A comparative evaluation of therapeutic efficacy and safety of Falknor’s needling versus autoimplantation in cutaneous warts

Background: Warts, the most common manifestation caused by human papillomaviruses. Treatment is needed because of risk of transmission, cosmetic point of view, multiple, painful, and disfigurement caused by warts. Aims and Objectives: In this study, two techniques of autologous therapy are compared in terms of safety and efficacy. Falknor’s needling and autoimplantation, both are minimally invasive procedures with the aim of treating one wart and inducing immunity against the viral infected cells. Materials and Methods: Forty patients of clinically diagnosed cutaneous warts were randomly divided into two groups. In Group A, Falknor’s needling was performed on a single lesion in each patient. In Group B, autoimplantation was done by harvesting a single lesion and then implanting the tissue in subcutaneous tissue of the patient at other body site. Results: Data were analyzed using SPSS software v. 23 (IBM Statistics, Chicago, USA) and Microsoft Office 2007. Both the modalities showed excellent response (P = 0.504) in the treatment of warts with Grade 4 improvement in 85% (17 patients each) in both the modalities, with 5% of the patients showing Grade 2 and Grade 3 improvement each in needling group. Conclusion: Both the modalities of autologous therapy are simple, easy to perform, safe, and cheap modalities with excellent results in the treatment of cutaneous warts.

To evaluate the serum magnesium levels in fresh myocardial infraction patients and to compare them with normal healthy individuals – A comparative study

Background: Now-a-days, myocardial infarction (MI) is one of the most prevalent disorders. Lack of blood supply causes MI/heart attacks. Ischemia or a lack of oxygen causes heart tissue damage and is ultimately fatal. Several studies demonstrated the association of magnesium deficiency with MI. Aim and Objectives: The aim of the study was to evaluate the levels of serum magnesium in MI patients and to compare them with normal healthy individuals. Materials and Methods: The present study assessed magnesium levels in 50 MI and another 50 without MI, healthy participants serve as a control. All the study participants were recruited from Government Medical College, Amritsar. Results: In normal individuals (n = 50), the Mean ± standard deviation (SD) of serum magnesium was 1.994 ± 0.28 mg/dl and SE. of 0.04, while in MI patients Mean ± SD was 1.13 ± 0.49 mg/dl and SE of 0.07. The mean of magnesium was significant (t = 10.8, P < 0.001) high in MI patients as compared to the control. Conclusion: Thus, it concludes that magnesium can be used as a diagnostic investigation tool for assessing patients suffering from MI.

Comparative evaluation of therapeutic efficacy and safety of 40% hydrogen peroxide versus 80% of trichloroacetic acid in genital warts

Background: Warts are a common manifestation of infection due to HPV, prevalence more common in developing world. No modality is 100% efficacious in the management of warts. Topical therapy is more preferred method by majority of patients. Trichloroacetic acid (TCA) solution is well established modality in treatment of genital warts. Hydrogen peroxide used in higher concentrations is a good cautery agent. Aim and Objectives: The study was conducted to evaluate and compare the therapeutic efficacy and safety of 40% hydrogen peroxide solution and 80% TCA solution in genital warts. Materials and Methods: Topical 40% hydrogen peroxide and 80% TCA were used in Group A (20 patients) and Group B (20 patients), respectively, for three sittings at 2 weeks interval. Results: About 65% of the patients in TCA and 55% patients in H2O2 group had significant improvement (Grade 4 and Grade 3) (P = 0.311). Descriptive statistical methods and 2-Chi-square relation were used for analyzing data with Statistical Package for the Social Sciences (SPSS) 21 (SPSS Inc., Chicago, IL, USA). Results: About 40% H2O2 and 80% TCA, both are cost-effective and easy to use modalities with 40% H2O2 having better safety profile as compared to 80% TCA. H2O2 group showed decrease in size of lesions 63.33% versus and TCA group 70% (p value 0.311) with 10% of TCA group patients having ulcer formation versus none of the patients having significant adverse effect in H2O2 group. Conclusion: We found both the modalities to be safe and effective. However, we recommend further studies should be carried out to assess the safety and efficacy with bigger sample size and control arms for both the groups topical 40% hydrogen peroxide solution and topical 80% TCA solution.

Evaluation of Physiochemical Properties, Thermal Behavior and Phytopharmaceutical Potential of Citrus aurantium’s Essential Oil

The study investigates the therapeutic potential of the Citrus aurantium var. amara essential oil extracted from the blossoms of the bitter orange plant by examining its chemical composition, thermal stability, and potency against infectious disease-causing pathogens. Initially, the volatile components of the essential oil were evaluated by obtaining a chromatographic fingerprint using HPTLC and FTIR spectrum identification. Furthermore, a thermal profile of the essential oil was obtained using the thermogravimetric-differential thermal analysis and differential scanning calorimetric analysis. A predetermined set of antibiotic-resistant microorganisms were used to examine the antibacterial activity of the essential oil. Lastly, its anti-inflammatory activity was assessed using the albumin denaturation assay. The research concluded that the Citrus aurantium var. Amara essential oil exhibits potential therapeutic characteristics which can be further explored through in vivo studies.

Spectrum of MRI abnormalities in pediatric seizures

Background: Seizure is a pediatric emergency. Accurate determination of the etiology of seizures is very important to start an effective treatment. The study aims to determine the spectrum of Imaging abnormalities by Magnetic Imaging Resonance (MRI) in children who presented with seizures. Methods: It is a hospital-based prospective observational study which was carried out in Government Medical College and Rajindra Hospital, Patiala. This study included 50 pediatric patients in the age group between 0 months to 18 years who were referred to the Department of Radiodiagnosis for brain MRI between October 2017 to September 2019. Results: Neuroimaging abnormality was found in 19 (38%) cases. 31 (62%) patients had no abnormal finding. The most common imaging findings were inflammatory granuloma in 5 (10%) patients. Other findings were- Hypoxic-ischemic injury (HII) in 4 (8%), Mesial temporal sclerosis in 2(4%), cerebral atrophy in 1(2%), Hemorrhage in 1(2%), Tuberous sclerosis in 1(2%), Focal cortical dysplasia in 1(2%), Lissencephaly in 1 (2%), Joubert syndrome in 1(2%), and Arachnoid cyst in 1 (2%) patients. Conclusion: The MRI was able to identify brain lesions in 38% of pediatric patients who presented with seizures. The study revealed inflammatory granuloma as the commonest cause of seizures in children, followed by Hypoxic-Ischemic Injury. Early recognition of potentially treatable diseases helps in timely treatment and arrest of disease progression. It is recommended to use MRI as a primary investigation during the evaluation and management of pediatric seizures.

Does tumor stroma ratio of breast cancer trucut biopsy determine response to neoadjuvant therapy?

Aims and Objectives: We examined the prognostic value of Tumor stroma ratio (TSR) in breast tumor core biopsy (TCB) specimen to determine response to neoadjuvant therapy (NAT) prior to modified radical mastectomy (MRM). Methods: This was a retrospective analysis of patients with breast cancer who underwent TCB before NAT between August 2016 and July 2018. TSR in TCB was studied independently by 2 pathologists ( VM, VS) defined as stroma rich (TSR?50%) or stroma poor (TSR>50%). MRM specimen of these patients were subsequently studied .Residual cancer burden (RCB) was calculated using the MD Anderson RCB calculator, categorized as complete (0), good (1) Partial (2) and no response (3). Statistical analysis was done to assess correlation of TSR to RCB. Results: A total of 62 patients were analyzed. Mean(SD) age was 48(11) years.Twenty eight (45%) and 34 (55%) patients were stroma rich and stroma poor respectively. Twenty six (42%) patients were responders and 36 (58%) non-responders to NAT. Among stroma rich patients, only 3 (10%) were responders (Class 0 &1)and 25 (90%) non-responders(Class2&3)to NAT, among stroma poor patients 23 (68%) responded well and 11 (32%) did not.TSR had a moderate negative correlation with RCB (-0.6). On univariate analysis, only TSR had a significant effect on RCB class (<0.001). Conclusions: TSR on TCB is a useful prognostic factor to determine response of breast carcinoma patients to neoadjuvant therapy.It is cost effective, simple and quick. Larger multi-centric studies would be useful to study its clinical implications.

Fever work-up unfolds a rare diagnosis of native valve endocarditis caused by Mycobacterium abscessus

Endocarditis caused by Mycobacterium abscessus is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Accurate identification and sensitivity, combination therapy, and prolonged duration of antibiotics are, therefore, important for a successful outcome.

Role of grey scale ultrasound and Colour Doppler findings to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy

Introduction: Ectopic pregnancy and corpus luteum cyst are two most common differential diagnosis in a patient with UPT positive and no sonographic evidence of intrauterine pregnancy. Aim: To diagnose ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy on the basis of grey scale ultrasound and colour Doppler findings. Material and Methods: This was a hospital based prospective study carried out on a study group of 40 patients with UPT positive and clinical features suggestive of ectopic pregnancy over a period of two years.Grey scale ultrasound and colour Doppler parameters were studied. Results: Out of 40 patients,30 were diagnosed with ectopic pregnancy and 10 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (80%) and endometrium (60%). Free fluid with echoes was seen in the pelvis in 70% ectopic pregnancies whereas most of the corpus luteum cysts (80%) had no free fluid. Most of the corpus luteum cysts (70%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid.Yolk sac was seen exclusively in ectopic pregnancy (30%). RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy. Conclusion: Wall thickness of the mass, echogenicity of the wall as compared to ovaryand endometrium, internal echotexture of the cystic mass, presence of yolk sac and presence of free fluid with echoes are significant ultrasound parameters which help to differentiate between the two. RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy.

Studies on persistent organic pollutants residue in water, sediment and fish tissues of river Sutlej, India

Aim: To study the level of persistent organic pollutants in the environment of River Sutlej and rule out its detrimental effects on aquatic fauna. Methodology: Two different sites were selected for the study, one was before the confluence of a polluted tributary (Site I) another was after the confluence of polluted tributary (Site II). Analysis of water, sediment, gills and muscles of selected fish species was done to detect the level of persistent organic pollutants using Gas Chromatography. Results: Among POP's, PCB-28 was detected during monsoon period(0.55 ng ul-1) at Site I, while as it was detected both during monsoon (0.65 ng ul-1) and post-monsoon (0.49 ng ul-1) period at Site II in the water samples. Similarly, PCB-28 was detected in gills of Cirrhinus mrigala during pre (0.26 ng g-1) and post-monsoon (0.27 ng g-1) periods at Site I, while at Site II it was detected only during monsoon period (0.17 ng g-1). In Aoricthysaor gills, only PCB-28 was detected during pre-monsoon (0.34 ng g-1) and monsoon periods (0.19 ng g-1) at Site II. In Heteropneustes fossilis PCB-28 was detected during pre-monsoon period (0.26 ng g-1) at Site I, while at Site II it was found during pre-monsoon (0.21 ng g-1) and monsoon (0.17 ng g-1) periods. In Catla Catla gill samples among PCB's only PCB-28 was detected during pre-monsoon (0.32 ng g-1), monsoon (0.29 ng g-1) and post-monsoon periods (0.24 ng g-1) at Site II while Mirex (0.01 ng g-1) was detected at Site I during post-monsoon period. Interpretation: The study concluded that continuous monitoring of pesticide residue is warranted in the river Sutlej to rule out any detrimental effect of pesticide pollution on aquatic fauna.

Role of anti-tissue transglutaminase IgA+IgG antibodies in detection of potential celiac disease in patients with type 1 diabetes

Background & objectives: Celiac disease (CD) can exist in various forms in type 1 diabetes (T1D) patients and can remain undetected, leading to severe complications. This study was aimed to evaluate five commercially available anti-tissue transglutaminase (tTG) ELISA kits with distinct formats for the detection of CD and potential CD in T1D patients. Clinical and demographic profiles of the patients with different disease subsets were also studied. Methods: Fifty T1D patients with classical and non-classical symptoms of CD and 100 T1D patients without any symptoms of CD were included in this study. Anti-tTG autoantibody levels were estimated by five ELISA kits followed by histological examination of duodenal biopsy. HLA DQ2-DQ8 and DRB1-DQB1 typing was done, and serum levels for transforming growth factor (TGF)-?1 were also estimated. Results: Assay format detecting anti-tTG IgA antibodies against recombinant antigens along with neopeptides of gliadin was most efficient in the detection of CD in symptomatic patients, and assay format detecting IgA+IgG helped in the detection of potential CD in asymptomatic T1D patients. These findings were supported by histological examination and human leucocyte antigen analysis. Patients with potential CD were found to have markedly deranged glycaemic control parameters and also had significantly raised serum levels of TGF-?1, (P <0.05) compared to T1D patients. Interpretation & conclusions: Potential CD can be frequently seen in T1D patients. This can be attributed to the dietary patterns prevalent in the subcontinent and the genetic basis of the disease. Anti-tTG IgA+IgG antibodies can be useful in the detection of these potential CD cases in T1D patients. Early intervention with gluten-free diet can be considered in these patients for better disease management.

Breast reconstruction in low resource settings: Autologous latissimus dorsi flap provides a viable option.

BACKGROUND: Breast reconstruction (BR) plays a significant role in the woman’s physical, emotional and psychological recovery from breast cancer. However, the current most accepted methods of reconstruction are expensive, may require microsurgical skills and can be offered to a very small number of patients seeking treatment in tertiary care centers. For the large majority of women seeking treatment in public hospitals, solution lies in finding a method of reconstruction, which is autologous, produces a reasonable match to the contralateral breast in size, shape and symmetry and produces minimal donor site morbidity. It should also be a technique, which is cost effective and can withstand the effects of radiotherapy (RT). The autologous latissimus dorsi (LD) flap is one such versatile technique, which can serve as an ideal reconstructive option for the majority of patients. MATERIALS AND METHODS: During a period of 6 years, 19 patients underwent immediate BR using this flap in the Department of General Surgery. Patients who were young (mean age 37.4 years), had small to medium sized breasts, with operable breast cancer (Stage II and IIIa) were selected for the procedure. RESULTS: Satisfactory cosmetic results as rated by patients as well as surgeons were achieved in the majority. Donor site morbidities were seroma formation (78%) and donor site wound breakdown (21%). Post‑operative RT was well‑tolerated by the reconstructed breast. CONCLUSION: Autologous LD flap reconstruction is a safe and economical option for BR in low resource settings and is suitable for women with small and medium sized breasts.

Information and rehabilitation needs of Indian breast cancer patients: Report of a cross-sectional study.

Background: Breast cancer causes significant disruption to the quality of life (QOL) of its patients, which is compounded further by lack of information and adequate facilities for rehabilitation. Materials and Methods: This descriptive cross-sectional study was conducted in women who had completed their Primary treatment of breast cancer. The QOL was assessed by Functional assessment of cancer therapy-breast (FACT-B) version 4, and information and rehabilitation needs were enquired about in a semi-structured interview. Results: A total of 154 patients were enrolled and divided into three groups according to the time elapsed after initial treatment; Group I: 1-2 years, Group II: 2-5 years, Group III: >5 years The FACT-B mean scores were; Group I (n = 64): 79.06 ± 14.60; Group II (n = 48): 85.75 ± 20.15; and Group III (n = 42): 89.83 ± 12.80. Patients in Group I scored lowest on physical well-being subscale, Group II on breast specific subscale and Group III on Social well-being subscale. Pain, lack of energy, inability to meet the needs of the family, fear that the condition will get worse and loss of body image were significant factors contributing to poor QOL. Analysis of interviewshowed many unmet information needs. Main rehabilitation needs were effective treatment of physical symptoms and counselling about body image issues and sexual dysfunctions. Easy availability of clinical and social support services were major felt needs in the long-term follow-up. Conclusions: Targeted Interventions are needed to address issues relating to QOL and rehabilitation needs of breast cancer patients.

Prevalence and Antibiotic Susceptibility Pattern of Methicillin Resistant Staphylococcus aureus in Tertiary Care Hospitals.

Aims: Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in hospitals with hospital based outbreaks world-wide. The present study was carried out to estimate the prevalence of MRSA isolates in clinical specimens and to investigate the sensitivity pattern of resistant isolates against various antibiotics used for treating hospitalized patients. Study Design: The percentage of MRSA was defined as the number of S. aureus isolates resistant to methicillin divided by the total number of S. aureus isolates for which methicillin susceptibility test results were reported. Place and Duration of the Study: The study was conducted during January 2012 to December 2012 at Asian Hospital (tertiary care hospital), Faridabad, Delhi. Methodology: A total of 107 isolates of S. aureus were identified by standard laboratory procedures including catalase test, slide and tube coagulase tests, β- haemolysis on blood agar and growth on mannitol salt agar. Subsequently, antibiotic sensitivity pattern of S. aureus were determined by automated antibiotic susceptibility testing system Vitek 2 compact identification and susceptibility testing (ID/AST) system by using AST-GP-67 card. Result: 23 isolates (21.4%) were identified as MRSA and the remaining 84 (78.6%) were methicillin sensitive S. aureus (MSSA). All MRSA isolates were found to be resistant to penicillin, oxacillin, ciprofloxacin and levofloxacin. The antibiotic resistance pattern of these isolates were high against trimethoprim-sulfamethoxazole (91.3%), erythromycin (47.8%), gentamicin (43.5%), moxifloxacin (42.9%), and less resistance rate was observed against tetracycline (30.4%) rifampicin (13.6%) and clindamycin (4.8%). However, all isolates of Staphylococcus were sensitive to vancomycin, linezolid, nitrofurantoin, quinpristin/daflopristin. Conclusion: Findings presented in this study indicated a high level of resistance to widely used therapeutic agents. An appropriate knowledge on the current antibiotic susceptibility pattern of MRSA is essential for appropriate therapeutic scenario.

Mammographic density as a risk factor for breast cancer in a low risk population.

Background: Mammographic density is a function of abundance of epithelial and connective tissue in breast. It has been identified as an independent risk factor for breast cancer in studies in western populations. We conducted a case control study to evaluate the role of mammographic density as risk factor for the development of breast cancer in Indian patients. Methods: One hundred and one cases of breast cancer and 123 healthy controls were included in the study. Mammographic density of the breast tissue of all controls and the contralateral breast of breast cancer patients was measured using a six category scale by a qualified radiologist. Results: A low prevalence of dense mammographic patterns (16.3% in controls and 26.7% in cases) was seen in the study population. Premenopausal women with breast density of 50% or more had 3.8 times risk of developing breast cancer than women with breast density of Conclusion: High mammographic density patterns are associated with an increased risk for the development of breast cancer in younger women in a low risk population, whereas no such increase in risk is seen in postmenopausal women.

Studies on glucose-metabolizing enzymes in cytosolic and bacteroidal fractions of mungbean (Vigna radiata L.) and lentil (Lens culinaris L.) nodules.

Nitrogen is exported in the form of ureides or amides from the nodules in pulse crops. In order to understand the carbon metabolism in ureide and amide exporting nodules, activities of enzymes involved in glucose metabolism were compared in cytosolic and bacteroidal fractions of mungbean (ureide exporter) and lentil (amide exporter) nodules during development. Activities of hexokinase, fructokinase, phosphoglucomutase, fructose-1,6-bisphosphatase, phosphohexose isomerase and UDP-glucose pyrophosphorylase were detected in cytosolic fraction of nodules of both the crops during development. Out of these enzymes, specific activity of phosphohexose isomerase was the highest in nodules of both the crops, in comparison with other enzymes. In comparison with mungbean, activities of various enzymes were less in cytosolic fraction of lentil. Activities of hexokinase, fructokinase, phosphoglucomutase were present only in cytosolic fraction of mungbean (Vigna radiata L.), however, low activity of these enzymes was also observed in lentil (Lens culinaris L.) bacteroids. Activities of phosphohexose isomerase and fructose-1,6-bisphosphatase were higher in bacteroids of lentil, as compared to mungbean during early nodule development, but this pattern was reversed with progress of crop development. Higher activities of phosphoglucomutase and fructose-1,6-phosphatase in mungbean cytosolic fraction could lead to increased flow of carbon towards pentose phosphate pathway.

Massive amebic liver abscess--an unusual presentation.

A 40-year-old woman presented with a huge lump in the right half of the abdomen and irregular menses. Ultrasonography showed a cystic lump with septations, extending from the upper abdomen to the pelvis; the right ovary was not seen. On exploration, there was a large cyst arising from the right lobe of the liver; the aspirate was bilious. Since the cyst wall was adherent to retroperitoneal structures, complete excision was not possible. A roux-en-Y loop of jejunum was anastomosed to the cyst wall. Biopsy of the wall showed inflammatory granulation tissue with trophozoites of Entamoeba histolytica. She was treated with metronidazole, and recovered uneventfully.