Immunophenotypic characterization of normal and abnormal plasma cells in bone marrow of newly diagnosed multiple myeloma patients

Background: Identification of plasma cells into abnormal (APC) and normal (NPC) compartments is of utmost importance in flow cytometric (FC) analysis of multiple myeloma (MM) and related plasma cell dyscrasias for diagnosis, prognosis, and follow-up. No single phenotypic marker is sufficient to distinguish NPC from APC. Materials and Methods: 43 newly diagnosed cases of MM and 13 controls were included in the study. Bone marrow (BM) samples from the 2nd pass were processed on the same day with antibodies against CD38, CD138, CD19, CD81, CD45, CD117, CD200, CD56, cytoKappa, and cytoLambda in a 4-color experiment with CD38 and CD138 as gating antibodies. Results: Mean APC% in cases was 96.5%. The expected Immunophenotype (IP) of APC which is CD19-/56+/45-/81-/117+/200+ was found in only 13/43 MM cases. In 30/43 cases, APC revealed deviation from expected IP either for single or a combination of markers. Sensitivity for APC detection was highest for CD19 (95.2%) followed by CD56 (90.4%) and CD81 (83.7%). Specificity was highest for CD19 (100%), CD56 (100%), and CD81 (100%) followed by CD117 (92.3%). Combination of markers with maximum sensitivity to detect APC (97.6%) was CD81- or CD19- and CD200+ or CD56+ (two markers); and for NPC (92.3%) was CD81+ and CD19+ and CD56- (three markers). Conclusion: Plasma cell IP can be highly variable with multiple minor subpopulations in both cases and normal controls. CD 19 and CD56 are highly informative markers for a 4-color experiment. Assessment of multiple markers in an 8–10 color experiment is more informative but the lack of advanced flow cytometers should not limit the use of FC in a 4-color approach. Our results emphasize that even basic equipment with limited fluorochrome can provide meaningful information if used appropriately.

Clinico-epidemiological Trends of Leprosy in 21st Century and During COVID-19 Pandemic

Leprosy is the oldest disease affecting humankind since ancient times. Despite MDT’s availability for disease curability, vast pockets of multi-bacillary (MB) cases persist in the community. We conducted this study to know the clinico-epidemiological trends of leprosy over four years and five months in this era of the COVID-19 pandemic (C19P). A total of 90 cases were registered; 59 (65.5%) were males, and 31 (34.5%) were females. The majority (69%) of cases were in the 15-45 age groups. Childhood leprosy was detected in 3(3.3%) cases. A history of contact with leprosy patients could be established in 16 (17.8%) cases. The cases comprised 54.5% local inhabitants and 45.5% were migrants. The MB cases 77 out of 90 (85.6%) were in higher proportion than pauci-bacillary (PB) cases. In the clinical spectrum, BL leprosy was most common in 39% of cases, followed by LL and BT leprosy. Thirty-seven (41%) patients were suffering from lepra reactions (LR), and out of them, 59.4% had type 2 reactions (T2R), and the rest had type 1 reactions (T1R). Disabilities were found in a total of 56 (62.2%) cases, and grade 2 disabilities (G2D) were recorded in 25 (44.6%) patients. Ulnar nerve (UN) was most commonly affected nerve in 64.4% of cases, followed by lateral peroneal (LPN) and posterior tibial nerve (PTN). We observed the impact of Covid 19 infection peak C19P in two ways; firstly, during the C19P peak in 2020, there was a drastic fall in total registered cases (TRC) to 4/year against 22/year in pre-C19P with a relative increase in LRs and disabilities. In post-C19P peak periods, not only was there a marked rise in TRC (20/5 months), but LR (50%) and disabilities (75%) also showed a significant rise. A high proportion of MB cases, LRs and disability rates indicate the need for population-based studies and subsequent public health measures for early diagnosis and treatment. Further large sample-sized, in-depth studies can tell the exact impact of C19P on leprosy.

Prevalence of Hepatitis B and Hepatitis C Virus Infection in Patients with Advanced Renal Failure: A Tertiary Care Centre Study from North Indian Population

Abstract: Viral hepatitis (Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV)) related liver disease is a leading cause of morbidity and mortality especially in the patients with advanced renal failure who are treated with dialysis, and this is due to high number of blood transfusion sessions and/or cross contamination from the dialysis circuits. Aims & Objectives: This study aimed to determine the prevalence of HBV and HCV infections in patients with advanced renal failure (ARF). Materials & Methods: A cross-sectional study was done in joint collaboration of Department of Nephrology and Department of Gastroenterology, KGMU, Lucknow, from June 2018 to June 2020 among, CRF patients. Clinical data such as age, gender, duration of dialysis; number of transfusions, Serum sample was collected from each patient. Serological markers for HBV and HCV were determined with ELISA by using commercial diagnostic kits. HCV-RNA and HBV-DNA were determined quantitatively by polymerase chain reaction (PCR) assay. Results: A total 934 patients with advanced renal failure attended the nephrology OPD. Out of 934 patients, 65 (6.96%) patients screened positive for HBV/HCV infection. The results of this study also showed that the prevalence of viral hepatitis infection in the haemodialysis (HD) and without HD patients is 8.25% and 6.3% respectively. Conclusion: It has been found that viral infections, particularly HBV and HCV infections are common in advanced renal failure patients who are on HD.

Huge Anterior Mediastinal Teratoma Leading to Orthopnea in a Young Patient

The anterior mediastinal cysts and masses (AMCM) can be of varied origin and presentation. Although the space in the mediastinum is limited the cysts and masses can grow to a large size before the presentation. They displace the adjacent structures and then can grow into the pleural cavities thereby acquiring a large size. We share our experience of a case of a huge anterior mediastinal cystic mass in a young female who had a characteristic presentation of sudden onset breathlessness in the supine position and immediate relief in the sitting position. The patient recovered well after surgical treatment.

Bacille Calmette-Guérin vaccine induced lymphadenitis in infants and children masquerading with tubercular lymphadenitis at tertiary care hospital in North India

Background: Bacille calmette–guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis in 1921. It is a safe vaccine. However, there can be minor adverse reactions such as pain, swelling, and redness at local injection site. The lesser known severe adverse reactions such as lymphadenitis, BCG osteitis, and disseminated BCG infection can be present after BCG vaccination. Aims and Objectives: The aim of the study was to report the cases of BCG lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) after BCG vaccination in infants and children. Materials and Methods: All the infants and children (1 month–2 years) who presented with regional lymphadenopathy for FNAC after BCG vaccination were included in the study. Results: Total 21 patients with BCG lymphadenitis were recruited. In all the cases, the lymphadenitis involved ipsilateral left axillary lymph nodes. In three patient sites of involvement included the left supraclavicular lymph nodes and in other three patients left cervical lymph nodes along with left axillary lymph node. Sixteen patients had suppurative granulomatous lymphadenitis (SGLA) on FNAC and positive for Ziehl–Neelsen (ZN) staining for acid fast bacilli (AFB), while rest nine had non-suppurative granulomatous lymphadenitis (NSGLA) with negative for ZN staining for AFB. Conclusion: Early diagnosis of BCG lymphadenitis can help in proper management. Furthermore, it can prevent unnecessary anti tubercular treatment in children.

Determinants of Reproductive Tract Infection among married women in rural and peri-urban areas of Aligarh: A cross sectional Study

Background: Reproductive Tract Infections (RTI) have a direct impact on reproductive and child health through infertility, cancers, and pregnancy complications, and they have an indirect impact through their role in facilitating the sexual transmission of the human immunodeficiency virus. Objectives: To find the prevalence and determinants of RTI/STI among married women of reproductive age group in rural and peri-urban areas of Aligarh. Methods: The data were collected by using a pretested, semi-structured with both open and closed-ended questionnaire from 500 married women of reproductive age group. The collected data were analyzed using IBM SPSS 20.0 Proportion, frequencies, ?2, and logistic regression were used to interpret the data. Results: Prevalence of RTI/STI symptoms was found to (42.8%) in rural areas and 37.6 % in periurban areas. Strong association was found in study subjects having lower educational status, who were not using any contraceptive method, not following good menstrual hygiene, early marriage age had husband history of RTI/STI, had a history of abortion, had a history of violence, and increased parity. Conclusions: Prevalence of symptoms found to be associated with these females having low educational status, early age of marriage, high parity, partner history of reproductive Tract Infections, history of violence etc. So, there should be more focus on improvement in these factors to reduce the prevalence.

Physical, mental, spiritual and social wellbeing of urban population during the COVID-19 lockdown phases: a cross-sectional study

Background: COVID 19 pandemic created immense mental & physical agony among human beings worldwide. The present study was conducted to assess the physical, mental, social and spiritual wellbeing of young adults and the elderly, during the lock-down phase of COVID-19. Methods: The cross-sectional study was conducted among 227 healthy adults in Bhubaneswar, capital of Odisha. Data was collected using a self-administered questionnaire pertaining to the physical, mental, social and spiritual health of participants. Results: During the lockdown, around two-thirds (65.4%) of the participants reported feeling helpless. The elderly felt more helpless than the young adults. One-third (73, 32.6%) of the participants experienced health issues during the lockdown period. The majority of the study participants (83.8%) mentioned that their family members shared tasks during lockdown which was a very positive sign observed in this study. Faith in God for the elderly and family support for the young adults made them mentally stronger. Conclusion: Managing pandemic needs a multipronged approach. But focusing on psychosocial health will prevent future unseen mental health pandemics and improve the resilience of mankind.

PREGNANCY WITH PINK BLOOD: A CASE REPORT

A 24 year old female P1L1 presented to our hospital on first post operative day of emergency caesarean delivery with complaint of fever with chills and rigors. The per-operative notes showed the presence of thick pinkish maternal blood when compared to cord blood, which turned opaque white while sampling. On examination she had pallor and raised blood pressure. Her lipid levels were very high and ultrasound showed bilateral mild pleural effusion with minimal ascites with increase echogenicity of peripancreatic fat. She was started on injectable antibiotics following which she improved in symptoms. She was also started on fenofibrate and orlistat following which her lipid profile improved and the blood stopped turning opaque white and she was then discharged against medical advice due to financial constraints

A comparative study of tactile perception in blind and sighted subjects

Background: Blind people are underprivileged from visual experience and visual imaginary that result them to become more dependent on haptic system for the job of tactile perception. Thus, the self-guided tactile investigation in blind individuals enables them to recognize the shapes more rapidly than the sighted counterparts. Aim and Objectives: The aim of the study was to see the increased tactile perception among the blind than the blind folded sighted subjects. Materials and Methods: The study was carried out on 150 blind and 181 blindfolded sighted subjects. In this, each subject was instructed to arrange the aluminum oxide abrasive sand papers of different grit size having grade 60, 80, 100, 120, 140, 200, 240, 360, 400, and 600 from rough to smooth as fast and accurate as possible in seconds to express the functions of haptic sense. Results: The present study showed that the blind subjects had outperformed in terms of speed and accuracy of tactile perception. Conclusions: Lack of vision among blind individuals enables their brain to enhance the sense of vision and the previous tactile exposure and memories along with their regular practice enhance the touch perception in terms of speed and accuracy.

A comparative study of auditory reaction time among blind and blindfolded sighted subjects

Background: Reaction time refers to elapsed time between a given stimulus to an individual and its subsequent rapid voluntary response by the same individual. Mostly, it depends on processing of the stimulus, decision-making, and response programming. Aim and Objective: This study aims to see the effect of vision on auditory reaction time. Materials and Methods: For this study, two groups of subjects were taken. The first group contained 150 blind subjects and the second group contained 181 normal sighted subjects. Estimation of simple and choice auditory reaction time was done with the help of multiple-choice reaction time apparatus received from Inco Ambala Ltd. in sitting position. It has an accuracy of ±0.001 s. Three times auditory stimulus was given to each subject to record the reaction time. The minimum recorded time interval to the voluntary response was taken as final reading in each subject. Results: In this study, the blind subjects showed a mean simple and choice reaction time of 148.84 ± 14.43 and 304 ± 29.54, respectively, while the blindfolded normal subjects showed a mean simple and choice reaction time of 153.80 ± 15.84 and 314.19 ± 31.81, respectively. These were found to be statistically significant. Conclusions: Blind individuals commonly utilize tactual and auditory cues for information and orientation and they reliance on touch and audition, together with more practice in using these modalities to guide behavior, are often reflected in better performance of blind relative to sighted participants in tactile or auditory discrimination tasks.

Comparison of circulating DNA in malignant neoplasia from diverse locations: Investigating a diagnostic role

Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomarker in several solid tumors. Raised levels have been reported in several malignancies and may correlate with clinicopathological and treatment response. The current study was designed to assess the diagnostics of cfDNA in different tumor types of malignancies correlating with tumor (T), nodes (N), and metastases (M) stage. Design: Serum samples were collected from treatment naïve cases with histologically diagnosed tumors including 23 brain tumors, 48 breasts, 50 gallbladder carcinoma (GBC), 13 lungs, 68 oral squamous cell carcinoma (OSCC), and 25 normal controls. CfDNA was quantified with real-time polymerase chain reaction (PCR), Invasive ductal carcinoma (IDC) using beta-globin gene amplification. Cut off values for diagnostics were calculated using receiver operating curve analysis. Results: Contrary to other cfDNA studies where it was postulated that cfDNA would not cross the blood–brain barrier and reach the systemic circulation, we found detectable cfDNA in glioma with median (Q1–Q3) of 349.22 ng/ml (19.87–1276.58). Median cfDNA concentration in breast, gallbladder, lung, oral and normal controls was 328.72 (128.38–624.44), 778.50 (589.88–1864.35), 348.73 (194.67–483.61), 386.27 (47.88–959.67), and 74.12 (49.66–120.00), respectively. Grades I and II glioma had significantly lower levels compared to Grades III and IV (P = 0.0001). Significant difference in median cfDNA values in IDC and GBC was observed with increasing tumor grades, stage, T stage, nodal stage and metastasis and with stage of OSCC cases. Conclusion: CfDNA levels showed good diagnostic discrimination in glioma, GBC, breast, lung carcinoma, and OSCC. Significant increase in titers was evident with increase in cancer stage from I to IV in breast, GBC and OSCC.

A RARE CASE REPORT OF ALVEOLAR RHABDOMYOSARCOMA IN VAGINA OF YOUNG FEMALES

Alveolar rhabdomyosarcoma in a rare aggressive tumour which manifests in children and young adults. The site of alveolar rhabdomyosarcoma in vagina is also extremely rare. We presented a case report of 38 yrs.lady who was having complain of intermenstrual bleeding & discharge per vaginum from last 6 months. A large fleshy infiltrative bluish friable mass (3*3cm) present at the junction of middle rd rd and upper 1/3 and upper 1/3 of posterior vaginal wall . Another similar mass (2* 2cm) was also present in the lateral vaginal wall. Wide excision of both growth was done & postoperatively chemotherapy was given.

CONGENITAL CYTOMEGALOVIRUS INFECTION AND ITS EFFECTS ON FETUS A CASE REPORT

Cytomegalovirus infection during pregnancy is very common. Vertical transmission is possible in all three trimester of pregnancy. 1 in 150 children are born with congenital Cytomegalovirus infection. It is the most common infective cause of mental handicap in newborn, Congenital Cytomegalovirus infection can cause sensorineural deafness, developmental delay and even fetal death. We present a case of Isolated bilateral ventriculomegaly at 33 weeks 4 days diagnosed as congenital Cytomegalovirus infection. Careful maternal and fetal monitoring and timely intervention leads to good fetal outcome.

BARDET BIEDL SYNDROME IN PREGNANCY A CASE REPORT

Bardet Biedl Syndrome (BBS) is a rare idiopathic autosomal recessive disorder which affects multiple organs and organ systems. In India less than 15 cases have been reported so far. We present case of 41 year old third gravida who presented at 17 weeks of gestation. She had a suspicious history of delayed milestones in the previous child and ultrasound findings of echogenic kidneys, bilateral talipes, and polydactyly. Index child evaluation showed type-6 variant of BBS. Amniocentesis in the present pregnancy showed the same mutation in the fetus. The couple decided on termination of t pregnancy.

Association of UGT1A6 gene polymorphism with clinical outcome in pediatric epileptic patients on sodium valproate monotherapy

Pediatric epilepsy comprises chronic neurological disorders characterized by recurrent seizures. Sodium valproate is one of the common antiseizure medications used for treatment. Glucuronide conjugation is the major metabolic pathway of sodium valproate, carried out by the enzyme uridine 5′-diphosphate (UDP) glucuronosyl transferase (UGT) whose gene polymorphisms may alter the clinical outcome. The objective of this study was to assess the association between UGT1A6 genetic polymorphism and clinical outcome in terms of efficacy and tolerability in pediatric epileptic patients on sodium valproate monotherapy. Pediatric epileptic patients (n=65) aged 2-18 years receiving sodium valproate monotherapy for the past one month were included. Genetic polymorphism patterns of UGT1A6 (T19G, A541G, A552C) were evaluated by PCR-RFLP. Clinical outcome was seizure control during the 6 months observation period. Tolerability was measured by estimating the hepatic, renal, and other lab parameters. Out of 65 patients, TT (40%), TG (57%), and GG (3%) patterns were observed in UGT1A6 (T19G) gene, AA (51%), AG (40%), and GG (9%) in (A541G) gene, and AA (43%), AC (43%), and CC (14%) in (A552C) gene. No statistical difference in clinical outcome was found for different UGT1A6 genetic polymorphism patterns. We concluded that different patterns of UGT1A6 genetic polymorphism were not associated with the clinical outcome of sodium valproate in terms of efficacy and tolerability. Sodium valproate was well-tolerated among pediatric patients with epilepsy and can be used as an effective antiseizure medication.

Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema

Purpose: To evaluate the long-term safety and efficacy of the intravitreal dexamethasone implant in the treatment of diabetic macular edema (DME) as initial therapy. Methods: A hospital-based prospective, non-comparative case study of recently detected DME patients was conducted between July 2016 and December 2017, in which30 eyes of 30 patients were studied. Presenting vision, age, gender, duration of diabetes, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, fundus fluorescein angiography, optical coherence tomography (OCT), and blood sugar levels were noted. Patients with increased central macular thickness (CMT) received an intravitreal dexamethasone implant as initial therapy. All were followed up at 1 week, 1 month, 3 months, 6 months, and 1 year, and the findings were recorded and analyzed using SPSS software. Results: 30 eyes of 30 patients were studied which included 22 males and 8 females. The mean age of presentation was 58.7 ± 4.45 years. The mean decrease in CMT following intravitreal dexamethasone was 269.27 ± 112.002, 253.5 ± 108.294, and 286.73 ± 143.395 ?m at the end of 3, 6, and 12 months, respectively, and the mean improvement in visual acuity (VA) was 2.27 ± 1.70 lines at 3 months, 2.27 ± 1.83 lines at 6 months, and 1.17 ± 2.00 lines at 12 months. Out of 30 cases, 4 had persistent DME and 6 had recurrence of DME at completion of 1 year of follow-up. Conclusion: Intravitreal dexamethasone as initial therapy in the treatment of DME is both safe and efficacious in the reduction of CMT and improvement of vision and can be considered as primary therapy for DME.

Spectrum Of Histomorphological Lesions In Cystoscopic Urinary Bladder Biopsies

Urinary bladder tumors were one of the most common entities of urological pathology. Neoplastic & nonneoplastic lesions of urinary bladder were the common reasons for morbidity and mortality throughout world. Among neoplastic lesions, urothelial carcinoma is a common primary tumor of urinary bladder. The aim of this retrospective study was to determine the spectrum of various urothelial lesions from cystoscopic bladder biopsies received over a period of 3 years. All the urinary bladder biopsies received with two inadequate biopsies were included in this study. Out of 54 biopsies received, 12 were non neoplastic & 40 were neoplastic cases and two were inadequate biopsies. Majority of the cases were in 60-79 years age group. Males were affected more than females ( 2.85:1 ratio). Majority of the neoplastic lesions were urothelial carcinomas. Conclusion : Among the bladder tumors ,urothelial carcinoma was the most common type, among these, high grade urothelial carcinoma was common in our study. Non invasive were more common than invasive carcinoma.Identification of grade &invasion into muscle layer has an impact on prognosis as well as on therapeutic approach.

Serum Prostate-specific Antigen Following Antibiotics in Symptomatic Patients with Lower Urinary Tract Symptoms

Introduction: With the current practice of routine Serum PSA examination, there arises a diagnostic dilemma with regard totheir further evaluation and treatment.Aim: The aim is to study the incidence of cancer (CA) prostate in cases with elevated Serum PSA.Methodology: We studied 50 men aged between 50 and 80 years with elevations in Serum PSA (total PSA) after certainexclusion criteria, these cases are given a course of antibiotics for 6 weeks and repeat Serum PSA levels obtained. In thosewith persistent elevation in Serum PSA above 4 ng/ml, transrectal ultrasound-guided biopsy was done.Results: In our study population, 36.6% of cases with persistent PSA elevation were proven positive for malignancy by biopsy.Conclusion: A fall in Serum PSA following a course of antibiotic therapy does not exclude the presence of a carcinomatouselement in prostates.

Effectiveness Of Neuro-Muscular Electrical Stimulations (NMES) In Reducing Subluxation Of The Shoulder After Stroke: Randomized Controlled Experimental Study

Background: Shoulder subluxation in stroke is one of the most common and challenging squeals. Shoulder subluxation limits the patient’s daily activities, and it may lead to permanent disability. NMES (NeuroMuscular Electrical Stimulation) had been studied widely on shoulder subluxation with controversial results, but no evidence is reported of its effectiveness in shoulder subluxation. As NMES helps in producing strong contraction and thereby helps in improving the strength of the muscles and as it also helps in learning to contract appropriate muscles, this study was made to examine the Effectiveness of Electrical Stimulations in reducing Subluxation of the Shoulder after Stroke. Method: Study design, A Randomized control experimental design of 30 subjects. Subjects were randomly assigned into two groups, experimental (NMES group) and control (Non-NMES group) with 15 subjects in each group. Outcome measures were taken before and after the intervention on both the groups by using ‘Pain Estimation Scale’ (PES), 'Subluxation Grading’ by X-rays (AP view) and upper arm section of ‘Motor Assessment Scale’(MAS). Experimental group electrodes were placed over posterior deltoid and supraspinatus. Treatment time was 30 mints two times a day for five days in a week and six weeks. Results: Comparison of electrical stimulation with non-electrical stimulation was done by considering the differences of pre and post treatments in both groups and significance is observed by using independent sample t-test. Statistical analysis proved that there was significant (p<0.05) improvement using NMES compared to NON-NMES in all the three parameters. Conclusion: Electrical stimulation has shown significant improvement in reducing shoulder subluxation, pain and increased motor recovery of the arm in stroke patients compared to the patient's given non-electrical stimulation training.