiocytoma (FH) commonly occurs in the superficial layers of the skin. Orbit and limbus are documented ophthalmic sites of involvement but isolated corneal FH has never been reported in literature. We present the first case of FH exclusively involving the cornea where a 10-year-old male child presented with a 3-month history of a painless growth on the superior cornea of the right eye with deterioration of vision. Tumor excision with therapeutic penetrating keratoplasty was done and the histopathological examination confirmed the diagnosis. There was no recurrence and the corneal graft was clear at 1 year.

ABC, VED and lead time analysis in the surgical store of a public sector tertiary care hospital in Delhi

Background: An efficient inventory control system would help optimize the use of resources and eventually help improve patient care. Objectives: The study aimed to find out the surgical consumables using always, better, and control (ABC) and vital, essential, and desirable (VED) technique as well as calculating the lead time of specific category A and vital surgical consumables. Methods: This was a descriptive, record-based study conducted from January to March 2016 in the surgical stores of the All India Institute of Medical Sciences, New Delhi. The study comprised all the surgical consumables which were procured during the financial year 2014–2015. Stores ledger containing details of the consumption of the items, supply orders, and procurement files of the items were studied for performing ABC analysis and calculating the lead time. A list of surgical consumables was distributed to the doctors, nursing staff, technical staff, and hospital stores personnel to categorize them into VED categories after explaining them the basis for the classification. Results: ABC analysis revealed that 35 items (14%), 52 items (21%), and 171 items (69%) were categorized into A (70% annual consumption value [ACV]), B (20% ACV), and C (10% ACV) category, respectively. In the current study, vital items comprised the majority of the items, i.e., 73% of the total items and essential (E) category of items comprised 26% of all the items. The average internal, external, and total lead time was 17 days (range 3–30 days), 25 days (range 5–38) and 44 days (range 18–98 days), respectively. Conclusions: Hospitals stores need to implement inventory management techniques to reduce the number of stock-outs and internal lead time.

Ectopic Eruption of a Transmigrated Mandibular Canine: A Rare Case Report.

Migration of teeth, both physiological as well as pathological, is a well-documented phenomenon. Transmigration, on the other hand, is a rare phenomenon where a tooth crosses the midline and migrates to the opposite side without any pathological influence. An impacted tooth especially canines migrate to a location some distance away but do not usually cross the midline. Even so, the tooth remains impacted. Here is a unique case of transmigration of a left mandibular canine, which has erupted labial to its counterpart on the right mandibular arch. Transmigration of the mandibular canine is a rare phenomenon. Even rare is an eruption of this transmigrated canine into the opposite arch where it can be mistaken as a supernumerary tooth.

Pigmented Basal Cell Carcinoma: A Case Report.

Basal cell carcinoma (BCC) which is also known as rodent ulcer is the most common type of skin cancer. Prolonged exposure to high-intensity ultraviolet radiation is regarded as the most common risk factor of BCC. This ionizing radiation can induce DNA damage such as point mutations, and single stranded DNA breaks. Other possible pathogenic mechanism includes the involvement of the tumor suppresser gene, and the members of sonic hedgehog signal transduction pathway. Pigmented BCC (PBCC) is a rare variant of BCC, of which only very few cases have been reported in literature. This is a case report of such a case of PBCC.

Extra Gingival Pyogenic Granuloma: Unusual Location for the Usual Lesion.

Pyogenic granuloma (PG) is a benign non-neoplastic mucocutaneous lesion formed in reaction to mild irritation or hormonal changes. Although this fairly common lesion has a striking predilection for the gingiva, it can also be found extra gingivally. The clinical diagnosis of such an uncommon extra gingival PG can be quite challenging as the lesions appear as smooth or lobulated red nodules with easy bleeding, occasionally ulcerated mimicking malignancies. The purpose of this article is to report an unusual case of extra gingival PG occurring on the upper lip. The diagnosis of oral lesions is complex due to distinct appearance of the same lesion and leads the clinician to consider lesions with different diagnostic methods.

Oral Manifestations of Neurofibromatosis: A Rare Case Report.

Neurofibroma (NF) is a rare benign non-odontogenic tumor of the oral cavity. NF may present either as solitary lesions or as part of the generalized syndrome of NF or von Recklinghausen’s disease of the skin. The heterogeneous nature of NF was established by Riccardi et al. and he recognized at least seven types of NF. Among these proposed classifications of the disease, two distinct forms are generally accepted namely, a peripheral form known as NF Type I (NF-I), and a central form known as NF-II. NF-I represents the classic form of this disease, described by Recklinghawsen in 1882. Clinically, oral NF usually appears as slow growing, painless, pedunculated or sessile nodules. For illustration, a case of a NF with oral findings is been presented.

Proliferative Veruccous Leukoplakia: An Extensive Red and White Lesion.

Proliferative verrucous leukoplakia (PVL) is a rare form of leukoplakia, which was first described by Hansen et al. in the year 1985. PVL is a disease with aggressive behavior due to its high rate of recurrence and a high rate of malignant transformation, usually more than 70%. This is a long-term progressive condition, which is observed more frequently in females over the age of 60 years. In the course of time, PVL tends to become multifocal with progressive deterioration of the lesions, making it more and more difficult to control. Unlike other cases of leukoplakia, tobacco use does not seem to have a significant influence on the appearance and progression of PVL. As this condition is seen in non-smokers, the etiology of PVL remains unclear making the management and diagnosis difficult. The aim of this article is to present a case which is diagnosed based on the diagnostic criteria proposed by Cerero-Lapiadra et al.

Is taxane/platinum/5 fluorouracil superior to taxane/platinum alone and does docetaxel trump paclitaxel in induction therapy for locally advanced oral cavity cancers.

BACKGROUND: Cisplatin and 5 fluorouracil drug combination is inferior to the combination of taxane with these 2 drugs. However, often in clinical practice at our center giving TPF (docetaxel, cisplatin, 5 fluorouracil) is difficult in view of logistics and tolerance issues. In such a scenario, we prefer to use the 2 drugs combination of platinum and taxane. However, no study has addressed whether a 2 drugs combination, which includes taxane is inferior to the 3 drugs combination and which the taxane of choice is in the 2 drugs combination of taxane and platinum. METHODS: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy (IC) in oral cavity cancers from 2010 to 2012. We chose for analysis those patients who had a baseline scan done within 4 weeks of starting therapy and a follow‑up scan done within 2 weeks of completion of the second cycle of IC. Response was scored in accordance with RECIST version 1.1. Chi‑square analysis was done to compare response rates (RRs) between regimens. RESULTS: Two hundred and forty‑five patients were identified. The median age was 45 years (24–70 years), 208 (84.9%) were male patients, and 154 patients (62.9%) had primary in the Buccal mucosa. The regimens received were TPF 22 (9%), docetaxel + cisplatin 97 (39.6%), paclitaxel + cisplatin 89 (36.3%), docetaxel + carboplatin 16 (6.5%) and paclitaxel + carboplatin 21 (8.6%). The overall RRs were complete response, partial response, stable disease and progressive disease in 4 (1.6%), 56 (22.9%), 145 (59.2%) and 40 (16.3%). The 3 drugs regimen (TPF) had 50% RR as compared to 22% RR with 2 drugs regimen (P = 0.004). Docetaxel containing regimens had 30.3% RR as compared to 17.2% RR with paclitaxel containing regimens (P = 0.094). CONCLUSIONS: TPF has better RR than a 2 drugs taxane‑containing regimen and docetaxel leads to a better RR than paclitaxel for IC in locally advanced oral cavity cancers.

Multiple Supernumerary Teeth in a Non Syndromic Patient: Case Report.

Supernumerary teeth, also known as hyperdontia, is a term used to describe extra teeth that develop in addition to the 20 primary and 32 permanent teeth that we are predisposed to have. Hyperdontia is seen more commonly in the permanent dentition than primary teeth. Th e incidence in the permanent dentition is reported to vary between 0.1% and 3.8%, and its frequency in the primary dentition is found to be 0.3-0.8%. A 32-year-old male patient reported to the department of oral medicine and radiology with the chief complaint of stains and deposits, his clinical examination revealed 9 supernumerary teeth and panoramic radiographic revealed 3 more extra making a total of 12 supernumerary teeth.

Safety and Immunogenicity of a Quadrivalent Meningococcal Conjugate Vaccine (MenACYW-DT): A Multicenter, Open-label, Non-randomized, Phase III Clinical Trial.

Objective: To assess the safety and immunogenicity of a quadrivalent meningococcal (groups A,C,Y,W) polysaccharide diphtheria toxoid conjugate vaccine (MenACYW-DT) in India. Design: Open-label, descriptive, non-randomized study. Setting: Three medical college hospitals, one each in New Delhi, Bengaluru and Mumbai, India. Participants: 300 healthy, vaccine-naïve participants (100 children aged 2-11 years, 100 adolescents aged 12-17 years, and 100 adults aged 18-55 years). Intervention: One dose (0.5 mL) of MenACYW-DT administered intramuscularly. Main outcome measures: Serum bactericidal antibody titers against A, C, Y, and W were measured before and after MenACWY-DT vaccination. Safety data were also collected Results: Thirty days post-vaccination, geometric mean titers rose across all serogroups. Most participants had protective titers ≥8 (1/dil) across the four serogroups. The percentage (95% CI) achieving ≥8 (1/dil) in the Adolescent Group was typical – A: 96.9% (91.2%; 99.4%); C: 96.9% (91.2%; 99.4%); Y:100% (96.3%; 100%); W:100% (96.3%; 100%). In general, solicited reactions were mild and short-lived. Unsolicited events were uncommon and unrelated to vaccination. Conclusions: MenACYW-DT was well tolerated and elicited a robust and protective immune response 30 days post-vaccination against meningococcal serogroups A, C, Y, and W-135 in the Indian study participants aged 2-55 years.

Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference.

Impact Factor for 2013 is 1.131 Click here to download free Android Application for this and other journals Click here to view optimized website for mobile devices Journal is indexed with MEDLINE/Index Medicus and Science Citation Index ExpandedShare on facebookShare on twitterShare on citeulikeShare on connoteaShare on googleShare on linkedinMore Sharing Services MINI SYMPOSIUM: HEAD NECK CANCER Year : 2013 | Volume : 50 | Issue : 1 | Page : 1-8 Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference? VM Patil1, V Noronha1, VK Muddu1, S Gulia1, B Bhosale1, S Arya2, S Juvekar2, P Chatturvedi3, DA Chaukar3, P Pai3, A D'cruz3, K Prabhash1 1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India 2 Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India 3 Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India Date of Web Publication 20-May-2013 Correspondence Address: K Prabhash Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra India DOI: 10.4103/0019-509X.112263 PMID: 23713035 » Abstract Background: Locally advanced and unresectable oral cavity cancers have a poor prognosis. Induction might be beneficial in this setting by reducing tumor bulk and allowing definitive surgery. Aim: To analyze the impact of induction chemotherapy on locally advanced, technically unresectable oral cavity cancers. Materials and Methods: Retrospective analysis of patients with locally advanced oral cavity cancers, who were treated with neoadjuvant chemotherapy (NACT) during the period between June 2009 and December 2010. Data from a prospectively filled database were analyzed for information on patient characteristics, chemotherapy received, toxicity, response rates, local treatment offered, patterns of failure, and overall survival. The statistical analysis was performed with SPSS version 16. Results: 123 patients, with a median age of 42 years were analyzed. Buccal mucosa was the most common subsite (68.30%). Three drug regimen was utilized in 26 patients (21.10%) and the rest received two drug regimen. Resectability was achieved in 17 patients treated with 3 drug regimen (68.00%) and 36 patients receiving 2 drug regimen. Febrile neutropenia was seen in 3 patients (3.09%) receiving 2 drug regimen and in 9 patients (34.62%) receiving 3 drug regimen. The estimated median OS was not reached in patients who had clinical response and underwent surgery as opposed to 8 months in patients treated with non-surgical modality post NACT (P = 0.0001). Conclusion: Induction chemotherapy was effective in converting technically unresectable oral cavity cancers to operable disease in approximately 40% of patients and was associated with significantly improved overall survival in comparison to nonsurgical treatment.

Autobiographical memory deficits in acute transient psychosis after remission

Background : In our clinical practice, in patients who went into clinical remission from their psychotic episodes, we found variability in recall pattern of events and experiences occurring during psychotic states. Aims: The present study aimed to find out the deficits in autobiographical memory regarding the events and experiences which occurred during psychotic states in clinically remitted acute and transient psychotic disorder (ATPD) patients. Method: Consecutive patients (20), who went into clinical remission within a period of three months of onset of their first ATPD episodes, along with their informants (20), who were selected as per specific inclusion and exclusion criteria, were interviewed within a period of two months of clinical remission of their psychotic episodes. The interviews were based on a list which included items regarding different events and experiences restricted to the period of patients' illness and their recall abilities were compared. Results: Catatonic features, features suggestive of dis-inhibition, impairment of personal care, manic features and biological function impairment were the items which patients found difficult to recall. Conclusion: The study showed that the patients had autobiographical memory deficits regarding their catatonic features, dis-inhibitions, personal care and biological function impairments and manic symptoms after their clinical remission, which has clinical and management implications. However the study was limited by the small sample size and naturalistic design. Key message - Patients found it difficult to remember catatonic features, dis-inhibitions, manic symptoms, personal care and biological function impairments which occurred during their psychotic episodes after clinical remission of their acute transient psychotic episodes.

A cystic hepatic lesion: when to worry? / La lesión cística del hígado: ¿cuándo preocuparse?

A 16-year old female presented to hospital with abdominal pain. Features on computed tomography raised the possibility of biliary cystadenoma or cystadenocarcinoma. She underwent a liver resection, and histopathology confirmed a serous biliary cystadenoma. This case is presented to highlight the radiological features of this uncommon pre-malignant condition as well as to summarize a management algorithm for cystic liver lesions.

Una mujer de 16 años de edad acudió al hospital con un dolor abdominal. Las características observadas con tomografía computarizada apuntaban a un cistoadenoma biliar o un cistoadenocarcinoma como diagnósticos diferenciales. La paciente fue sometida a una resección del hígado, y la histopatología confirmó un cistoadenoma biliar seroso. Presentamos este caso para resaltar los rasgos radiológicos de esta condición premaligna rara, así como para resumir un algoritmo de tratamiento para las lesiones císticas de hígado.

Adenosquamous carcinoma of colon.

Primary adenosquamous carcinoma of the colon is an aggressive entity. We report a 41-year-old man with a combination of adenocarcinoma and squamous cell carcinoma of the cecum, treated by right hemicolectomy and ileo-transverse anastomosis. Postoperatively he received adjuvant chemotherapy. However, the tumor recurred at the original site within two months and thereafter the patient was lost to follow up.

Ocular fireworks injuries. Clinical features and visual outcome.

In a prospective analysis of ocular fireworks injuries over three consecutive years (1997 to 1999) during the Indian festival of Diwali, 42 patients presented with various types of fireworks-related ocular injuries. Twenty two (52%) patients had to be admitted for the management of their ocular injuries.