Neuropsychiatric manifestations in multiple sclerosis: clinical case report and review of literature

Background: Multiple sclerosis (MS) is a neurological disability affecting young and middle-aged adults. Neuropsychiatric manifestations in the background of multiple sclerosis had been reported as a sporadic occurrence. Case description: Here, we report the case of a 57-year-old man who developed neuropsychiatric manifestations during the course of MS. Discussion: In our case, the presence of MS might be a possible reason for the neuropsychiatric manifestations. However, not many case reports have previously acknowledged wherein a patient developed neuropsychiatric symptoms secondary to multiple sclerosis. Conclusion: Hence, this case stresses the need for future studies assessing the relationship between multiple sclerosis and psychosis.

Experience of cervical Pap smear screening in tertiary care hospital

Background: Cervical cancer is the leading cause of death in women in developing countries like India. It is preventable by regular screening by Pap smear and can be detected at pre-invasive stage. Thus, reducing the morbidity and mortality related with cervical cancers. Objective: This study aims at detecting the prevalence and current trends of various epithelial cell abnormalities (ECAs) in females attending a tertiary care hospital. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital between July 2015 and May 2019. A total of 15,270 cases comprising 11,494 conventional and 3776 liquid-based cytology Pap smears were included in the study. Clinical data and history of the patients were retrieved. All cases were reported according to Bethesda system 2014. Results: Among 15,270 cases, 793 Pap smears were unsatisfactory, 14,153 Pap smears were negative for intraepithelial lesion/malignancy, and 325 cases had ECA. Conclusion: Large hospital-based studies are required for proper implementation of health services and for the selection of a feasible as well as sensitive screening test for early detection of cervical dysplasias which can be helpful in decreasing the burden of cervical cancer in our community.

Formulation And Evaluation Of Famotidine Fast Dissolving Tablets Using Synthetic Superdisintegrants

Objective: The main aim of the present research work was to formulate fast dissolving tablets of famotidine by direct compression method and to evaluate the effect of synthetic super disintegrating agent on drug release pattern. Methods: The fast dissolving tablets were prepared by using crospovidone, croscarmellose sodium, sodium starch glycolate as superdisintegrants (2, 4 and 6 %w/w), mannitol 20 % and microcrystalline cellulose (44, 46 and 48 % w/w) as a directly compressible vehicle. All the prepared tablets were evaluated for hardness, friability, drug content uniformity, weight variation, disintegrating time, wetting time and in vitro drug release studies. Results: All the prepared fast dissolving tablets formulations were within the Pharmacopoeial standards limits. Based on in vitro drug release studies (>90 % within 30 min), the optimised formulations were optimised tested for the short term stability (at 40 ˚C/75% RH for 3 mo) and drug excipient interaction (fourier transform infrared spectroscopy). Conclusion: Hence, formulation prepared with 6 % w/w of crosspovidine and 44 % w/w of microcrystalline cellulose as emerged as the overall best formulation (>90 % within 30 min) compared to marketed product (>70 % within 30 min). Short-term stability studies on the formulations indicated that there are no significant changes in drug content and in vitro drug release (p<0.05).

A rare cause of progressive neuropathy: Arachnoiditis ossificans

Arachnoiditis ossificans (AO) is a rare type of chronic arachnoiditis characterized by the presence of calcification or ossification of the spinal arachnoid which is usually associated with progressive neurological deficits. It is usually followed by prior history of trauma, surgery, infection, or myelography. Magnetic resonance imaging and computed tomography are the characteristics that are helpful in the diagnosis of most cases. Prognosis and treatment depends on the site and clinical presentation of the patients. We present a case of a young female who presented with a long-standing history of neurological symptoms and a intradural lesion mimicking a tumor.

Pathogen burden & associated antibiogram of Pseudomonas spp. in a tertiary care hospital of India

Antimicrobial resistance particularly in Gram-negative bacilli is an increasing problem worldwide. Pseudomonas spp. is one the most common Gram-negative bacteria associated with nosocomial infections and therefore, its trend of antimicrobial resistance needs to be studied. The aim of this study was to evaluate the rate of antimicrobial resistance and changes in resistance pattern over a period of five years (2012-2016) in Pseudomonas spp. isolated from trauma patients attending a tertiary care hospital in north India. During the study, a total of 2444 Pseudomonas spp. were isolated from the various clinical sample. The most common species isolated was P. aeruginosa (2331, 95%). The highest level of resistance was observed against levofloxacin (1678, 69%) and the lowest level of resistance was observed against tobramycin (1254, 51%). Irrational and inappropriate use of antibiotics was found to be responsible for multidrug resistance in Pseudomonas spp. Hence, there is an urgent need to emphasize strict antibiotic policy to minimize the misuse of antimicrobials.

Liquid-based cytology versus conventional cytology in fine-needle aspirates of salivary gland neoplasms

Background: Liquid-based cytology (LBC) is a method of retrieving and processing of cytological material for the assessment of both gynecological and nongynecological cases introduced in 1996. Mostly conventional smears (CS) are prepared in Indian scenario; however, due to increasing popularity of LBC in nongynecology specimens, LBC is also used in few centers for diagnosing salivary gland neoplasm. Aim: The aim of this study is to compare CS and LBC in fine-needle aspiration cytology (FNAC) of the salivary gland neoplasms in terms of cytomorphological details, adequacy, ease of interpretation, pitfalls, and diagnostic efficiency. Materials and Methods: We conducted a prospective, observational, comparative study which included 64 salivary gland neoplasms. Both CS and LBC (SurePath) were prepared as per standard protocols and examined. Results and Conclusion: In our study, specificity and positive predictive value of both the techniques (conventional and LBC) were found to be 100%. Sensitivity of both the techniques was found to be similar (66.7%). Negative predictive value and diagnostic accuracy of conventional technique were found to be almost similar to that of LBC technique (97.6% vs. 97.2% and 97.7% vs. 97.4%). In terms of adequacy and cellularity, CSs were better than LBC. Ease of interpretation was better with CSs due to abundant chondromyxoid stroma, an important clue in the diagnosis of pleomorphic adenoma. Nuclear details and background were better in LBC as compared to CS. Hence, we conclude that in salivary gland FNAC, both CS and LBC have similar diagnostic efficiency. however, interpretation of conventional smears is easier than Liquid Based Cytology especially in cases of pleomorphic adenoma. However, some advantages of LBC in respect to conventional cytology, with better-preserved morphology obtained from LBC becomes furthermore obligatory.

Magnetic resonance imaging in focal liver lesions: Imaging with pathological correlation

Background: Magnetic resonance signal intensity of focal liver lesions is affected by numerous pathologic factors. Lesion histologic features, such as cellularity, vascularity, stromal component, and intratumoral necrosis or hemorrhage, strongly affect T1 and T2 relaxation times. Aim: Our study is done to assess the lesion characterization potential of MRI by evaluating unenhanced and dynamic gadolinium enhanced sequences. Materials and methods: A total of 50 consecutive patients who were diagnosed by sonography as having focal liver lesions for period of 2 years were included in the study. Results: Most of the patients are of 30 - 60 years. The mean age for malignant lesions is 51 years. Of 50 patients 32 are males and 18 are males. Male: female ratio 2:1. 65% of the lesions are located in right lobe of the liver. The most common benign lesion encountered was liver abscess followed by haemangiomas and most common malignant lesion was metastases. Abscess and hemangiomas were predominant in benign whereas metastases and hepatocellular carcinomas were predominant in malignant lesions. The difference in mean ADC values in both the groups was significant. Conclusions: MR imaging is a powerful tool for the evaluation of focal liver lesions. Pre contrast T1 weighted gradient echo images, T2 weighted images, inphase and out phase imaging, EPI - DWI and gadolinium enhanced T1 weighted images provide accurate characterization of the lesions.

Effect of bupivacaine and bupivacaine-clonidine combination in supraclavicular brachial plexus block A comparative study

Addition of clonidine to local anesthetics improves peripheral nerve blocks by reducing the onset time, improving the efficacy and extending postoperative analgesia. This study evaluated the effect of Bupivacaine clonidine combination in supraclavicular brachial plexus block for upper limb surgeries. A randomized double-blind controlled trial was performed in 60 patients. Group B (n=30) patients received 25 mL 0.5% Bupivacaine and 0.2 mL of Saline, whereas group C (n = 30) received 25 mL 0.5% bupivacaine and 0.2 mL (30 mcg) clonidine through supraclavicular brachial plexus block. In both groups, differences between age, sex, ASA grades, weight, vital parameters were statistically insignificant. Time of onset of sensory blockade and motor blockade were reduced in group C compared to Group B and were statistically significant. Duration of sensory and motor blockade were prolonged in group C compared to Group B and were statistically significant. Duration of post operative analgesia was prolonged in group C compared to Group B and were statistically significant. Sedation score of patients in group C were higher than those in group C intra-operatively and postoperatively. No clinically significant differences were observed in pulse rate, mean blood pressure and oxygen saturation. Due to its sedative properties, it can reduce patient anxiety and provide optimal intra-operative and postoperative patient comfort.

Post-operative analgesic efficacy of fentanyl via different routes A comparative study of nebulisation, intranasal and intravenous routes

Background: Pain is main post operative adverse outcomes causing patient distress, prolonging hospital stay, and increasing the incidence of admissions after surgery. Study was done to assess and compare the post-operative analgesic effects of fentanyl via nebulisation, intranasal and intravenous routes to provide better analgesia, anxiolysis and sedation to the patient. Materials and methods: After approval from ethical committee of SPMC, Bikaner and written informed valid consent from patients, sixty patients of either sex belonging to ASA class I and II, were randomised into three group (Group I - Nebulised Fentanyl, Group II - Intranasal Fentanyl, Group III - Intravenous Fentanyl). With all aseptic precaution, subarachnoid block was instilated via 23/25 gauze spinal needle by injecting sufficient dose of bupivacaine heavy 5% to achieve an adequate sensory and motor block for the proposed surgery. When patient complained pain 1st time, fentanyl was given via nebulisation in group I, intranasal in group II, and intravenous in group III with dose 4 mcg/kg, 1.5 mcg/kg, 2 mcg/kg respectively. Patients were assessed for pain by VAS score. For statistical data, SPSS 10.0 software was used. Results: In present study, Ramsay sedation score, patient satisfaction score and duration of analgesia was better in group II as compared to group I and III. Group III had lesser time of onset of analgesia in comparison to group II and I respectively. Singh R, Pareek A, Kumari M, Khilji MY, Sirohiya P. Post-operative analgesic efficacy of fentanyl via different routes – A comparative study of nebulisation, intranasal and intravenous routes. IAIM, 2016; 3(6): 16-22. Page 17 Conclusion: On the basis of analgesic efficacy, we concluded that intranasal group was better than nebulisation and intravenous route.

Maxillary plexiform ameloblastoma showing basaloid differentiation: Report of a rare case with review of literature.

Ameloblastoma is a benign, locally aggressive tumor originating from the odontogenic epithelium. It manifests as a slow growing swelling, causing expansion of the jaw bones. Radiologically, it presents as a unilocular or multilocular radiolucency exhibiting a characteristic soap bubble or honeycomb appearance. Ameloblastoma exhibits several histologic patterns of which basal cell variant is a rare entity. The present case report is that of a maxillary ameloblastoma exhibiting a basaloid differentiation that may put one in the mind of a basaloid squamous cell carcinoma or a basal cell carcinoma. Confirmation of such rare variants should be done not only based on histopathology but with the help of supplemental immunohistochemical analysis. The present case report helps in exposing a rare variant of ameloblastoma and emphasizes the role of advanced diagnostic aids such as immunohistochemistry in establishing the diagnosis.

Fine needle aspiration cytology in childhood TB lymphadenitis.

Objective. To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. Methods. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Results. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Conclusion. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

Fraser syndrome.

Fraser syndrome or cryptophthalmos is a rare autosomal recessive disorder characterized by major features such as cryptophthalmos, syndactyly and abnormal genitalia. The diagnosis of this syndrome can be made on clinical examination and perinatal autopsy. We present the autopsy findings of a rare case of Fraser syndrome in a male infant.

Correlation between chemical composition of biliary calculi and sera of stone formers.

A quantitative chemical analysis of total cholesterol, bilirubin, calcium, inorganic phosphate and iron of three types of biliary calculi (cholesterol, pigment and mixed) of 40 gall stone former was carried out and correlated to with those of there sera. A moderately positive correlation for inorganic phosphate, Ca2+ and Fe2+ content of sera and calculi of cholesterol stone patient was found. A Good positive correlation for total cholesterol, a moderately positive correlation for bilirubin and iron but no correlation for inorganic phosphate and calcium content of sera and calculi of pigment stone patient was observed. A good moderately positive correlation for iron but no correlation for total cholesterol, bilirubin, inorganic phosphate and Ca2+ content of sera and calculi of stone patient was found.

n-Propanol as a substrate for assaying the ligninperoxidase activity of Phanerochaete chrysoporium.

The steady state kinetics of ligninperoxidase catalysed reaction using n-propanol as the organic substrate and monitoring the formation of propanaldehyde at lambda = 300 nm spectrophotometerically as functions of different reaction parameters has been studied. It has been concluded that n-propanol can be used as a substrate for analysing the activity of ligninperoxidase. The turnover number of ligninperoxidase of Phanerochaete chrysosporium using n-propanol as substrate has been found to be higher approximately by a factor of 10(3) as compared to that using veratryl alcohol as the substrate. The method works in assaying the activity of ligninperoxidase produced by Aspergillus fumigatus indicating that it can be used for assaying the ligninperoxidase activities produced by other microorganisms also and is not limited to assaying the ligninase activity produced by Phanerochaete chrysosporium alone. Under identical experimental conditions, horseradish peroxidase does not show peroxidase activity using n-propanol as substrate indicating that the method does not interfere with the activities of other peroxidases.

Modulatory influences of tamoxifen, tocopherol, retinyl acetate, aminoglutethimide, ergocryptine and selenium on DMBA-induced initiation of mammary carcinogenesis in rats.

Present study evaluates the chemopreventive actions of tamoxifen (10 mg/kg), retinyl acetate (50 mg/kg), tocopherol (200 mg/kg), aminoglutethimide (1 mg/kg), ergocryptine (5 mg/kg), and sodium selenite (1 mg/kg) when given singly/in combinations on the initiation of mammary carcinogenesis induced by 20 mg of DMBA in virgin female rats. DMBA was given when rats were 50 days old and the modulators were given in diet 10 days before and 10 days after carcinogen treatment and experiments were terminated 6 months later. DMBA alone yielded tumors in 62% rats. When modulators were given singly and in combinations of two, tumor incidences were not altered significantly. The range of tumor incidences was between 30% and 13% when the agents were given in combinations of 3, 4 and 5. Finally when all 6 modulators were given together the tumor incidence dropped down to 8.3%.

Genetic analysis of a group of mentally retarded children.

Genetic analysis of 169 mentally retarded (MR) children from Madras, revealed chromosomal abnormalities in 17%. Down syndrome was the major chromosomal anomaly (24/169 = 14.2%). These included three cases of trisomy-21 mosaics, and one case of de novo Robertsonian translocation. MR children with chromosomal abnormalities were either mildly or moderately retarded. Syndromes with known etiology occurred in 3% of the MR cases. Microcephaly, neonatal anoxia, perinatal stress and pharmacological attempt for abortion were found to be important pathogenic factors associated with MR. Most of the microcephalics (11/169 = 6.5%) were severely retarded, whereas those associated with neonatal anoxia and perinatal stress were either mildly or moderately retarded. Birth-order effects were found only among Down syndrome patients. Segregation analysis of the three groups of proband families (viz. mild, moderate and severe MR) indicated that autosomal recessive mode of inheritance is compatible in moderate and severe MR proband families. The proportion of X-linked instances of MR is estimated to be about 22% of the cases.