ANGIOKERATOMA: A RARE MANIFESTATION

Angiokeratoma shows dilatation of capillaries in the upper dermis and it also shows some epidermal changes, like- hyperkeratosis, papillomatosis, and thickening of epidermis or acanthosis .Clinical presentation of angiokeratoma includes plaques over the skin of lower limbs, mostly on the buttocks or thigh. It is usually identified clinically but a definitive diagnosis is made only on histopathological examination.A deeper biopsy of the lesion is empirically essential to make a concrete diagnosis as the characteristic changes seen in angiokeratoma, are limited to superficial dermis. Our case report has a 24 years old female presenting with unilateral, linear, bluish-black verrucous plaque on the back of left elbow.

LYMPHOEPITHELIOMA LIKE CARCINOMA OF URINARY BLADDER: A RARE CASE REPORT

Urinary bladder neoplasm is the 10 most common cancer in the world, predominantly affecting males. Nowadays incidence of urinary bladder carcinoma in female has increased. It is a uncommon type carcinoma of urinary bladder. It resembles to non-keratinizing carcinoma of nasopharynx. This study report a case of 65 years old male presented with painless gross hematuria for 3 weeks. Patient was a known case of Meckel's diverticulum. Ultrasonography and cystoscopy showed a mass on lateral wall of urinary bladder measuring 3x3 cm . A radical cystectomy of the urinary bladder tumor was done. He was diagnosed as case of lymphoepithelioma like carcinoma of urinary bladder along with benign prostate hyperplasia and Meckel's diverticulum was made with stage 2. According to the WHO classification criteria, Lymphoepithelioma like carcinoma is a subtype of undifferentiated carcinomas. Immunohistochemical stains are helpful to differentiate Lymphoepithelioma from primary lymphoma of the bladder. Differentiation of LELCB from urothelial carcinoma is important, since it has better prognosis compared to pure urothelial carcinoma. It is important to diagnose this neoplasm for therapeutic as well as prognostic purpose.

ECCRINE SPIRADENOMA : CASE REPORT WITH AN UNUSUAL CLININAL PRESENTATION

Eccrine spiradenoma is one of the rare, benign dermal neoplasm showing eccrine sweat gland differentiation. The literature search accounts for less than 100 reported cases of eccrine spiradenoma. Clinically, the lesion presents as solitary, intradermal, circumscribed, round or oval, firm, painful or tender nodule measuring from 0.3 - 5 cm in diameter. Rarely if ES, presents as multiple lesions, in combination with other types of adnexal tumors such as cylindromas & trichoepitheliomas, it can be considered as a part of the Brooke-Spiegler syndrome. Majority of these tumours appear on the head/face & upper trunk region of the body. Spiradenomas arise in early adulthood in most instances with few reports also of congenital cases and no sex predilection seen. The definitive diagnosis is made by excisional biopsy of the tumour. Complete tumor excision with clear surgical margins is considered the primary treatment for these cases. Here, we present a rare case report of a 58 years old male presenting with a soft, cystic lesion in the left lumbar region of the abdomen for past 2 years duration. Surgical excision of the tumour was done with clear margins and the specimen was sent for histopathological examination. Due to the overlapping histomorphological features, this tumour is often confused with cylindromas and trichoepitheliomas along with other vascular tumours. Eccrine Spiradenoma, although a benign tumour, but malignant transformation has been described especially in long-standing cases or multiple lesions. So, early diagnosis is very important to prevent recurrence and to identify any onset of malignant transformation

HIGH GRADE GLIOMA IN A 2 1/2 YEAR OLD: A CASE REPORT

INTRODUCTION- Gliomas are the tumor of glial cells found in Central nervous System. High Grade Gliomas are rare in pediatric age group. Definitive diagnosis is made by histopathological examination. A 2 ½ year old male admitted with the complaint of abnormal tonic-clonic body movements along with headache, nausea, vomiting and fever. CT scan showed a poorly circumscribed hypodense lesion involving fronto- parietal region. Surgery was performed and specimen sent for histopathological examination. Histopathological examination showed features of high grade glioma like microvascular proliferation, necrosis and haemorrhage. Cerebral tumors are the most common childhood neoplastic tumors. Gliomas are generally classified into low grade glioma and high grade glioma. High Grade glioma is rare in pediatric age group. Most commonly they present in supra tentorial compartment. The most common cerebral cortex involved are frontal lobe followed by parietal and temporal. Clinical signs and symptoms of High grade gliomas are seizure, headache, nausea, vomiting and visual disturbances. CT scan showed a poorly circumscribed hypodense lesion involving left fronto- parietal region mainly. Definitive diagnosis of high grade glioma is by histopathological examination. Histopathological examination showed hypercellular heterogeneous tumor lying on a fibrillary background. Areas of microvascular proliferation along with necrosis and haemorrhage are also seen. Surgical resection followed by chemotherapy and local radiotherapy are the present recommendation. High grade gliomas are rare pediatric tumor associated with poor outcome. Surgery was performed due to neurological worsening, which was unsuccessful and patient died. Diagnosis was confirmed on histopathological examination. Poor prognosis and high morbidity even after evolution of treatment, demands further research to improve the prognosis and reduce morbidities

AMELANOTIC MELANOMA- RARE CASE REPORT

Amelanotic melanoma is an uncommon type of of melanoma which lacks melanin pigment (1). Of all the melanoma cases, approximately 2- 8% cases represents amelanotic melanoma. The exact prevalence of this malignancy is more due to misdiagnosis. Due to lack of clinical criteria and pigmentation, the condition often detected late (2). Amelanotic melanomas are commonly found on the face, which shows microscopically the characteristics of desmoplasia (desmoplastic melanoma), but other body parts can also be involved (4)

Assessment of cardiac complication in diabetic patient of rural India

Background: Diabetes mellitus (DM) is a common endocrine disorder affecting approximately 382 million people worldwide. Diabetes mellitus (DM) is group of metabolic disorder in which glucose is underutilized, thus producing hyperglycemia resulting from a defect in insulin secretion, action, or both. Cardiovascular disease is the most common cause of death and disability among people with diabetes. The cardiovascular disease that accompany diabetes include angina, myocardial infarction (heart attack), Stroke, peripheral artery disease and congestive heart failure. In people with diabetes, high blood pressure, high cholesterol, high blood glucose and other risk factors contribute to the increased risk of cardiovascular complications.Method:  This study was conducted to determine the cardiac complication in diabetic patient of rural India. It was Cross sectional retrospective study, done in between period of January 2018 to December 2019.Result: In the present study authors found that   47.7% patients have Coronary artery disease (CAD), Silent 21.6% have myocardial ischemia (SMI), 36% Diastolic dysfunction (DF), 28.8% have Systolic dysfunction (SDF).Conclusion: In this study authors found that wide spectrum of cardiac complications in diabetic patients ranging silent myocardial ischemia to heart failure. CAD was the most common complication including silent myocardial ischemia (SMI) which is the one of the major concern of rural diabetic population which need proper screening by exercise treadmill test.

Evaluation of corticosteroid use in outpatient department of dermatology of a tertiary care teaching hospital: a prospective observational study

Background: Corticosteroids are widely prescribed drugs in dermatology. Rational prescribing of steroids is important for best therapeutic outcome at lowest possible dose. A study was carried out at a tertiary care teaching hospital in order to evaluate the use of corticosteroids which provided a picture of trends in the usage of corticosteroids in dermatology at that set-up. Materials and Methods: This prospective, observational study was carried out in department of dermatology for 1 year after ethical approval. Data was analysed for parameters related to corticosteroids, their potency, WHO drug prescribing indicators, effectiveness as well as effects of corticosteroids on quality of life of patients. Statistical analysis was done using Microsoft Excel Office 365. Results: In the 223 patients, 44.84% patients belonged to 21-40 years age group. Mostcommon indication was eczema in 29.15% cases. Topical betamethasone (25.11%) and oral prednisolone (20.17%) were most frequently prescribed. 95/140 topical steroids prescribed were super highly potent. Among concomitant drugs, a majority of 38% were antihistaminics. Degree of polypharmacy showed 04 drugs in a majority (43.15%) of prescriptions. Only 6.27% drugs were prescribed by generic name. Conclusion: Corticosteroids were beneficial to a large no. of patients. Initial usage of low potency steroids topically wherever possible can be emphasized. WHO drug prescribing indicators analysis indicated the need to adhere to WHO guidelines as well as prescribing drugs by generic name. To maintain a balance between judicious use and frequent abuse with corticosteroid is important along with physician’s vigilance and patient education.

Clinical and microbiological characteristics of Rhodotorula mucilaginosa infections in a tertiary-Care facility.

Background: Rhodotorula spp. are an emergent opportunistic pathogen, particularly in immunocompromised individuals. Materials and Methods: The aim of the study was to review reported cases of Rhodotorula infection over a period of 9 years to determine epidemiology, risk factors, treatment and outcome. Results: The Rhodotorula spp. were isolated from cerebrospinal fluid (9) and blood (5). The most common pre-disposing factors were prolonged hospital stay (>1 month) and prolonged usage of broad-spectrum antibiotics (>1 month). All the isolates were identified as R. mucilaginosa by conventional methods. Amphotericin B demonstrated lowest minimum inhibitory concentration (MIC) as compared with other anti-fungal agents (fluconazole, itraconazole and voriconazole). Conclusions: The recognition of unusual yeasts as an agent of life-threatening infection and their intrinsic resistance increases the burden on the mycology laboratory for complete species identification and to determine minimum inhibitory concentration.

Clinical Analysis, Management and Outcome of Intussusception in Children.

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. Early diagnosis and management is essential to reduce morbidity and mortality. The objective was to To review the diagnostic criteria of intussusception in infants and children to increase awareness of attending personnel for effective management decrease the rate of operative treatment and complications. Materials and Methods: The data collected of all 38 patients admitted in Kanti Childrens Hospital between 2008 September to 2009 September were studied prospectively. Each patient was evaluated in regard to age at presentation, sex, signs and symptoms, diagnostic method, treatment (operative, non-operative). Results: During study period of one year there were a total of 20 (52%) males and 18 (48%) females of age 3 months to 6 years. Pain abdomen was seen in 25(66%), vomiting 16(42%), diarrhea 15(40%), blood mixed with stool 10(26%). These symptoms were seen in different combination. X-ray erect abdomen was done in 15 and ultrasound in all 38 cases. Ten out of 15 (66.6%) patients with early presentation and diagnosis had successful barium enema reduction.10 (66.6%) had successful reduction and admitted to our hospital. 28(74%) patients were undergone laparatomy. Among 28 (74%) patents that had lapartotomy, manual reduction was successful in 18 and 10 required bowel resection and anastomosis. Conclusion: The awareness of early features of intussusception is important for early referral to tertiary centers for successful non-operative barium reduction and reduce the need of laparotomies in children.

Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach.

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 – 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided.

Multicenter evaluation of individual donor nucleic acid testing (NAT) for simultaneous detection of human immunodeficiency virus -1 & hepatitis B & C viruses in Indian blood donors.

BACKGROUND & OBJECTIVE: India has a high prevalence of HIV-1, hapatitis C and B virus (HCV and HBV) in the blood donors but has yet to implement nucleic acid testing (NAT) in blood screening. We undertook a multicentre evaluation of blood donor testing by NAT for simultaneous detection of HIV-1, HBV and HCV in a single tube and also to determine the feasibility of NAT implementation in India's low volume setting. METHODS: A total of 12,224 unlinked samples along with their serological results were obtained from representative eight blood banks in India and were individually manually tested by the Procleix Ultrio Assay (Chiron Corp. Emeryville, CA) for simultaneous detection of HIV-1, HCV, and HBV. RESULTS: Of the 12,224 samples tested, 209 (1.71%) were seroreactive. One hundred thirty three samples (1.09%) were reactive by Ultrio assay, 84 samples were seroreactive but NAT non reactive. There were eight NAT yield cases: 1 HIV, 1 HIV-HCV co-infection, and 6 HBV. INTERPRETATION & CONCLUSION: Our observed NAT yield for all three viruses was 1 in 1528 (0.065%). We estimate NAT could interdict 3272 infectious donations a year among our approximate 5 million annual donations.

Protein-c deficiency presenting with subacute intestinal obstruction due to mesenteric vein thrombosis.

We describe a patient with protein C deficiency who presented with subacute intestinal obstruction due to ischaemic small bowel stricture. The patient also had left sided ileofemoral thrombosis. Venous thrombosis at unusual sites especially if associated with deep vein thrombosis of lower limb warrants a thorough screen for underlying thrombophilia. This, however, is a rare cause for ischaemic small bowel stricture.

Effect of pre-storage gamma irradiation on red blood cells.

BACKGROUND & OBJECTIVE: The irradiation of blood components has received increased attention due to increasing categories of patients eligible to receive such blood to prevent transfusion-associated graft versus host disease. Irradiation leads to enhancement of storage lesions, which could have deleterious effects when such blood is transfused. The aim of the present study was to assess the biochemical changes during conventional preservation of irradiated and non-irradiated whole blood. METHODS: Ten units of whole blood were taken from healthy donors and divided into two parts. One aliquot was subjected to gamma irradiation and then stored under conventional blood banking conditions. Sampling was done from these irradiated and non-irradiated blood bags and tests for free plasma haemoglobin, plasma potassium and lactate dehydrogenase (LDH) were performed. RESULTS: A progressive increase in the mean values of plasma Hb, K+ and LDH was seen in both the groups. The increase was statistically significant. INTERPRETATION & CONCLUSION: Our findings indicated that the gamma irradiation of blood resulted in increased plasma haemoglobin, potassium and LDH. These biochemical changes might not have clinical significance when irradiated blood is transfused to a select group of patients. There is a need for further in vivo studies to follow up the consequences of transfusion of irradiated blood in patients.

Etiology of acute lower respiratory tract infection.

OBJECTIVE: To identify pathogens responsible for acute severe lower respiratory tract infection (ALRTI) in under five children by non-invasive methods. METHOD: 95 children hospitalized with acute severe lower respiratory tract infection were investigated for identification of viruses, bacteria, chlamydia or mycoplasma by nasopharyngeal aspirates, blood culture and serology. RESULT: Etiological agents could be identified in 94% of the patients. Viruses from NP aspirate could be isolated in 36 (38%), bacterial isolates from blood cultures in 15 (16%); mycoplasma was identified in 23 (24%) and chlamydia in 10 (11%) by serological tests; mixed infections were present in 8 (8%) patients. CONCLUSION: Noninvasive methods can be useful in identifying etiological agents in severe ALRTI.

Correlation between chemical composition of biliary calculi and sera of stone formers.

A quantitative chemical analysis of total cholesterol, bilirubin, calcium, inorganic phosphate and iron of three types of biliary calculi (cholesterol, pigment and mixed) of 40 gall stone former was carried out and correlated to with those of there sera. A moderately positive correlation for inorganic phosphate, Ca2+ and Fe2+ content of sera and calculi of cholesterol stone patient was found. A Good positive correlation for total cholesterol, a moderately positive correlation for bilirubin and iron but no correlation for inorganic phosphate and calcium content of sera and calculi of pigment stone patient was observed. A good moderately positive correlation for iron but no correlation for total cholesterol, bilirubin, inorganic phosphate and Ca2+ content of sera and calculi of stone patient was found.

Massive lower intestinal bleeding--a decade of experience.

BACKGROUND: Lower gastrointestinal bleeding is defined as hemorrhage orginating distal to the ligament of Treitz. Its diagnosis is difficult, often requiring endoscopy, angiography and isotope scans. METHODS: All patients with massive lower gastrointestinal bleeding seen in three gastroenterology centers of Armed Forces during an 11 year period between 1988 and 1999 were retrospectively analysed. RESULTS: A total of 91 patients with massive lower gastro intestinal bleeding were seen during 11 years. The mean age of the patients was 38.9 years and 64 were males. Aetiological diagnosis was: Non-specific ulcers--11, Ileal tuberculosis--8, NSAID enteropathy--8, Enteric fever--7, Meckel's diverticulum--7, Polyps--6, Ulcerative colitis--5, Carcinoma colon--5, Colonic diverticulosis--5, No cause found--5, Polyposis coli--5, Jejunal diverticulae--3, Angiodysplasia colon--3, Radiation colitis--3, Ischaemic colitis--3, Ileal tumor--2, Ileal angiodysplasia--2, Intestinal Lymphoma--2, Bechet's syndrome--1. Bleeding stopped on conservative therapy in 18 patients (including 5 where no diagnosis could be made). Diagnosis was made in 36 patients on fiber-optic colonoscopy done during active bleeding. Remaining patients were subjected to emergency laparotomy and diagnosis was obvious on inspection of abdominal contents in 25 cases. The diagnosis was finally made in remaining 12 cases by intraoperative endoscopic examination through an ileotomy. Four patients died, only one of them due to rebleed after surgery from an additional lesion. CONCLUSIONS: Compared with experience in Western countries, massive lower gastro-intestinal hemorrhage in India affects younger patients, has different causes and carries a lower mortality. Colonoscopy is useful in making diagnosis during active lower intestinal bleeding in about one-third cases. Exploratory laparotomy and Intra-operative endoscopy are complimentary to above examination and can make the diagnosis in most of the remaining cases.

Eosinophilic gastritis--an unusual cause of gastric outlet obstruction.

Eosinophilic gastroenteritis is a rare entity. We report a 41-year-old man who presented with features of gastric outlet obstruction due to a submucosal lesion in the distal end of the stomach. Distal gastrectomy with Billroth II reconstruction was done. Histology showed eosinophilic gastritis infiltrating the muscular and serosal layers of the pylorus and antrum.

Red cell alloimmunization in multi-transfused chronic renal failure patients undergoing hemodialysis.

Red blood cell (RBC) transfusions are frequently used in the management of patients with chronic renal failure (CRF) undergoing hemodialysis for dialysis-related anaemia. Consequently, they are subject to all hazards associated with repeated transfusions, such as red cell alloimmunization. A retrospective study was performed to estimate the frequency of alloimmunization against red cell antigens in multitransfused CRF patients. A total of 81 patients (67 males & 14 females) with CRF were studied who received a mean of 8.5 units of RBC matched for ABO & Rh(D) antigens only. Using standard techniques (indirect antiglobulin test, enzyme, polyethylene glycol, and low ionic strength solution), we observed a RBC alloimmunization rate of 9.8% (8/81). Nine alloantibodies were detected in 8 patients, and most (88%) involved antigens in the Rhesus & Kell systems. No correlation was observed with the alloantibody formation & number of units transfused. The calculated risk of 1.3% observed in the present study, suggests that renal failure patients are not at a higher risk of red cell alloimmunization than the general population.

Association of Lewis blood group with ischaemic heart disease.

A total of 96 patients (74 males and 22 females) with ischaemic heart disease (IHD) who presented at a hospital in north India for cardiac bypass surgery, percutaneous coronary angioplasty or unstable angina were investigated for Lewis blood group phenotypes. A hundred and four normal healthy blood donors matched for age and sex served as controls. Lewis blood group typing was carried out on red cells using saline haemagglutination technique in a test tube with monoclonal antisera. 29.1 per cent of IHD patients had Le(a-b-) phenotype compared to 9.6 per cent of controls (P < 0.01). The relative risk of IHD for Le(a-b-) phenotype was found to be highly significant (risk = 3.87). We conclude that there is an increased frequency of Le(a-b-) phenotype among Indian patients with IHD.