Etiology of Hemoptysis in Children and Adolescents – Multicentric Retrospective Data (2012-2021) From Chennai

Objective: To analyze the etiology of hemoptysis in children and to correlate the severity of bleed with the etiology. Methods: This retrospective multicentre study reviewed data from inpatient units of four tertiary care public and private sector pediatric hospitals in Tamil Nadu. Methods: Inpatient case records of children (aged 2 month-15 years) treated for hemoptysis at the four institutions between April, 2012 and March, 2021 were identified, after ethical clearance from respective institutions. Data of children with underlying known bleeding disorders like hemophilia or platelet abnormality were excluded from the study. Hemoptysis was categorized as mild, moderate and severe Results: Of the 73 children who had presented with hemoptysis during the study period, 60 (82.2%) children had mild, 9 (12.3%) had moderate and rest had severe hemoptysis. Idiopathic pulmonary hemorrhage was the most common cause of hemoptysis. The common causes of mild hemoptysis in children were idiopathic pulmonary hemorrhage (n=15, 25%), pulmonary tuberculosis (n=12, 20%) and pneumonia (n=8, 13.3%). Congenital airway anomalies and vascular anomalies were more likely to present with moderate to severe bleed. Conclusion: Etiology of hemoptysis is broad and categorizing them into mild, moderate and severe may give a clue about the possible etiology, there by restricting to the required investigations.

An interesting case of COVID induced multi system inflammatory syndrome

COVID-19 derives from infection with Coronavirus [severe acute respiratory syndrome (SARS)-CoV-2] is associated with high morbidity and mortality. These hazardous impacts are due to the release of a storm of pro-inflammatory cytokines and thrombogenic agents. Increasing evidences about multi organ involvement in COVID infection have started pouring in, where patients who either recovered from or had mild symptoms after COVID-19, exhibit diffuse multi organ related symptoms. We describe a case of a 23-year-old male who presented to emergency room with intermittent high-grade fever, sudden onset of breathlessness, giddiness and weakness. His COVID RTPCR was negative. He was unvaccinated but his covid antibodies were increased multifold. Further examination revealed active multi organ involvement which suggestive for multisystem inflammatory syndrome (MIS). With appropriate diagnosis and treatment patient improved clinically over a course of 3 weeks and discharged and is under regular follow up.

A case of Osler-Weber-Rendu syndrome associated with portal hypertension

Osler-Weber-Rendu syndrome is a rare autosomal dominant vascular disorder, characterised by multiple telangiectasesof the skin and mucous membranes with recurrent nasal and gastrointestinal bleedings and arteriovenous malformations of various organ systems. It is also called as hereditary hemorrhagic telangiectasia (HHT). The occurrence of telangiectases in the stomach and small bowel can result in chronic bleeding and anaemia. We report a rare case of 39 year old female with Osler Weber Rendu syndrome associated with portal hypertension. She had recurrent nasal and gastrointestinal bleeding, and presented with complaints of progressive dyspnea NYHA class III. On further evaluation she was found to have portal hypertension, which is a rare association.

Prevalence of Obesity and Overweight and Its Correlates among 20-40 Year Old Population in an Urban Area in Southern India

Introduction: Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of consequences of overweight or obesity. The study was conducted to estimate the prevalence of Overweight and obesity among 20-40 years old residing in an urban area in North Karnataka and to study the risk factors affecting overweight and obesity. Methods: A Cross Sectional Study was done among adults aged 20-40 years in urban field practice area in North Karnataka in 2017-18. The sample size was calculated to be 207. Selection of study subjects was done using systematic random sampling. Data regarding socio-demographic profile and anthropometric measurements were collected and BMI calculated. Results: The prevalence of overweight was 45.9% and obesity was 11.1%. Females had more prevalence of overweight (46.8%) and obesity (13.8%) as compared to males. overweight was more in sedentary workers (50%).There was a high prevalence of obesity among participants with mixed diet(82.6%) and 63.1% of participants eating junk food were overweight and 69.5% were obese. The prevalence of overweight was more among participants with class IV socioeconomic status (45.3%) followed by class III (31.6%). Conclusion: There is a growing prevalence of overweight and obesity in urban areas that calls for an urgent need to prevent the further consequences and decrease the burden.

Defaecation disorders among information technology personnel: A cross-sectional study

BACKGROUND Individuals working in the information technology (IT) industry are likely to develop lifestyle disorders. We aimed to determine the presence of defaecation-related disorders in IT personnel in Chennai. METHODS This cross-sectional, questionnaire-based study was done from June to December 2018. We included employees between 18 and 60 years of age and excluded those with <1 year stay in Chennai, pregnancy and those who sent incomplete responses. The cohort was classified as normal, irritable bowel syndrome (IBS), faecal evacuation disorder (FED) and a combination of the latter two. RESULTS The overall response rate was 95.6%. The study included 54.7% of men, and the median age was 31 years. The majority of respondents used an Indian toilet (554; 58%). Almost all (96.2%) passed stools daily, and stool consistency was soft in 59%. Based on the study criteria, 180 (18.8%) had FED, 56 (5.9%) had IBS and a small group had a combination of symptoms of IBS and FED (20; 2.1%). Respondents with symptoms of IBS had a higher proportion of comorbid states (p<0.0001), lesser stool frequency (p<0.0001) and required more toilet time (p<0.00001). CONCLUSION Over one-fourth (26.7%) of the respondents had defaecation-related issues, 18.8% had symptoms suggestive of FED and 5.6% that of IBS, often above 30 years of age.

A de novo marker chromosome 15 in a child with isolated developmental delay

We report a rare case of a 14-month-old male child who was referred for developmental delay. Clinical examination revealed a hypotonic infant with speech delay and no dysmorphic features. The banding cytogenetics revealed a small supernumerary marker chromosome. Upon silver staining, the marker showed the presence of satellite regions on either ends. Further, analysis using fluorescence in situ hybridization on marker chromosome revealed its origin from chromosome 15.

Epidermal growth factor receptor and anaplastic lymphoma kinase mutation in adenocarcinoma lung: Their incidence and correlation with histologic patterns

Introduction: Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutational analysis in adenocarcinoma lung are growing in importance as these tests are essential in guiding the use of targeted therapy. However, the prevalence of these mutations in various populations in India has not been studied. Furthermore, the correlation of histologic pattern with the mutation is not clear. Materials and Methods: A total of 64 biopsy-proven lung adenocarcinomas were selected. In 51 of these, EGFR mutational analysis was performed using Qiagen EGFR pyrosequencing kit and in 56 cases of these ALK1 immunohistochemistry (IHC) was done using ALK (D5F3) antibody and the Ventana Benchmark® XT automated IHC slide staining system for the detection of overexpression. The adenocarcinomas were classified into well, moderate, and poorly differentiated, and the histological pattern was recorded according to the WHO 2014 classification. Results: EGFR mutation was positive in 23 cases (45.10%) and positive ALK1 expression by IHC in 12 cases (21.43%). Both mutations were positive in two cases. Both mutations were seen in well-differentiated and moderately differentiated adenocarcinoma, and the expression was highest in tumors with a predominant acinar pattern. Conclusions: The incidence of both EGFR and ALK1 mutations is higher in the population studied and seem to correlate with a well differentiated, acinar pattern on morphology.

Combination of noise removal and contrast enhancement methods for the preprocessing of mammogram images - towards the detection of breast cancer / Combinação de métodos de remoção de ruído e aperfeiçoamento de contraste para o pré-processamento de imagens de mamografias - rumo à detecção do câncer de mama

Breast cancer is a major killer disease for women and men. It can be treated and controlled only if it is detected at its earlier stage. Early detection can be achieved by the help of Computer Aided Detection (CAD) methods. From the detailed study on previous researches, it is found that, there is no system producing 100% accuracy because of one or more reasons. Absence of effective preprocessing is the discussed reason that obstructs the detection accuracy of CAD method. Noise removal and contrast enhancement are the two types of preprocessing. There is no system performs both the preprocessing on mammogram image. This work is an attempt to develop an enhanced preprocessing method for CAD of breast cancer by incorporating suitable noise reduction and contrast enhancement methods in the conventional CAD system. Among the available noise reduction techniques, Fast Discrete Curvelet Transform (FDCT) based UnequiSpaced Fast Fourier Transform (USFFT) has been utilized and the Modified Local Range Modification (MLRM) technique has been utilized for contrast enhancement. Contrast enhancement after noise reduction double enhances the mammogram image and the proposed methods MSE value for the mammogram image mdb072 has been 1.44% reduced when comparing to the LRM method. Reduction in MSE increases the PSNR to 0.16%. Many mammogram images have been tested and the result shows that, increase in contrast, decrease in mean square error and increase in peak signal to noise ratio when comparing to existing methods.

Introdução: O câncer de mama é uma grande doença mortal para mulheres e homens. Ele só pode ser tratado e controlado se for detectado em sua fase inicial. A detecção precoce pode ser alcançada com a ajuda de métodos de detecção assistida por computador (CAD). A partir do estudo detalhado sobre pesquisas anteriores, verifica-se que, não há um sistema com 100% de precisão por causa de uma ou mais razões. A ausência de pré-processamento efetivo é o motivo discutido que obstrui a precisão de detecção do método CAD. A remoção de ruído e o aprimoramento do contraste são os dois tipos de pré-processamento. Não existe um sistema que realize ambos os pré-processamentos na imagem da mamografia. Objetivo: Este trabalho é uma tentativa de desenvolver um método de pré-processamento aprimorado para CAD de câncer de mama, incorporando métodos adequados de redução de ruído e aprimoramento de contraste no sistema de CAD convencional. Métodos: Entre as técnicas de redução de ruído disponíveis, a transformada de curva discreta rápida (FDCT) baseada na transformada rápida de Fourier desigualmente espaçada (USFFT) foi utilizada e a técnica de modificação de faixa local modificada (MLRM) foi utilizada para aprimoramento de contraste. Resultados: o aprimoramento do contraste após a redução do ruído melhora o dobro da imagem da mamografia e os métodos propostos para o valor de MSE para a imagem da mamografia mdb072 foram reduzidas em 1,44% quando comparados ao método LRM. A redução de MSE aumenta o PSNR para 0,16%. Conclusão: muitas imagens de mamografia foram testadas e o resultado mostra que, aumento no contraste, diminuição do erro quadrático médio e aumento da relação pico do sinal/ruído quando comparado aos métodos existentes.

Postradiation angiosarcoma of bladder with extensive osseous metaplasia.

Angiosarcomas are rare soft tissue neoplasms accounting for <2% of all sarcomas. Rare cases have been reported in other sites like breast, spleen, liver, bone and bladder. This is a case report of an angiosarcoma of the bladder in a 65 year old lady who came with complaints of haematuria. Ultrasonography and computerized tomography revealed a bladder tumour with calcification, which on cystoscopy also showed a calcified mass. The patient had a past history of carcinoma cervix for which she had undergone surgery and radiotherapy, 22 years ago. Biopsy of the bladder mass showed features of a high grade epithelioid sarcoma with extensive osseous metaplasia. On immune stains,the tumour was positive for CD31 and vimentin and negative for cytokeratin, desmin and CD34. Until now, only sixteen cases of angiosarcoma of the bladder have been reported in english literature, of which 6 occurred secondary to radiation. Our case is the first to occur after 22 years of radiotherapy and have extensive osseous metaplasia.

Female form of persistent mullerian duct syndrome: rare entity

Persistent Mullerian duct syndrome [PMDS] is a rare form of Disorder of sex development in which Mullerian duct derivatives [fallopian tubes, uterus and the proximal vagina] are present in an otherwise normally differentiated 46 XY male. In the majority of cases, PMDS is a surprise finding either during orchidopexy or during inguinal hernia repair. We report a case of 4 year child with female type [Type III] PMDS. We are discussing the presentation, management and review of the literature

Crossed Polydactyly and Greig Cephalopolysyndactyly Syndrome.

Greig cephalopolysyndactyly syndrome is a rare genetic disorder, with an autosomal dominant inheritance and consisting of a triad of polysyndactyly, macrocephaly and hypertelorism. Crossed polydactyly is a finding characteristically associated with this syndrome. We report a one and half year old male child who presented with classic clinical features and family history diagnostic of the above syndrome.

Antimicrobial activity of zerumbone from zingiber zurumbet against staphylococcus epidermidis and aspergillus spp.

Zingiber zerumbet belongs to the family Zingiberaceae and is generally known as bitter ginger. Zerumbone one of the major compound from Zingiber zerumbet rhizomes. Zerumbone finds its usage in medicinal applications, food flavoring, condiments, fragrances etc. Bioactive compound zerumbone was isolated from the column chromatography eluting with hexane and ethyl acetate mixture varying the polarity. The compound zerumbone exhibited strong antibacterial activity against Staphylococcus epidermidis, moderate activity against Escherichia coli, moderate antifungal activity against Aspergillus oryza and Aspergillus niger.

Primary extramammary Paget's disease with extensive skeletal metastases.

Extramammary Paget's disease (EMPD) is an uncommon malignancy that is most commonly seen in the vulval area in postmenopausal women. Pruritus is the predominant symptom. The clinical presentation can be so nonspecific that it can be misdiagnosed as an inflammatory or infective condition. We report an elderly male patient with EMPD over the pubic area, which remained asymptomatic for 5 years; he presented with severe low backache of 5 months' duration. Skin biopsy and immunohistochemistry showed the typical epidermal changes and deep dermal invasion. Positron emission tomography scan revealed involvement of regional lymph nodes as well as extensive skeletal metastases.

Isochromosome X mosaicism in a child with Kabuki syndrome phenotype: A rare cytogenetic association.

Isochromosome is a structurally unbalanced chromosome consisting of two short arms or two long arms, which are derived by abnormal centromere division or sister-chromatid exchange. Most autosomal isochromosomes are unusual, while those involving sex chromosomes are common. Kabuki syndrome (KS, OMIM 147920) is a multiple malformation/mental retardation syndrome of unknown etiology. A conventional cytogenetic study on lymphocytes from a 4-year-old girl with physical features suggestive of KS was found to have mosaicism for isochromosome for the long arm of the X. Although most manifestations present in this patient have been described before, this report is a rare association of clinical and cytogenetic findings in this syndrome. A genome-wide analysis and a larger number of patient groups studied could improve our understanding of the genetic basis of KS.

Fiberoptic Bronchoscopy in Unresolved Atelectasis in Infants.

This retrospective analysis documents the usefulness of fiberoptic bronchoscopy in finding the etiology of 56 cases of unresolved atelectasis in infancy, over a two year period (June 2005 to May 2007). Fiberoptic bronchoscopy identified the etiology leading to a revised diagnosis and change in management strategy in 38 (67.8%) cases, which included congenital airway anomalies (46.4%), inflammatory changes (10.7%), mucus plugs (28.5%), hypoplasia (4%), endobronchial granulation tissue (3.5%) and foreign body (3.5%). Fiberoptic bronchoscopy plays an important role in diagnostic work up of infants with unresolved atelectasis.

Lower airway anomalies in infants with laryngomalacia.

Objective. To study the prevalence of associated airway anomalies in infants presenting with moderate to severe laryngomalacia. Methods. Eighty three symptomatic infants with recurrent respiratory symptoms including wheeze and cough diagnosed as moderate to severe laryngomalacia based on their clinical and direct laryngoscopic findings were subjected to fiberoptic bronchoscopy (FOB) during the period March 2007 to February 2009 in the Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India. Analysis of the clinical features, radiological findings and associated lower airway anomalies by FOB was done. Results. Lower airway anomalies were demonstrated in 40 (48%) infants of the study population. Tracheomalacia was the most common lower airway anomaly 24(29%) followed by bronchomalacia 8(10%) and tracheobronchomalacia 6 (7%). (4:1:1). Conclusion. Infants with moderate and severe laryngomalacia should be evaluated with flexible fibreoptic bronchoscopy to rule out associated lower airway lesions.