Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

CHINESE STRING OF PEARLS POLICY AND INDIA'S SECURITY IMPLICATIONS

String of Pearls refers to the Chinese intention to establish a network in India Ocean Region (IOR) surrounding India. Each Pearl represents some form of permanent Chinese military installation in a series of locations along a String. Recent development of ports around India, in Gwadar, Hambantota, Sittwe on the Bay of Bengal Coast in Myanmar etc. are seen as part of a string of pearls. Although these are commercial ports, the fear is that these could be easily converted to Naval facilities in case of a conflict in India

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India

Purpose: To report the clinico?demographic profile of rhino?orbito?cerebral mucormycosis (ROCM) in patients during the “second wave” of the COVID?19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross?sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID?19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID?19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty?six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID?19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Knowledge of Accredited Social Health Activist (ASHA) Workers Regarding Maternal Health Services: A Comparative Study between Rural and Urban Areas of a Block of Haryana

Introduction: All people, everywhere, deserve the right care, right in their community. In any community, maternal mortality ratio strongly reflects the overall effectiveness of health systems. To increase utilization of existing health services, Accredited Social Health Activist (ASHA) is the key component of the National Rural Health Mission. o assess compare the level of knowledgeO : bjective T any of ASHA workers regarding maternal health services in between rural and urban areas of a block of Haryana. Method: The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. The assessment of knowledge of ASHA workers was done on the basis of scoring. Appropriate statistical tests like percentages and chi-square (?2) test were applied. RegardingResult :s maternal health services majority of ASHA workers had good knowledge, assessed by score gained by them and none of them was having poor knowledge about maternal health services. However in rural area score, gained was better than urban area & the observed difference was found to be statistically significant. Knowledge of identification & treatment of anaemia and identification of danger signs during pregnancy were inadequate among ASHA workers of both areas. Knowledge of ASHA workers wasConclusion: inadequate as far as anaemia and danger signs during pregnancy were concerned. Frequent and regular refresher training should be organized in their working area.

Special Features in the Reproductive Anatomy, Physiology, and Behavior of Male Camels (Camelus dromedarius)

The peculiarities of anatomic and physiologic features of dromedary camels are elucidated in this review and compared with Bactrian, camels, and other species. Both dromedary and Bactrian camel scrotum varies in length from 10-20 cm and the testes are in the perineal region behind the thighs (like dogs) and weigh from 80-90 gm and length varies from 10-14 cm. Compared to ram and buck, camel epididymis has a higher weight (20-46 g) and has a unique structure called the intra-epithelial glands. Both dromedaries and Bactrian camels do not have seminal vesicles. Male camels have specialized secretory glands behind the ears known as poll glands that are bigger in the Bactrian camels compared to dromedary camels and similar glands are not seen in any of the other domestic species. Camels have a special reproductive behavior during the breeding season known as rut and include extrusion of the soft palate, copious froth from the mouth, gurgling sounds, splashing of urine, increased secretion from the poll glands and loss of appetite with considerable reduction in body weight. Such behaviors are not evidenced by any other domestic species including buffalo. Serum testosterone rises substantially in male camels during rut (2-42 ng/mL) compared to the non-rutting season (0.6-8 ng/mL) and the resultant increase in the size of the testes, number, and functionality of Leydig cells and secretion of poll glands. The serum thyroidal hormones also increase significantly during the rut season. It is concluded that male camels have some special anatomic and physiologic features of reproduction not observed in other domestic species.

Study of central aortic blood pressure in hypertensive patients & its relation with blood pressure-lowering drugs

Background & objectives: In clinical settings, peripheral blood pressure (PBP) is measured routinely. It is thought that central blood pressure (CBP) which reflects aortic BP, may be more predictive of outcomes in specific populations. Hence, this study was carried out to measure CBP in patients with hypertension and to see the effect of antihypertensive drugs on CBP. Methods: This cross-sectional study was conducted on 134 hypertensive patients and 134 normotensive healthy individuals as controls. Peripheral BPs and CBPs were measured of all patients and controls. The data were correlated and the effect of antihypertensive drugs on CBP was also evaluated. Results: Of the 134 hypertensive patients, 44 (32.84%) were newly diagnosed and the rest 90 (67.16%) had a history of hypertension and were on treatment. Of these 90 patients on treatment, 37 (41.11%) had uncontrolled peripheral BP and 53 (58.89%) had normal peripheral BP. Of the 134 hypertensive patients, 45 (33.58%) had controlled CBP. In 90 patients, who were on antihypertensive treatment, 45 (50%) had controlled CBP and 45 (50%) had uncontrolled CBP. Patients on calcium channel blockers (CCBs) had better control of CBP. Interpretation & conclusions: Hypertension is diagnosed mainly by measuring peripheral BP. CBP, which correlates better with the incidence of cardiovascular events, is not routinely measured. Patients with a history of hypertension and on treatment had normal office peripheral BP, but a few of them had high CBP and may require modification in treatment for control of CBP. Control of CBP was better in patients taking CCB.

Nosocomial infections-related antimicrobial resistance in a multidisciplinary intensive care unit

Background: Intensive care units (ICUs) have become hubs of nosocomial infections worldwide. There has been a continuous rise in the development of antimicrobial resistance among ICU-acquired infections. Particularly, the Gram-negative bacteria implicated in ICU-acquired infections have become resistant to the majority of the antibiotics leading to a critical therapeutic problem. The present study was conducted to determine the antimicrobial resistance pattern of microorganisms causing nosocomial infections (ventilator- associated pneumonia [VAP], central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) in a multidisciplinary ICU. Materials and Methods: This prospective observational cohort study included the patients with ICU stay ? 48 h and any of the ICU-acquired infections: VAP, CLABSI, or CAUTI. The appropriate specimen was collected as per the standard procedure and cultured. The antimicrobial susceptibility of all the bacterial isolates recovered from the samples was performed according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The antimicrobial resistance data were analyzed using WHONET Microbiology Laboratory Database software 5.6 (WHONET 5.6). Results: Gram-negative microorganisms were the principal pathogens causing various infections in the ICU, out of which Pseudomonas aeruginosa and Klebsiella pneumonia were the commonest. Most of the Gram- negative bacteria showed a high degree of resistance to the majority of the antibiotics. Colistin was observed to be the most effective antimicrobial for Gram-negative pathogens followed by doripenem, meropenem, and tigecycline. The majority of Staphylococcus aureus isolates (71.4%) were methicillin-resistant S. aureus; however, all were sensitive to vancomycin and linezolid. Vancomycin-resistant Enterococci constituted 43% of Enterococcus isolates and were sensitive to linezolid and tigecycline. Conclusion: Antimicrobial resistance was very high among the pathogens causing nosocomial infections in the ICU, especially Gram-negative bacteria demonstrated a substantially high degree of resistance to the majority of the antibiotics. Antibiotic stewardship will help control the emergence of multidrug-resistant microbes.

Evaluation of Lung Volume and Effect of Vital Staining as Motivation to Quit Tobacco among Nicotine Dependents of Kanpur, India

Abstract Objective: To quantify and compare respiratory functions and further screen the oral mucosa of tobacco and non-tobacco users. Material and Methods: First control group, non-tobacco users (n=55); Second group, smokers' group (n=168) who currently smoked cigarettes; Third group smokeless/chewing type, tobacco group (n=81); Fourth group, both smokeless and smoking type tobacco users (n=46). Fagerstrom Test for Nicotine Dependences (FTND) and Fagerström Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) instruments were used to assess nicotine dependence. Subsequently, spirometry and Toluidine Blue (TB) vital staining were performed. Chi-squared and one-way analysis of variance (ANOVA) were used for statistical analysis. Results: Fagerstrom test resulted in 48.8% of subjects with low dependency, followed by an increase in nicotine dependency from low to moderate (29.2%), moderate (15.6%), and highly dependent (6.4%) groups. All respiratory function tests and oral screening confirmed significant changes amongst tobacco and non-tobacco users. The forced vital capacity of non-smoker group was significantly different from other tobacco users' group (p<0.05). Conclusion: Early effects of tobacco use can lead to complications with the respiratory system and oral cavity. Such data can be used to delineate the harm of tobacco and should be used to urge individuals to evade the utilization of tobacco (AU).

Study of relationship between umbilical cord blood hemoglobin percentage and perinatal asphyxia

Background: Perinatal asphyxia may be caused by perinatal anemia. The pathophysiology and neurodevelopment effects are theoretically different from other causes of fetal asphyxia. Severe asphyxia can occur in infants around the time of birth by various reasons. The aim of this study to find the relationship between cord blood hemoglobin and perinatal asphyxia.Methods: This was a retrospective comparative study in department of OBG In tertiary care health centre. Umbilical cord blood samples were collected from 100 newborns with asphyxia at birth as study group and 100 newborns with non asphyxia as control group. Hemoglobin was measured colorimetrically.Results: This study finds that maximum number of patients in both the control and study group had hemoglobin in the range of 16.3-17.3 gm/dl. The difference was not statistically significant. P value>0.05.Conclusions: Hematological changes observed early after delivery can determine the duration of hypoxemia (acute versus chronic) Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed no abnormalities in neurodevelopment in contrast to children who were born asphyxiated due to various another causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.

Determination of nitrofurantoin and fosfomycin susceptibility among urinary Escherichia coli isolates

Background: Urinary tract infections (UTIs) are one of the most common infections. For treatment of UTIs, there are limited antibiotics due to increased resistance among uropathogens. Two older antibiotics; Nitrofurantoin and Fosfomycin have become novel oral therapeutic options against uropathogens. Aim of the study was to identify UTI causing micro-organisms and evaluate in-vitro activity of nitrofurantoin and fosfomycin against most common isolated organism (E. coli).Methods: Results of urine samples culture and susceptibility testing over a period of 1 year were analysed and included in this study.Results: Micro-organisms were isolated from 568 urine samples. Most commonly isolated organism was Escherichia coli (40.50%), followed by Klebsiella spp. (20.07%) and Staphylococcus spp. (17.07%). Susceptibility of E. coli to nitrofurantoin and fosfomycin was 91.74% and 65.65% respectively. Conclusion: Good activity of nitrofurantoin and fosfomycin against E. coli indicates that these two drugs are potential therapeutic alternatives for urinary tract infections.

Open reduction for neglected traumatic hip dislocation in children and adolescents

Background: Neglected traumatic dislocation of the hip is extremely rare in children, and the preferred treatment remains unclear. In this study we studied the role of open reduction in neglected traumatic hip dislocation in children and adolescents as a modality of treatment.Methods: Eight patients with a neglected, traumatic dislocation of the hip received in the emergency department of GMC, Jammu were managed by open reduction. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed in the study.Results: All patients presented with limp and pain. Six patients had minimal difficulty in squatting while two had marked difficulty. Leg lengths were within 2 cm in 7 of 8 cases at follow-up, and only 1 patient had a discrepancy greater than 2 cm.Conclusions: Open reduction is a satisfactory treatment for neglected hip dislocation. It restores joint stability, range of motion and limb length.

Clinical Presentation, Management and Outcome in Diverticular Colovesical Fistulas - Our Experience.

Colovesical fistula (CVF) is an abnormal communication between the urinary bladder and the large intestine, usually sigmoid colon. Diverticulitis is the most common cause of CVF in most of the western studies, accounting for approximately 70% of cases. Diverticular CVF is uncommon in Asia. This case series shares the experience of six cases of diverticular CVF in Indian population. METHODSMedical records of six patients with diverticular colovesical fistulas during the period January 2016 - August 2019 were reviewed with regard to symptoms, diagnostic investigations, and management. Various aspects of the disease were analysed to determine the common features of colovesical fistula in our population. RESULTSAll patients with diverticular colovesical fistula were presented with urinary symptoms and none were aware about their existing colonic diverticulosis. Five out of the six cases presented with pneumaturia. Contrast enhanced computed tomography (CECT) abdomen detected sigmoid diverticulosis with vesical fistula in all cases. The most common site of fistula found on cystoscopy was on the left superolateral wall of bladder. All cases were operated as a single stage procedure including fistula repair, colonic resection, omental interposition with no temporary colostomy which provided an excellent surgical cure. CONCLUSIONSColovesical fistula secondary to diverticular disease has shown a rising incidence and can be effectively managed by a multidisciplinary team. It requires prompt diagnosis, adequate preoperative evaluation, perioperative care including bowel preparation, nutritional supplementation, appropriate antibiotics, and meticulous surgical skills allowing an elective one-stage approach.

A Study of Comparison between DJ Stenting and Silodosin after Ureteroscopic Lithotripsy for Mid and Lower Ureteric Calculus.

Ureteric calculi are known to affect approximately 10 – 15% of the overall population. We wanted to determine as to whether silodosin can be used instead of DJ stenting in patients with uncomplicated ureteroscopic lithotripsy.METHODSWe selected 60 patients who underwent ureteroscopic lithotripsy (URSL) in the study group. They were divided into ‘stented group’ and ‘non-stented group on silodosin’. Patients with stone of 5 to 18 mm size with no intraoperative mucosal injury and no stricture were included in the study. All patients underwent surgery using an 8/9.8 Fr rigid ureteroscope, without ureteral dilation, with lithotripsy using an electro-hydraulic lithotripter, without extraction. A 4.5 Fr Double J stent was placed in the first group for three to four weeks. The patients underwent urine routine examination, plain x-ray KUB, and ultrasound abdomen before and after lithotripsy. Lower urinary tract symptoms and pain scores were recorded on 3, 7 and 15 days postoperatively. We compared mean operative time, emergency visits, rehospitalisation rates, and residual fragments between each group.RESULTSOut of 60 patients, 53.3% of patients had lower ureteric calculus, 30% had mid ureteric, and 16.7% had calculus at vesicoureteric junction. The mean calculus size on the left side was 10.23 mm, and on the right side was 10.33 mm. The mean intraoperative time was 33.23 minutes in stented and 29.9 minutes in the silodosin group (p< 0.003). Patients underwent assessment for flank pain, fever, and LUTS on postoperative days (POD) 3, 7 and 15. There was no statistically significant difference between the two groups though patients with DJ stent had more symptoms on inquiry. A total of 5 patients in the treatment groups were re-hospitalised, two patients (6.7%) in the stented group, and three patients (10%) in the silodosin group, out of which three patients (5%) required a secondary procedure which was not statistically significant. Three subjects treated with silodosin and 12 with the DJ stent in situ had residual fragments on POD 21 which was statistically significant (p 0.27).CONCLUSIONSPatients with uncomplicated URSL have similar recovery of renal function when treated with silodosin as compared to the placement of DJ stent. Treatment without stent with silodosin also has less irritative LUTS. We conclude that silodosin can be an alternative to DJ stent after uncomplicated ureteroscopic electrohydraulic lithotripsy, thereby reducing operative time and patient morbidity.

Clinical, hematological and cytogenetic profile in fibroblast growth factor receptor 1 rearranged hematoloymphoid malignancies

The background of this study is FGFR1 belongs to a family of four, high-affinity receptor tyrosine kinase and is a legitimate oncogene associated with uterine, cervical, prostate, bladder, colorectal and lung cancers. It is rarely concomitant in myeloid and lymphoid neoplasms but has an aggressive clinical course with a high mortality rate when present. Cytogenetic abnormalities involving the FGFR1 gene is most frequently observed in AML, MPN with eosinophilia, T-ALL and T-LBL with ZMYM2 gene being the most common fusion partner. Methods of this study was to authors report a series of 4 cases with FGFR1 rearrangements. Results is three patients presented as T-cell Lymphoblastic lymphoma (T-LBL) and one as mixed phenotype acute leukemia (MPAL). The T-LBL cases harboured the FGFR1/ ZMYM2 fusion and the MPAL case harbored the CNTRL/FGFR1 fusion as identified by conventional cytogenetics and confirmed by molecular studies. Conclusion is authors herewith describe the clinical, biochemical, molecular and cytogenetic features observed in these cases.

OHVIRA syndrome with Orofacial clefts: a rare association

Obstucted hemivagina with ipsilateral renal anomaly (OHVIRA) syndrome or Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly consist of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. We are reporting an adolescent girl with orofacial defect who presented with lower abdominal pain. She attained menarche 3 months earlier and had a regular menstrual cycle with cyclical abdominal pain. On abdominal examination a firm, mobile tender mass extending from left iliac fossa up to umbilicus (24 weeks size) was found.  Lower border of mass could not be approached. Further evaluation with ultrasound showed enlarged uterus with collection with internal echoes and non-visualization of the left kidney. CECT showed absent left kidney and didelphys uterus with large left hematocolpometra with left complex adenexal cyst. Patient was posted for hematocolpos drainage and vaginoplasty. An unusual presentation of regular menstruation and nonspecific abdominal pain delays the diagnosis, which can lead to severe complications such as endometriosis and infertility.

Serum CRP and Leptin Levels to Assess Nutritional Status in Patients on Maintenance Hemodialysis

Introduction: Malnutrition is common in patients withEnd Stage Renal Disease (ESRD) on Hemodialysis (HD).Depending on the parameter measured, the prevalence ofmalnutrition in the chronic dialysis population ranges from 10to 54%. It is related with the secretion of a number of proteins(adipokines), including leptin and adiponectin and alsocytokines such as IL-6. This study was planned with the aimof reviewing the association of nutritional status with serumleptin and CRP levels in hemodialysis patients.Material and methods: The present study was conducted inthe department of Medicine at Chattrapati Shivaji SubhartiHospital from August 2017 to March 2019; consisted of50 patients of End stage Renal Disease on maintenancehemodialysis admitted in Chattrapati Shivaji Subharti Hospitalduring the time period.Results: Out of the 50 subjects, 35 (70%) were male and15 (30%) were females. The Lean Body Mass (%) in thestudy subjects was 59.76±5.92. The overall mean leptinlevel distribution among the subjects was 1.51±0.36. Theoverall mean CRP level distribution among the subjects. was3.75±0.47. A positive correlation was found between CRPand BMI with statistical significance as p<0.05 (table 11).Similarly a highly positive correlation was found betweenLeptin and BMI as p<0.01.Conclusion: Our study point to possible use of serum leptinand CRP concentration as an indicator of nutritional status inHD patients based on observed significant positive correlationbetween serum leptin and CRP concentrations with BMIvalues.

Single-nucleotide polymorphisms in CLEC7A, CD209 and TLR4 gene and their association with susceptibility to paratuberculosis in Indian cattle

The aim of this study was to identify the single-nucleotide polymorphisms (SNPs) in bovine candidate genes CLEC7A, CD209 and TLR4, and explore the association between these SNPs with the occurrence of bovine paratuberculosis (PTB) disease. For this purpose, 549 animals were screened by a panel of four diagnostic tests, namely Johnin PPD test, ELISA test, faecal microscopy and IS900 blood PCR against Mycobacterium avium ssp. paratuberculosis (MAP) to develop case–control populations. SNPs were genotyped by polymerase chain reaction-restriction fragment length polymorphism method. Genotypic–phenotypic associations were assessed by the PROCLOGISTIC procedure of SAS 9.3. Of the seven SNPs; rs110353594 in CLEC7A gene and rs8193046 in TLR4 gene were found to be associated with PTB. For SNP rs110353594, odds of CC and CT genotypes vs TT genotype was 1.543 (0.420–5.667; 95% CI) and 0.284 (0.104–0.774; 95% CI), respectively which means that CT genotype was more resistant than TT and CC genotypes against bovine PTB. For SNP rs8193046, odds of AA and AG genotypes versus GG genotype was 0.947 (0.296–3.034; 95% CI) and 3.947 (1.555–10.022; 95% CI), respectively, i.e. probability for getting an infection in animals with AG genotype was 3.94 times more as compared to GG genotype. Hence, a selection programme favouring CT genotype for rs110353594 and against AG genotype for rs8193046 may be beneficial for conferring resistance against bovine PTB

Perception of smoking habits and related diseases among society

Background: Smoking is practiced by a third of world’s population. Tobacco is leading cause of deaths world over. Six million people (1/8 second) die from tobacco each year. Objective of this study was to study demographic profile and awareness regarding tobacco smoking among people of Rohilkhand, Bareilly.Methods: Randomly selected individuals of Rohilkhand region. Questionnaire method involved.Results: Among 1040 sample size, 70% were males with mean age of 37.68 years. 73.94% population belonged to upper lower socio-economic class. 52% (62.9% male and 26.6% females) were current smokers of which 60.6% were exclusive beedi smokers. 50% were unaware of oral and lung cancer due to smoking. 34% were unaware about effects of passive smoking. 48.48% smokers report cough with expectoration as commonest symptom. 60% finds peer group influential for the behavior. 76.9% smokers are willing to quit smoking. 63.4% are open for counseling. 26% were unaware of ban/law related to smoking in public places. 68% believe there is increasing trend in prevalence of its use, among minors, educational institutes and hospitals.Conclusions: Despite high awareness of ill effects of smoking, there is an increasing trend in prevalence of smoking with an increased involvement of minors attributed to peer pressure. People are unaware of passive smoking and its harmful effect on body. Moreover, advertisements, visuals and captions have failed in making an impact. There occurs a need of awareness programmes, intervention sessions, medical therapy and strict anti-smoking laws by the government, social welfare and healthcare volunteers to help people quit and control the menace in society.

Usual interstitial pneumonia - secondary vs idiopathic pulmonary fibrosis

Background: Interstitial Lung Diseases is a group of disorders where the pulmonary interstitium, alveolar structures and the small airways are affected. Identification of a specific pattern on HRCT, with a thorough clinical evaluation can help a physician in narrowing down the differential diagnosis for the underlying cause. Usual Interstitial Pneumonia (UIP) is a frequently identified pattern. Differentiating patients with definite UIP pattern, into IPF and non-IPF spectrums is important. Aim of this study is to compare UIP patients with a secondary cause vs Idiopathic Pulmonary Fibrosis.Methods: Statistically 33 patients having UIP pattern on HRCT were evaluated based on the history of extrapulmonary symptoms, environmental exposure, drugs and subsequent serology testing. Patients were divided into two groups - IPF and UIP with a secondary cause. Both groups were compared on various clinical parameters. Inferences were drawn from the same.Results: Total 66.6% patients were identified to have Idiopathic Pulmonary Fibrosis, 33.3% had UIP with a secondary cause. Majority of patients with a secondary cause had Connective Tissue Disorder (90.9%) and one patient of Chronic Hypersensitivity Pneumonitis (HP).Conclusions: Absence of extrapulmonary symptoms in UIP patients need no further investigations and can be diagnosed as a case of IPF. However, presence of extrapulmonary symptoms needs further evaluation to diagnose the underlying disease and start treatment for the same.

Cervical Infantile Fibrosarcoma: a rare cause of paediatric parapharyngeal neck mass

Soft tissue tumors are not uncommon in childhood and comprise entities that range from common to very rare malignancies. Infantile fibrosarcoma (IFS) is a rare pediatric malignancy mainly seen in the first two years of life. The data about the incidence of infantile fibrosarcoma occurring in the neck in the Indian subcontinent is scarce. To the best of our knowledge, only one case of infant cervical IFS has been reported previously in the Indian subcontinent. We present another case of an eight-year-old male patient with a rapidly growing mass on the left side of the neck. He was successfully treated with a combined modality of surgery and chemotherapy with a good outcome. Among the soft tissue tumors of childhood, IFS is a rare entity. It has a good prognosis and lesser chance of distant metastasis as compared to adult fibrosarcoma. Though surgical excision is the mainstay of treatment, chemotherapy also has a significant role in the treatment of primary tumor and metastasis. We discuss the stated case to bring to the notice this uncommon cause, which can be considered as a differential diagnosis of upper cervical swellings. A better understanding of this entity would help in early diagnosis and aggressive treatment, reducing the overall morbidity and mortality.