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Objective: (1) To study cerebrospinal fluid (CSF) adenosine deaminase (ADA) and CSF C-reactive protein (CRP) levels in the differentiation of viral, pyogenic, and tuberculous meningitis (TBM). (2) To estimate the borderline levels of CRP in CSF in viral, pyogenic, and TBM. Methods: A prospective and cross-sectional study was conducted at the Department of Medicine, SRN Hospital, Prayagraj, Uttar Pradesh, India, between August 2016 and September 2018. In this study, a total of 100 patients with meningitis were included applying specific inclusion and exclusion criteria after proper ethical approval. Results: Out of 100 patients, 61 were TBM, 31 were pyogenic meningitis, and eight were viral meningitis (VM). CSF CRP level was significantly increased in pyogenic meningitis (1.05 ± 0.36 mg/dL) compared to nonpyogenic meningitis [TBM (0.42 ± 0.13 mg/dL) and VM (0.37 ± 0.09 mg/dL)]. At the cut-off level of CRP in CSF > 0.6 mg/dL, its diagnostic sensitivity in pyogenic meningitis was 93.55% and specificity 94.20%. While CSF ADA levels were higher in the TBM group (13.32 ± 3.21 U/L) compared to the other two groups [pyogenic meningitis (6.15 ± 1.27 U/L) and VM (4.86 ± 0.88 U/L)]. At a cut-off, CSF ADA level of >10 U/L, its diagnostic sensitivity for TBM was 91.67% and specificity 90%. Conclusion: Cerebrospinal fluid (CSF) CRP levels were found to be raised in pyogenic meningitis, and CSF ADA was found to be elevated in TBM. While both ADA level and CRP level in CSF are found low in VM.
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@#Introduction: Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. Materials and methods: This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groupsone group received intra-articular steroid with hydrodilatation (HDS) and other group received intraarticular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. Result: There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Conclusion: Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.
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Background: For the management of connective tissue disorders (CTDs), antinuclear antibody (ANA) testing is essential, both from diagnostic and prognostic points of view. Usually, patterns obtained by ANA-IIF testing correlates to specific autoantibodies as obtained from the test for ENA (by LIA/ELISA, etc.). But to apply these data from western studies, we may need validation in the local population like our subjects in sub-Himalayan (Garhwal region) area where CTDs are common. Also, suppose ANA-IFA pattern's correlation is reliably known in our population, it can minimize the cost of managing CTDs by limiting ENA testing, which is 10 times costlier than ANA-IIF. Hence, this study was undertaken to know the specific autoantibody targets (ENA by LIA) against ANA-IIF patterns in our local population. Materials and Methods: In this retrospective cross-sectional work, serum samples of CTDs were tested for ANA by IIF (Euroimmune AG) and ENA by LIA (Euroline ANA-3G) continuously for 36 months. The manufacturer's kit insert was followed, and results were analyzed applying appropriate statistical methods. Results: Major ANA-IIF patterns were found to be associated with specific autoantibodies, for example, Nuclear homogenous with dsDNA, nucleosomes, histones; speckled pattern with nRNP/Sm, Sm, SSA/Ro-52, SSB; nucleolar pattern with Scl-70, Pm-Scl 100 and centromere pattern with CENP-B. Anticytoplasmic (ACA) are found to be linked with some ANA negative (by IIF) samples, emphasizing the need for careful observation for ACA especially where ANA is not found. Conclusions: In most subjects, specific ENA targets correlated well with ANA-IIF patterns, implying effective cost minimization in CTD management. Similar future prospective studies (with clinical data) can provide a database and reference for our population.
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Background-There is a definitive risk to human health because of mobile phones. The awareness towards mobile phones emitted electromagnetic radiation is of paramount importance to prevent health risks and possible negative health disorders. Aim and objectives-The aim of the survey is to assess the awareness of mobile phone radiation and its harmful effects on the body and the mobile phone usage trend among Otorhinolaryngologists from India. Methodology-The present survey aimed to obtain baseline data on cell phone usage and radiation awareness among a relatively homogenous cohort of Otorhinolaryngologists from India. This is a cross-sectional online survey assessing awareness of Mobile Phone radiation through a custom-made questionnaire devised by the authors which consisted of four parts: 1. Demographic details, 2. Mobile phone usage trend, 3. Knowledge of mobile phone radiation 4. Awareness of health hazards produced by mobile phone radiation. Results- The total number (n) of otorhinolaryngologists to whom the questionnaire was sent was 6336 of which 259 of them responded which formed the sample size of our study. Thus, the response rate of the survey was 4%. A total of 259 Otorhinolaryngologists participated in the study. The mean age of the population involved in the survey is 41.7810.32 years. The male-female ratio of the survey is 161:98 respectively. There were 172 private and 87 government ENT practitioners in the survey. MS otorhinolaryngology was the most common qualification of the study with 223 doctors having the degree, 20 having DNB, and 7 of them having completed DLO. The mean years of medical practice after postgraduation of the Otorhinolaryngologists participating in the questionnaire are 13.537.38 years. The major contributors to the survey were private ENT consultants with a count of 110, followed by Senior Residents 58, Assistant Professor 39, Professor 29, Associate professor 10, and Additional professor 13. It was evident from the questionnaire that 242 of the respondents were right-handed and 204 of the study population used their right ear for talking over the phone, it was also cross-checked by giving a miss call to them in close vicinity. The mean years of exposure to mobile phone usage by Otorhinolaryngologists are 15.01 5.75. A maximum of 153 surgeons were using mobile phones for 11-20 yrs. The average hours of daily mobile phone usage were 373 minutes. A highest of 101 Otorhinolaryngologists using mobile phones for >4 Hrs. Surprisingly through the questionnaire we came to know that a total of 60 doctors among the 250 use the phone daily for an average of more than 10 Hrs, which is 24% of the study population surveyed. Questions 15-24 were purposed to bring the awareness knowledge of the respondents towards electromagnetic radiation of the cellular phones, and it can be arbitrarily said that a score of 5 or more means that the person is aware. The average of the correct responses to each of the 10 questions given by the ENT practitioners is 5.97±1.66. Similarly, questions 25 to 35 assess the awareness of health hazards produced by mobile phone radiation. The mean correct response of the Otorhinolaryngologists is 6.30±1.87.
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Langerhans cell histiocytosis (LCH) also known as histiocytosis X, is a rare systemic disorder arising from the clonal proliferation of myeloid dendritic cells (histiocytes) with a tendency to involve single or multiple organ systems with variable clinical course and prognosis. Clinical presentation usually depends on the site of involvement. The organs commonly affected in adults by order of decreasing frequency include lungs, bone, skin, pituitary glands, lymph nodes, and the liver. Vulval and perianal involvement is extremely rare in adults. We describe the case of a 31-year-old non-smoker adult female with multisystemic LCH involving the vulva, perianal region, and lung. Probable involvement of other sites with LCH included mandibular bone, pituitary gland, skin, lymph nodes, liver, thyroid, and colon. She is undergoing systemic chemotherapy and has completed two cycles of cytarabine and steroids without any complications. Treatment is not standardized due to the very less incidence of the disease and inadequate knowledge regarding its pathophysiology. Langerhans cell histiocytosis remains a major concern for treating physicians because of its rarity with many faces and requires careful consideration for management.
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Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.
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Context: Many standard books, literatures, and internet described the characteristic lineament of each salivary gland lesion. Nevertheless, there are dozens of disarray, confusion, and unmanageable morphological features regarding proper reporting. To fight with these issues, Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018, but still the third category, Atypia of undetermined significance (AUS), poses difficulties for the pathologists and clinicians for a definite interpretation. Aim: The aim is to analyze the risk of neoplasia (RON) and risk of malignancy (ROM) of Milan's category III (AUS) by subdividing into six groups based on cytolomorphology. Settings and Design: The duration of study was from March 2018 to may 2021 with the focus on ROM and RON of all Milan's categories with especial attention on AUS. Methods and Material: Result of total 329 Fine Needle Aspiration Cytology of salivary glands was categorized according to MSRSGC. On the basis of cytomorphology, further subtyping of AUS and its cytohistopathology correlation was done. The ROM and RON of each subtype was analyzed. Statistical Analysis: All data were calculated by existing formulas. Results: Out of 329 aspirates, 24 (07.29%) cases belong to AUS with availability of histology in 13 (54.17%) cases. RON and ROM was 84.62% and 53.85%, respectively. Cases of lymphocytes with nuclear atypia (L-NA) was the most prevalent (29.17%). The RON were 60.00%, 68.57,% 84.62%, 94.87%, 87.50%, 100%, 100% and the ROM were 20.00%, 11.42%, 53.85%, 05.13%, 43.75%, 83.33% and 100% in each Milan's categories I, II, III, IVa, IVb, V, and VI, respectively. ROM was the highest in cystic fluid with nuclear atypia (C-NA) (100.0%), followed by basaloid cells (75%), L-NA (66.675), and SC (50%), but ROM was zero in NA and oncocytic cells. Conclusions: Subgrouping of AUS helps to dissipate the muddiness and provide more exact and reproducible diagnostic and prognostic tool.
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Background: Second generation antihistamines are first line therapy for chronic spontaneous urticaria (CSU). Sedation has been always a concern as a side effect of antihistamine for both patients and treating dermatologist. It is always better to prefer non-sedative antihistamine for CSU. Bepotastine is such promising non-sedative agent. Aim and Objectives: The objective of the study was to compare the efficacy and safety of bepotastine and levocetirizine in patients of CSU. Materials and Methods: This is a double arm, open label, randomized, and controlled study. Out of 99 patients, 50 patients belonged to Group A while 49 belonged to Group B. Subjects in Group A received bepotastine 10 mg twice daily while subjects in Group B received levocetirizine 5 mg once daily for 8 weeks. Patients were evaluated at baseline, day 14, day 28, and day 56 using Urticaria Activity Score (UAS) and Urticaria Control Test (UCT) for efficacy; and visual analog scale (VAS) for safety, that is, sedation. Results: The fall in mean UAS scores was statistically significant at day 14, day 28, and day 56 for both Groups A and B (P < 0.05) on intragroup comparison. While comparing the overall improvement between the two groups, there was no significant difference in UAS and UCT score at day 14, day 28, and day 56 between Group A and Group B, respectively (P > 0.05). At day 56, there was significant difference in mean VAS of Group A and B. Only one patient in Group B developed headache. Conclusion: Thus, both levocetirizine and bepotastine are equally effective for the treatment of CSU. Bepotastine has less sedative potential than levocetirizine.
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Background: Medical education is an extensively evolving field. Not only the medical curriculum keeps changing with time, so does the requirements for the students and teachers. Chalk and board is traditionally the most commonly used method of teaching whereas PowerPoint (PPT) presentation is the new generation most commonly used method. Aim and Objective: This study was conducted to evaluate the preference and perspectives of the undergraduate MBBS students’ pertaining to the two most commonly used audiovisual teaching aids namely chalk and board verses PPT presentation. Materials and Methods: An observational cross-sectional study was conducted involving two batches of MBBS undergraduate students. Results: A total of 144 students participated in the study. Eighty-four students were from 2nd year and 60 students from final year MBBS. In our study, we got favorable responses (Likert scale 4 and 5) for chalk and board method in 84 (58%) and for PPT presentation in 60 (41.9%) of students. One hundred and nineteen (82.6%) students preferred class notes over handouts. Most of the parameters were comparable among the two methods except the statements of lecture being interesting, interactive, better problem-solving, and emphasis on important points being in favor of chalk and board; and those of clarity, better diagrams ad flowcharts, covering more topics, and clinical case demonstration were in favor of PPT. Conclusion: No single aid is perfect in all aspects. Hence, a suitable aid should be chosen depending on the topic, clinical scenario, level of complexity of topics, and understanding that is required.
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Ewing sarcoma is a rare aggressive malignant round cell tumor, primarily presenting in bone and soft tissues. This study presents two cases of this tumor in unusual locations, one in right colon which presented with intussusception and other in ovary which presented clinically as carcinoma ovary. Both the cases showed histomorphology of primitive round cell tumor with characteristic immunohistochemical profile and was confirmed on molecular analysis. We aim to highlight the importance of considering Ewing sarcoma in the differential diagnoses in these locations as they have dismal prognosis with no standard treatment modality.
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Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions. Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).
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To study the histomorphological spectrum of uterine leiomyoma variants. This study is done over a period of three year (May 2019 to May 2022) in the Department of Pathology, LNMC, Bhopal. Total of 316 hysterectomy and 14 myomectomy specimens were studied. Specimens were fixed in formalin and paraffin embedded. H&E stained tissue sections were studied. In the study we performed retrospective analysis of hysterectomy and myomectomy specimen and 330 cases of leiomyoma were evaluated. Among 330 cases, 316(95.75%) were hysterectomy specimen for varying indication and 14(4.24%) were myomectomy specimen. Histologically the usual leiomyomas was comprising of 164(49.69%) cases followed by hyalinised leiomyoma 70(21.21%), myxoid leiomyoma 15(4.54%), hydropic change 12(3.63%), cellular 11(3.33%), lipoleiomyoma 10(3.03%), calcification 10(3.03%), infarct type necrosis 10(3.03%), mitotically active 8(2.42%), symplastic 7 (2.12%), schwanonian 6(1.81%), epithelioid 3(0.90%), dissecting leiomyoma 2 (0.60%) and stromal metaplasia (osseous and cartilaginous) 2(0.60%). Leiomyoma is the commonest benign smooth muscle tumor of the uterus with a number of histological variants. In this study conventional leiomyoma being the commonest variant followed by hyalinized leiomyoma, myxoid leiomyoma, hydropic leiomyoma and lipoleiomyoma. It is important to categorise various types of leiomyoma on histology to avoid misdiagnosis.
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Background: The spectrum of kidney diseases varies in the elderly population with frequent inconsistencies between clinical presentation and histopathological diagnosis. The immunofluorescence (IF) may provide additional information in such situations. Aims: The purpose was to study the spectrum of kidney diseases in patients above 50 years undergoing renal biopsy and utility of light chain (LC) IF in the diagnosis. Settings and Design: This was a retrospective, crosssectional, singlecenter-based study. Material and Methods: The clinical details, histopathological findings, and LC IF pattern in native renal biopsy of patients above 50 years were noted. Statistical Analysis: Continuous variables were presented as mean ± standard deviation (SD). Categorical variables were expressed as frequencies and percentages. Results: A total of 205 patients were included in the study. The most common clinical presentation was acute kidney injury/rapidly progressive glomerulonephritis (AKI/RPGN) (49%). Glomerular diseases (72%) were more common. Crescentic glomerulonephritis (21%) and membranous nephropathy (MN) (19%) were the most common glomerulopathy. LC restriction was observed in LC cast nephropathy (LCCN), primary amyloidosis, and LC also helped in classifying the cases of MPGN-type morphology. Conclusions: AKI/RPGN was the most common indication for renal biopsy in patients above 50 years. Crescentic GN and MN were the frequent glomerular pathology. LC IF is a useful adjunctive tool to classify various renal diseases.
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Background: Prescription pattern monitoring studies are tool for assessing the prescribing, dispensing, and distribution of medicines prevailing in a particular area. The main aim of such studies is to facilitate rational use of medicines. Irrational prescribing leads to increased incidence of adverse effects, drug interactions, and emergence of drug resistance. Aim and Objectives: This study aims to evaluate drug prescription pattern of outpatient department patients as per the drug use indicators developed by the World Health Organization (WHO) and also the occurrence of different medication errors. Materials and Methods: 662 prescriptions were evaluated. The WHO core drug prescribing indicators analyzed were Average number of medicines prescribed per patient encounter, percentage of medicines prescribed by generic name, percentage of encounters with an antibiotic, injections, or fixed-dose combination (FDC), score of generic prescription, and justification for the use of brand names. The categories of prescription errors which were studied were legibility, absence of doctor identity, diagnosis, drug dosage, and duration. Results: The most common medication error was lack of treatment duration (75.1%) and illegibility of the prescriptions (61.9%). Most of the drugs were prescribed in generics. About 72.5% of the prescriptions had 100% generic score. Although the use of brand names was not justifiable in most cases. The use of injectables, antibiotics, and FDC was 0.9%, 46.5% and 76.8%, respectively. Conclusion: Such studies should be done regularly to evaluate the lacunae in drug prescribing patterns and improve them.
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Accessory breast tissue occurs due to failure of resolution of embryonic mammary ridges present from axilla to groin bilaterally. It may be functional or non-functional. This condition is more commonly seen in the females and very few cases have been reported in males. Development of ectopic breast tissue is dependent on hormonal stimulation similar to normal breast.It remains asymptomatic usually and increases in size after a hormonal stimulation at the time or after puberty. Majority of the occurrences are completely benign, but this condition also has the potential to convert into a malignant lesion. Apocrine hidrocystoma is regarded as cystic retention and adenomatous proliferation of apocrine sweat glands. It commonly occurs on the head & neck, but can infrequently be present in other locations like axilla, vulva, penis. This is the report of case of apocrine hidrocystoma with accessory breast tissue in a 30 year old male presented with left axillary swelling. Cytomorphological assessment revealed benign epithelial lesion and a diagnosis was established only after a histopathological examination. It emphasises the role of histopathology in diagnosis of axillary breast lesions
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To study the histolopathological spectrum of non-neoplastic lesions of lung and to evaluate in relation to age, gender and clinico-radiological findings. This study is done over a period of 1 year (Nov 2020 to Nov 2021) in the Department of Pathology, LNMC, Bhopal. Total of 33 lobectomy specimens were studied. Specimens were fixed in formalin and paraffin embedded H&E-stained tissue sections were studied. Special stains (Gomorri's methenamine silver stain and Periodic acid Schiff stain) were done where ever required. Non-neoplastic lesions from 3 (9.09%) women and 30 (90.90%) men, with a median age of 43.86 (Interquartile range: 23-60 years) were collected. Fibrotic interstitial changes comprised the most common category of histologic findings, noted in 20 (60.6%) patients. Most cases consisted of usual interstitial pneumonia (UIP) (30.30%), followed by smoking related interstitial fibrosis/SRIF (desquamative interstitial pneumonia like patterns and respiratory bronchiolitis like pattern) (12.12%), non-specific interstitial pneumonia (NSIP) (9.09%) and patterns of “undefined” fibrosis (6.06%) such as peribronchial fibrosis, organizing pneumonias and other patterns of fibrosis that did not fall into a recognized category of idiopathic interstitial pneumonia. Granulomatous pathology was identified in 4 (10.81%) patients. On chest X-ray/CT scan chest, majority of lung lesions presented as diffuse and patchy opacities with honeycombing and bronchiectasis. Cigarette smoking was associated with 4 lung lesions. Histopathologic classification plays an important role in separating variable forms of non-neoplastic lung lesions & further subcategorising idiopathic interstitial pneumonia into clinically meaningful categories have important differences in natural history, prognosis, and treatment
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Objective: To assess the utility of number needed to treat (NNT) as a tool for cost effectiveness analysis. Methods: Two monoclonal antibodies (MAbs), used for induction therapy viz basiliximab and daclizumab in renal transplantation, were identified. Pivotal placebo controlled clinical trials, mentioned in the innovator package inserts, were compared and analyzed for acute graft rejection and graft survival at 12 mo. NNT viz-a-vis cost was calculated and compared. Results: Daclizumab was comparable to basiliximab for acute graft rejection (NNT 10 vs. 9) but better for graft survival (20 vs. 25) at 12 mo, when used along with triple drug regimen (cyclosporine, azathioprine and corticosteroid). However, considering the cost of regimen for these drugs, in terms of NNT, basiliximab was more cost effective (INR 12,52,044 vs. 28,70,400 for acute rejection and INR 34,77,900 vs. 57,40,800 for graft survival). On the other hand, when these MAbs were used along with dual drug regimen (cyclosporine and corticosteroid), daclizumab was more cost effective for graft survival at 12 mo. The higher cost of daclizumab regimen (INR 2,87,040 vs. 1,39,116 for basiliximab) was offset by its substantially lower NNT (20 vs. 58-75 for one extra graft survival at 12 mo). Conclusion: This study demonstrates the utility of NNT in ascertaining relative effectiveness of treatment modalities that would help to formulate appropriate healthcare policies.
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Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.
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Primary orbital chondromyxoid fibroma is a rarely reported entity. A 34-year-old lady presented with painless, non-axial proptosis of the left eye of 6 months duration. Orbital imaging showed a supero-temporal mass with calcific foci and bone erosion. The mass caused globe compression resulting in choroidal folds. Anterior orbitotomy with complete mass excision was performed. The histopathology revealed a chondromyxoid fibroma. At 12-months follow-up, the patient is doing fine with no clinical recurrence. Chondromyxoid fibroma is an important differential diagnosis for bony orbital tumors.
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Background & objectives: Humans are considered to be the principal host for hepatitis A virus (HAV) infection. In India, heterogeneous groups of susceptible individuals coexist in different regions. There has been a decline in antibody titres to HAV among young adults which may pose a major public health problem. The objective of this study was to assess the IgG anti-HAV level among healthcare workers (HCWs) in the age group of 20-60 yr and its association with the socio-demographic variables. Methods: Blood sample (2 ml) was collected under aseptic conditions from each participant followed by the preparation of serum and storing at ?20癈. ELISA-based kits were used for the determination of IgG antibodies to HAV in the human serum samples. Results: Two hundred and fifty four HCWs were enrolled. IgG anti-HAV antibodies were detected in 97.2 per cent of the samples analyzed. No differences were observed in the levels of IgG anti-HAV antibody and education, income, occupation and socio-economic classes of the HCWs. A seropositivity rate of over 90 per cent was seen amongst all the socio-economic classes. Interpretation & conclusions: High levels of IgG protective antibodies were seen among the studied HCWs, hence HAV vaccination may not be required. It will be advisable to do a cost-benefit analysis of vaccination for HAV.