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Renal cell carcinoma (RCC) is the most common subtype of adult renal tumors, and its detection rate in the early stages has been increased in the dawn of advanced imaging modalities. Nephrectomy is the mainstay of treatment; determination of tumor category and staging is the primary concern of oncopathologists. Non-neoplastic renal parenchyma is overlooked majority of times and thus misses the opportunity to detect concomitant medical renal diseases which also predict the renal outcome in the postoperative era. Although any kind of glomerular or extraglomerular pathology may be encountered, vascular changes in the form of arterionephrosclerosis are the commonest one. Here, we take the opportunity to report an unusual association of heavy chain deposition disease (HCDD) with clear cell subtypes of renal cell carcinoma in a 48-year-old male of Indian ethnicity.
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Background: Membranous nephropathy (MN) is a pattern of glomerular injury. Exact categorization into primary membranous nephropathy (PMN) or secondary membranous nephropathy (SMN) is essential for treatment. An endogenous podocyte antigen, M-type phospholipase A2 receptor (PLA2R) has been discovered to be involved in the pathogenesis of PMN. Aims and Objectives: In this article, we aimed to analyze renal tissue PLA2R and serum anti-PLA2R antibodies in MN cases and determined the diagnostic utility. Materials and Methods: The study was of prospective type carried out from March 2019 to August 2020. Analysis of cases of MN was performed with PLA2R paraffin immunoflourescence and serum anti-PLA2R antibody ELISA. Results: Overall sensitivity, specificity, PPV, and NPV of serum anti-PLA2R ELISA for PMN was 91.3%, 80%, 75%, and 93.3%, respectively, and of tissue PLA2R staining for PMN was 91.67%, 81.08%, 75.86%, and 93.75%, respectively. There was strong concordance between two methods. In the patients that were followed up, we found baseline serum anti-PLA2R antibody was less in complete remission group than that in non-remission group and the reduction in serum anti-PLA2R antibody was more in complete remission group than that in non-remission group. Conclusion: Routine light and immunofluorescence examination are incapable of giving exact categorical opinion regarding PMN and SMN. Serum anti-PLA2R antibody detection and renal tissue PLA2R analysis are sensitive and specific in detecting PMN. Baseline serum anti-PLA2R antibody and anti-PLA2R antibody quantification trends are related to prognosis of PMN. So they can be incorporated as additional biomarker.
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Lead is a dangerous element that exists naturally in the Earth's crust. Any kind of lead causes a detrimental response in the human body. It is discharged into the environment during the manufacturing of batteries, foundries, ammunition, lead paint, water pipes, and other manufactured goods. It can enter the body through a variety of pathways, including those in the air, water, soil, food, and dust. Concern is raised since there is no amount of lead that is safe for the human body. The problem persists despite several prevention measures that the state and the federal governments have put in place. This review assesses the effects of lead exposure on children as well as suggested solutions to the issue.
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Background- The malignancy of the oral cavity constitutes the most important group of malignancies in South and Southeast Asia.The risk increases with the use of tobacco products. Materials & Methods- Micronuclei frequency scoring was used as a biomarker to identify different potentially malignant disorders. Results- Mean micronuclei index was found higher using Hematoxylin and Eosin stain than Papanicolaou's stainand May Grunwald's stain. Conclusion- We concluded that the micronuclei frequencies in oral exfoliated epithelial cells using three different stains- Hematoxylin and Eosin stain, Papanicolaou's stain, May Grunwald's stain may be useful in predicting the malignant potential of premalignant lesions.
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Background: An undergraduate curriculum begins with anatomy, the importance of this knowledge is essential for understanding and contextualizing clinical pathophysiology. Didactic lecture and cadaveric dissection have been the mainstay of anatomical learning. Temporal bone is the complicated bone of the skull and lodges middle ear. Middle ear surgeries requires complete evaluation of middle ear surgical anatomy, mainly posterior tympanic cavity, as it contains many irregular spaces, removal of complete cholesteatoma is a challenge that surgeons face regularly. Endoscopic dissection is the innovative way and aids in viewing of nook and corner of middle ear. To compare theObjective: learning effectiveness of students through model teaching and endoscopic teaching of middle ear anatomy on cadaver specimen. Currently wet sagittal section of face and POP model of middle ear are theMethods and Materials: materials used for the study. For the new innovative approach, third year MBBS students were divided into two groups containing 30 in each group. Assessment of both the groups was done with questionnaire. Both the groups were assessed with same questions and scoring was done. In group A, maximum score was 11 and minimum was 3.25 out of 18.Results: In group B, maximum score was 17.5 and minimum was 5 out of 18. In group A, according to scaling, students fell into poor and average category whereas in group B , students fell into good and very good category as well. Conclusions: Analysis identified, statistically significant increase in performance for the endoscopic method compared to model teaching.Overall, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge and more efficient as compared to model teaching
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Background: Hypertension is consistently related to the development of ischemic heart disease, heart failure, stroke, and chronic kidney disease. Oxidative stress has been associated with mechanisms of hypertension which could be nullified by antioxidants such as Vitamin C and Vitamin E. Aim and Objectives: The objectives of the study are as follows: (i) To estimate the impact of antioxidant therapy on antioxidant capacity in hypertensive patients; (ii) to measure serum levels of glutathione, glutathione peroxidase (GPx), glutathione reductase (GR), and superoxide dismutase (SOD) in hypertensive patients before and after giving them antioxidant therapy for 45 days. Materials and Methods: Thirty randomly selected hypertensive patients were given Supradyn tablet once a day for 45 days. Ferric reducing ability of plasma (FRAP), SOD, GR, GPx, and reduced Glutathione assays were measured before and after the intervention therapy. Results: Total antioxidant capacity as measured by serum FRAP in hypertensive patients before and after the therapy was increased significantly from 578.8 ± 60.85 to 592.1 ± 59.66 (?mol/L), respectively. The levels of SOD, GPx, GR, and Glutathione in hypertensive patients before giving antioxidant therapy were 1.6 ± 0.49 U/ml, 184.6 ± 17.1 ?mol/L/min, 8.96 ± 1.15 ?mol/L/min, and 8.03 ± 0.96 ?mol/g of Hb, respectively. The same after giving them antioxidant therapy were 1.7 ± 0.46 U/ml, 182.4 ± 15.98 ?mol/L/min, 8.83 ± 1.11 ?mol/L/min, and 7.83 ± 0.94 ?mol/g of Hb, respectively. The levels of GPx, GR, and Glutathione were significantly decreased after giving antioxidant therapy for 45 days while SOD level did not change significantly. Conclusion: Antioxidant therapies for 45 days led to a significant increase in total antioxidant capacity as shown by plasma FRAP levels and a significant decrease in serum levels of enzymatic antioxidants such as GPx, GR and Glutathione in hypertensive patients. However, serum levels of SOD did not show a significant change.
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Background: The importance of prostatic carcinoma and its detection has increased manifold over the last few decades. Total serum acid phosphatase (ACP) was the world’s first emerged clinically useful tumor marker in the 1940s and 1950s in patients with prostatic diseases. With the introduction of the prostatic specific antigen (PSA) test in the 1980s, which performed significantly better in screening and treatment programs bringing disfavor to the advent of ACP. Aims and Objectives: To determine serum PSA and total serum ACP in patients with prostatic cancer and benign prostatic diseases, followed by evaluation of these tumor markers. Materials and Methods: This study was conducted on 30 patients with histologically proven cases of prostatic carcinoma and compared against 30 patients as control with benign prostatic pathology, residing in Punjab who were admitted and treated with symptoms complex of prostatism or retention urine or other urinary complaints as the primary symptoms. PSA and ACP in serum were determined using ELISA test kit and King and Kind method, respectively. Results: The mean level of serum PSA was 81.19 ± 49.02 for cancer prostate and 4.975 for benign prostatic diseases, while the mean level of serum ACP was 5.22 ± 1.70 and 2.52 ± 2.27, respectively, for the cancer prostate and benign prostatic diseases showing statistically difference between study and control groups was highly significant as P < 0.0001. Conclusion: Statistical analysis and results of the present study indicated that although serum ACP has better specificity to PSA, yet later is a very sensitive tumor marker in prostate diseases for screening, diagnosis, and post-treatment follow-up.
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Objectives: The purpose of this study was to see the effect of parenteral testosterone injection on penile length, glans diameter, and diameter at the base of the penis in hypospadias patients before surgery. Material and Methods: The study was conducted from September 2019 to March 2021. This study comprised a total of 20 hypospadias patients. At a dose of 2 mg/kg body weight, an injection testosterone propionate was administered deep intramuscularly in three doses with a 3-week gap before reconstructive surgery. Before surgery, the penile length, glans diameter, and penile diameter at the base of the penis were all measured. Results: The mean increase in penile length, glans diameter, and diameter at the base of penis following parenteral testosterone therapy was 1.07 ± 0.23 cm (P < 0.001), 1.01 ± 0.46 cm (P < 0.001), and 0.92 ± 0.12 cm (P < 0.001), respectively. All three measurements were statistically significant. Conclusion: Intramuscular testosterone increased penis size, glans diameter, and penile diameter without causing any notable side effects. Development of fine pubic hair, acne, and aggressiveness is minor adverse effects.
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Background & objectives: The National Tuberculosis (TB) Control Programme has transitioned from thrice-weekly to daily drug treatment regimens in India. This preliminary study was conceived to compare the pharmacokinetics of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) in TB patients being treated with daily and thrice weekly anti-TB treatment (ATT). Methods: This prospective observational study was undertaken in 49 newly diagnosed adult TB patients receiving either daily ATT (n=22) or thrice-weekly ATT (n=27). Plasma RMP, INH and PZA were estimated by high-performance liquid chromatography. Results: The peak concentration (Cmax) of RMP was significantly higher (RMP: 8.5 ?g/ml vs. 5.5 ?g/ml; P=0.003) and Cmax of INH was significantly lower (INH: 4.8 ?g/ml vs. 10.9 ?g/ml; P<0.001) in case of daily dosing compared to thrice-weekly ATT. Cmax of drugs and doses was significantly correlated. A higher proportion of patients had subtherapeutic RMP Cmax (8.0 ?g/ml) during thrice-weekly compared to daily ATT (78% vs. 36%; P=0.004). Multiple linear regression analysis showed that Cmax of RMP was significantly influenced by the dosing rhythm, pulmonary TB and Cmax of INH and PZA by the mg/kg doses. Interpretation & conclusions: RMP concentrations were higher and INH concentrations were lower during daily ATT, suggesting that INH doses may need to be increased in case of a daily regimen. Larger studies are, however, required using higher INH doses when monitoring for adverse drug reactions and treatment outcomes.
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Hoffman's syndrome is a rare form of hypothyroid myopathy, which causes proximal muscle weakness and pseudohypertrophy of muscles.Itis a complication of untreated or uncontrolled Hypothyroidism.The neurological manifestations of hypothyroidism usually occur late in the course of disease. It is quite rare to present with neurological manifestations in the earlier stage of disease. Very few cases of Hoffman抯 syndrome were reported from India. Here we report a case of 27-year-old male who presented to the medicine OPD with initial symptoms of proximal muscle weakness, fatigue and calf muscle hypertrophy. On further evaluation patient was found to have hypothyroid myopathy in the form of Hoffman抯 syndrome.
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Background: Rotator cuff tendinopathy (RCT) is a main source of disability work inefficiency and overall inefficiency. Platelet-rich plasma (PRP) has been postulated to be of great advantage in the management of RCT. Steroidal formulations are base of all joint morbidities since long for inflammatory and degenerative conditions in orthopedics. Aim and Objectives: The aim of the study was to compare the effect of PRP injections versus steroid Injection (triamcinolone) in subacromial space on pain control and improved shoulder functions in patients having chronic RCT. Study Design: This study was a randomized controlled trial and level of evidence. Materials and Methods: The study was conducted in the Orthopaedics Department of GMC, Patiala on 40 patients (aged more than 18 years) who presented in emergency and Outpatient Department with symptoms of shoulder pain and decreased mobility at shoulder. The patients were divided into two groups. Every odd number of patient presenting to us was given PRP injection (Study group) and every even number patient was given inj triamcinolone (control group) along with physical therapy in both study and control group. Patient was followed up subsequently after 4-week and 12-week time for resolution of symptoms and improved pain-free activities. Outcome assessment criterion used included VAS system and Oxford Shoulder Scoring System. Results: Comparison of the patients in the two groups revealed significant difference between the groups in VAS and OSS at 4-week and 12-week follow-ups. Long-term effect was more in case of PRP group as compared to steroid formulation which was almost similarly effective acutely. Conclusion: Subacromial PRP injection was found to be more effective in long-term in improving overall quality of life, disability, pain, improved work efficiency, and improved shoulder movements in patients with chronic RCT than those treated by subacromial steroidal injection along with exercise program.
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Background: Conventionally, teaching in the subject of physiology is undertaken with the help of didactic lectures, practical demonstrations, and tutorials. Case-based learning (CBL) is known to impart analytical and problem-solving skills in the students. CBL motivates students to apply clinical knowledge from real-life scenarios to solve problems. Aims and Objectives: The aim of the study was to compare the effectiveness of didactic lectures and CBL in physiology among 1st-year BDS students and to gauge their perception. Materials and Methods: After ethical approval, this study was conducted at physiology department PIMS Udaipur. After taking informed consent, two groups of 40 students were taught two different topics using CBL and didactic lectures with cross-over study design. Students’ learning was assessed by 20 pre-validated MCQs. Mean ± SD of the pre- and the post-test scores of the students was taken. The post-test scores of the students in both the groups were compared using Student’s t test. P < 0.05 was considered as significant. Students’ perception was analyzed on Likert scale. Results: CBL was found to be statistically significant (P < 0.01) in both the topics. MCQ scores of didactic lectures was 7.972 ± 1.765 and 7.667 ± 1.971 while that of CBL was 9.111 ± 2.081 and 9.222 ± 2.257 in anemia and jaundice, respectively. Students gave favorable and encouraging perception on CBL method. Conclusion: CBL was more effective than didactic lectures in teaching physiology to undergraduates. First-year BDS students found interactive case discussions more enjoyable and educationally stimulating than lectures. Students’ feedback indicated that CBL could be incorporated more in undergraduate physiology Curriculum.
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Trauma involving the eye, orbital and periorbital regions are commonly seen in cases of road traffic accidents, sports injuries and physical assaults, but cases of intraorbital / periorbital foreign bodies are rare. Early presentation, history of trauma, and imaging help in diagnosis. However, sometimes the diagnosis is missed, particularly in cases with late presentation and a vague history of minor trauma and trauma with a non-metallic foreign body. A missed foreign body may present later with infection, repeated inflammation, ptosis, and proptosis and motility defect, further complicating the management.Here, we present a case of missed foreign body during the primary repair of facial injury in a 32-year male with polytrauma sustained in a road traffic accident. Evidence of foreign body was reported in a CT scan head advised for head injury. Re-exploration of wound and removal of foreign body is performed under local anaesthesia.
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Background: An international public health concern is hypertension, sometimes referred to as high or elevated blood pressure. It adds to the burden of early mortality, disability, kidney failure, heart disease, and stroke. Early-stage hypertension rarely manifests as symptoms, and many sufferers go undetected. Those who receive a diagnosis might not have access to care and might struggle to maintain long-term control over their sickness. Aim and Objectives: The aim of the study is to ascertain the prevalence of hypertension and associated risk factors in the Uttar Pradesh region of Aligarh. Materials and Methods: In the realm of community medicine, a cross-sectional study was conducted in the community. Six hundred and forty-four research participants, who had to be at least 18 years old, were chosen by a methodical random sample of homes. All study participants had their anthropometry and blood pressure assessed using standardized equipment and procedures. Appropriate statistical tests were applied as per the types of dataset. Results: Hypertension was 25.2% prevalent. Males (33%) had a greater rate than females (18.3%). Age-related increases in the prevalence of hypertension were observed. Hypertension was highly correlated with factors such as upper socioeconomic class and sedentary lifestyle. Conclusion: Hypertension is very common and is correlated with sociodemographic characteristics. Therefore, extensive attempts at primordial prevention are required.
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Background: Visual evoked potentials (VEPs) are electrical potential differences recorded from the occipital lobe in response to different visual stimulus. In myopic individuals, there is blurring of the stimuli, causing defocusing which tends to affect the VEP parameters. Aim and Objective: The study was designed and done to evaluate the effect of various degrees of myopia on VEP in medical students of age 18–24 years. Materials and Methods: A total of 120 subjects were included in this study, consist of 60 individuals without having any refractive disorders and 60 individuals having various degree of myopia, that is, 22 subjects with mild myopia of <?3D, 26 subjects with moderate myopia of ?3 to ?6D, and 12 subjects with severe myopia of > ?6D. The study was approved by Ethical and Research Committee, Govt. Medical College, Patiala. Results: In the present study, mean values for P100 latency were significantly high in myopic group as than in control group. Furthermore, mean values for N75 latency were significantly high in the myopic group as compared to the control group and mean values for N145 latency were significantly high in the myopic group as compared to the control group for both the right and left eyes. Mean values for amplitude (N75-P100) was significantly lower for the myopic group as compared to the control group for both the left and right eyes. There is prolongation of latencies in myopic individuals as compared to the control and latencies increase with the increase in degree of myopia. Furthermore, there is decrease in the amplitude in myopic individuals and it decreases with the increase in degree of myopia. Conclusion: The mean values for latencies were found to be comparable and the mean values of latencies were found to be increasing with increase of degree of myopia. Probably, the reason behind this result may be the optical blurring of the stimulus which lead to defocusing, therefore causes the prolongation of latency. The mean values for amplitude were found to be comparable and the mean values of amplitude were found to be decreasing with increase of degree of myopia. Probably, the reason for our finding is that in a pattern reversal VEP, the amplitude relies on the visual system’s ability to determine the pattern and on the degree of retinal image focus.
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Background: Adverse drug reactions (ADRs) in children cannot be predicted based on those observed in adults. Systematic surveillance of ADRs in children, in particular to corticosteroids are limited. Aim and Objective: The aim of the study was to evaluate the pattern as well as causality, preventability, and severity of occurrence of ADRs due to corticosteroid therapy in pediatric idiopathic nephrotic syndrome (INS). Materials and Methods: After obtaining approval from Institutional Ethics Committee and informed consent/assent, 98 patients who developed ADRs were included in the study. Each patient’s demographic, clinical, treatment data, response pattern, and ADRs to corticosteroids as per Indian Academy of Pediatrics guidelines were noted in the pro forma. The data were analyzed using descriptive statistics. Results: Total of 148 ADRs were observed due to corticosteroids among 98 patients diagnosed with nephrotic syndrome. The most common ADR was cushingoid features (18%), followed by infections (14%), gastrointestinal symptoms (11.48%), hypocalcemia (8%), and growth retardation (7%). About 45% of the ADRs were of “possible” causality and 32% were certain. Severity assessment indicates 54% as mild and majority of ADRs were not preventable. Conclusions: This study provides data of ADRs to corticosteroid therapy in INS patients. Most of the ADRs were predictable and possibly preventable and mild, which highlights the importance of early detection and management of ADR.
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Healthcare fires have always been one of the major internal hazards and an oxygen-rich environment further aggravates these threats. The present case study reports such a fire incident in an Advanced Trauma Centre of a tertiary care hospital in North India wherein a tiny spark generated while handling an oxygen cylinder a health care worker got caught in a fire blaze. Fortunately, the flare was controlled within no time due to prompt action by a fellow HCW, and a major unexpected incident was averted. A formal investigation conducted by a team of experts ascertained that oxygen enrichment from leaking equipment, improper handling, and repeated striking of cylinder regulator by the spanner which attained the required threshold temperature was the probable cause for the onset of a flare. Henceforth, to miti-gate such incidents users shall follow manufacturer recommendations, and ensure only safe and suitable components are used as part of a compressed oxygen system. Maintenance of cylinders, valves, and regu-lators should be done periodically to mitigate the risks of such incidents. All hospitals shall carry out risk-assessment exercises and provide oxygen safety training to all healthcare staff.
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Introduction: Researchers found that cryotherapy at the ankle joint heightened adjacent muscle activity and reflex amplitude, which facilitated greater force production at the ankle complex. Furthermore, cryotherapy appears to increase musculoarticular stiffness, which has been associated with heightened muscular performance at a joint. Aim and objective: the aim of the study is to examine the influence of dynamic stretching and IBA technique on the physical performance. Methodology: Total 20 healthy male basketball athletes encompassing two groups participated in the current study. The study consisted of two groups, Group A (ice bag application) and Group B (dynamic stretching). Cold compress was applied over the anterior thigh, posterior thigh, and calf. Subjects were assigned to Group A, and Group B, using Convenience sampling method. Each candidate performed the 5 minutes of jogging before taking intervention. All subjects performed three functional performance tests: Vertical Jump Test, Agility T-test & 20-meter sprint. Each participant attended an orientation session to become familiar with the testing procedures. Subjects were randomly assigned into two groups and exposed to a crossover study design. The experiment was performed on two separate occasions whereby one group received the dynamic stretching in the first session, while the other group uses the cryotherapy first. After 48 hours, (cooling session) on the next occasion, the groups were changed and the second group receives the cryotherapy, while the first group performs dynamic stretching. On both occasions, the dynamic stretching and cryotherapy interventions were the same. Between the sessions, the subjects will not allow to participate in any kind of vigorous physical activity. Results: The present study showed an increase in performance of recreational Basketball players by the combination of 5 minutes of warm up plus 6 min of dynamic stretching on the vertical jump height and 20-meter sprint