Sjogren’s syndrome presenting as hypokalemic periodic paralysis, a rare manifestation: A case series

Sjogren’s syndrome is a chronic and slowly progressing autoimmune disease characterized by lyphocytic infiltration of exocrine glands resulting in Sicca syndrome (xerostomia and keratocunjuntivitis sicca). The disease can present alone or along with other autoimmune diseases leading to significant organ specific and systemic disease. Middle aged women (Female: Male: 9:1) are primarily affected. Extraglandular (systemic) manifestations are seen in one third of patients with Sjogren’s syndrome. Among the extraglandular manifestations, renal involvement is commonly seen. Renal involvement in the form of tubulointerstitial nephritis (TIN) is more common compared to glomerular involvement. Distal renal tubular acidosis (RTA) is more common manifestation of TIN presenting as mild hypokalemia, metabolic acidosis, and rarely with hypokalemic periodic paralysis. We report three cases of hypokalemic periodic paralysis with metabolic acidosis, two in respiratory paralysis, diagnosed as distal RTA. On further evaluation of distal RTA, the patient diagnosed to have Sjogren’s syndrome and managed accordingly. Our report shows that Sjogren’s syndrome is a rare but important cause of hypokaemic periodic paralysis due to RTA.

Recurrent aggressive multicystic ameloblastoma with hemangiomatous proliferation and giant cells: A perplexed diagnosis

Hemangiomatous ameloblastoma, a very rare variant of ameloblastoma, was originally described as ameloblastoma in which part of the tumor contained spaces filled with blood or large endothelial-lined capillaries. Ameloblastoma, the most commonly affecting a slow-growing, persistent, and locally aggressive neoplasm of epithelial origin, account for a major chunk of all odontogenic tumors. A 43-year-old female reported to our outpatient department with a rare association of multicystic ameloblastoma with unusual hemangiomatous proliferation (both in lining and the stroma) along with giant cells in the lesional tissue. There are <8 cases documented in the literature with the same histologic features and most are in the middle age with the mandibular location.

Isolation and characterization of foot-and-mouth disease virus from Odisha, India

Foot-and-mouth disease (FMD) is a highly contagious and rapidly transmissible disease of cloven footed animals. Emergence of genetically divergent strains of FMD virus (FMDV) is a major concern globally. FMD is endemic in India and three serotypes (O, A and Asia 1) prevail. The study was undertaken to characterize the isolates from the state of Odisha, India both genetically and antigenically. FMDV was detected in 7 of the 17 clinical samples collected from FMD affected/suspected animals, in which serotype O and A were found in three and four samples, respectively. Serotype O field isolates clustered in an unnamed group (designated here as Eastern cluster) circulating mostly in the Eastern region of the country and had 10-12.7% divergence from the Ind2001 lineage circulating predominantly throughout the country. The serotype A isolates sequenced in this study was grouped within VP359–deletion group of genotype 18, precisely in clade 18c, having high genetic homology to the virus circulating in the neighboring states, suggesting interstate movement. Both the serotype O and A isolates showed good antigenic relationship value with the respective vaccine strains currently used in the country

Assessment of Impact of Environmental Causative Factors on Severity of Asthma in Children.

Objective: The present study evaluated the association between environmental factors and severity of asthma in children. Materials and methods: Questionnaires were specifically designed factoring patients’ demographical profile, socioeconomic status, causative environmental factors and severity of asthma. Results: A total of 100 patients were interviewed who visited our pediatric department complaining of asthma symptoms. Maximum children were of the age group between 6 and 10 years (29%). The ratio of male (64%) was more than female (36%). Maximum patients belong to middle class family (33%) and lower middle class (29%). Among children cold/respiratory illness (87%) followed by exercise and sports (70%) was the most common environmental trigger for asthma. Asthma symptoms worsened during day time and winter season in this group. Conclusion: A significant positive association between environmental asthma triggers: smoke (p = 0.035), strong smell (p = 0.008), cold/respiratory illness (p = 0.035), hot/cold air (p = 0.03) and severity of asthma in children was observed. Winter season worsened the asthma symptoms (p = 0.047) in children.

Types of Rotavirus Causing Acute Diarrhea among Children in Western India, their Demographic Pattern and Disease Severity.

Background: Rotavirus infection is a major cause of severe acute gastroenteritis among infants and children all over the world1 with winter out-breaks of diarrhea in temperate and cooler parts almost round the year. However, this varies in different part of India.2-6 Diarrhea is a major cause of under-5 mortality, contributing to approximately over 1,50,000 infant deaths in our country per year.15,16 Different genotypes have been identified and many more are emerging by way of mutation, genetic shift and genetic drifts. Rotavirus are classified antigenically as A (Most common), B, C, D, E by ELISA and genotypically as G (1 through 12) and P (1 through 8) by Reverse Trans criptase PCR, in combinations. Materials and methods: Stool samples of 110 infants and children from 6 to 60 months of age, with suspected viral diarrhea over one year period were studied for serotypes and genotypes; and compared for their respective disease severity. Results: Thirty-four percent were found positive for Rotavirus-A by ELISA. Of the positive, 33.4% were found to be of G9 genotype, much higher than reported from other parts of the country. On the other hand, merely 13.6% of G1 and G4 each were detected, contrary to high prevalence elsewhere. On electro-pherotyping, the long-arm types were associated with more severe disease (64.6% showing moderate to severe dehydration) than their short-arm types (Only 16.6% showed moderate dehydration only) p < 0.009. No difference in incidence of severe dehydration between AD positive for Rotavirus (11.7%) and those found nega tive (11.8%), presumably due to other viruses, after excluding invasive diarrhea. Conclusion: Emergence of diverse strains, i.e. more of G9 and G12 genotypes than earlier reports of G1 and G2 types indicate considerable genetic shift in the region. Such trend could have significant implication on degree of seroconversion from currently used live vaccines, using G1 or bovine reassortant G1-3 strains only, seen in recent studies from Africa and Malayi.29 Contrary to claims that Rotavirus diarrhea usually threatened severe diarrhea, no significant difference in incidence of severe diarrhea was observed between Rotavirus positive and Rotavirus negative acute diarrhea.

Implication of DNA repair genes in prostate tumourigenesis in Indian males.

Background & objectives: Prostate cancer (CaP) is the fifth most common cancer among Indian men. Tumour protein p53 (TP53) gene increases the fidelity of DNA replication and homologous recombination by transcriptional transactivation of mismatch repair (MMR) genes. DNA repair thus has a potential role in molecular carcinogenesis of CaP. The aim of the present study was to identify mutations, and polymorphisms in TP53 gene and MMR protein expression in CaP in Indian male population. Methods: TP53 codon 72 polymorphism was analysed in 105 CaP, 120 benign prostatic hyperplasia (BPH) cases and 106 normal controls. Mutational analysis of TP53 was done in DNA extracted from formalin fixed paraffin embedded tissue of 80 CaP and 24 BPH cases. Expression of MMR proteins viz. hMLH1, hMSH2, hPMS1 and hPMS2 was studied in 80 CaP, 15 prostatic intraepithelial neoplasia (PIN) and 15 BPH cases. Results: A somatic C/A variation at the intronic boundary of exon 7 in TP53 gene was observed in one each biopsy samples from CaP and BPH. A significant association of codon 72 TP53 Pro/Pro genotype was observed with the risk of CaP (OR, 2.59, P=0.02) and BPH (OR, 6.27, P<0.001). Immunohistochemical analysis of MMR proteins showed maximum loss of hPMS1 expression in cases of CaP and PIN while no loss in expression of MMR proteins was observed in BPH cases. The study also identified a significant loss of hPMS2 protein in poorly differentiated tumours (Gleason score >7) than in well differentiated tumours (Gleason score 3-6) (P<0.05). Interpretation & conclusions: The results of the present study demonstrate that TP53 codon 72 polymorphism plays significant role in the pathogenesis and susceptibility to CaP and BPH. Also, an aberrant MMR protein expression could be involved in progression of prostate cancer through PIN, early CaP to aggressive CaP. The loss of hPMS2 protein expression may serve as a marker for progression of CaP.

Myocardial dysfunction in rheumatic carditis--does it really exist?

OBJECTIVES: Acute rheumatic fever (ARF) continues to affect millions of children in developing countries. Aim of the present study was to evaluate the role of myocardial dysfunction in the genesis of heart failure in patients with rheumatic carditis. There are limited studies on this subject. METHODS AND RESULTS: In this prospective study, 108 consecutive patients of ARF were evaluated by echocardiography and assay of cardiac troponin I blood levels. The patients were divided into three groups. Group A (n = 30): patients with no evidence of carditis; Group B (n = 45): patients with first attack of carditis; and group C (n = 33): patients with recurrent attacks of carditis. Left ventricular dimensions tended to be larger in Group B and C patients. Left ventricular ejection fraction did not differ between the groups (Group A: 63 +/- 8.1%, Group B: 58 +/- 7.9%, Group C: 61.2 +/- 9%, p = ns). Heart failure was present in 37.7% patients of Group B, and in 60.6% patients of Group C (p = < 0.05). Ejection fraction was normal in majority of heart failure patients (75.7%). It was reduced in 29.4% of patients in Group B and in 20% of Group C patients with heart failure (p = ns). All patients with low ejection fraction had hemodynamically significant regurgitant valvular lesions. Mean cardiac troponin I values, an index of myocardial damage, did not differ between the three groups (Group A: 0.062 +/- 0.027 ng/ml, Group B: 0.068 +/- 0.019 ng/ml, Group C: 0.071 +/- 0.031 ng/ml, p = ns). CONCLUSION: The present study did not demonstrate any echocardiographic abnormalities or cardiac troponin I elevation suggesting significant myocardial involvement during acute rheumatic fever. This lends credence to the view that myocardial involvement does not play any significant role in the genesis of heart failure in patients with rheumatic carditis.

Severe falciparum malaria.

Falciparum malaria affect all ages with multiple-systemic complications which varies in different age group. We studied 242 children with complicated Falciparum malaria with a median age of 6.5 years to look for occurrence of different complications in younger and older age groups and overall mortality picture. Unarousable coma (40.5%), severe anemia (26.03%), repeated seizures (46.2%) and hepatopathy (32.2%) were commonest complications. Under five children had higher risk of development of cerebral malaria (P<0.01), severe anemia (P<0.05) and seizures (P<0.001); whereas above five children had higher risk of acute renal failure (P<0.05) and malarial hepatopathy (P<0.02). Over all mortality was 9.9%, cerebral malaria being the commonest cause (6.6%). Multi-system involvement was seen in 58.4% cases of death. Children having pulmonary edema, shock and cerebral malaria had high case fatality rate.

Screening of prostate cancer in males with prostatism.

Comparison of different screening methods including digital rectal examination (DRE) and estimation of serum prostate specific antigen (PSA) had been done for detection of cancer prostate at initial stages in 186 patients presenting with prostatism. The detection rate of raised serum PSA (> 4 ng/dl) was found significantly higher than that of abnormal DRE because it could detect cases of prostate cancer at very early stages. On the other hand using abnormal DRE alone as criteria for biopsy, large number of these cases, specially at early stages, would have remained undetected (36.9%) thereby giving false low incidence. Serum PSA was found raised in pre neoplastic conditions (73.9%) like PIN and AAH also, majority of which were missed on DRE (65.2%). Raised serum PSA was found in many benign conditions (36.7%, false positive) also, hence prostatic biopsy is advised to confirm malignancy.

Prevalence of bacterial prostatitis in benign prostatic hyperplasia.

To define the prevalence of bacterial prostatitis and urinary tract infection (U.T.I) among benign prostatic hyperplasia patients (B.H.P) undergoing prostatectomy trans urethral resection of prostate (T.U.R.P.), 100 consecutive patient has their preoperative and post-operative urine cultures along with tissue culture of the resected prostatic tissue. Our data suggests that significant incidence (42%) of bacterial growth in prostatic tissue-occurs in patients with B.H.P. Pre-existing U.T.I. is not a reliable indicator by which this group could be identified pre-operatively and prostatic infection could be treated.

Incidence of anaerobic bacterial infection following transurethral instrumentation.

Total 300 patients undergoing transurethral instrumentation had their urine culture for aerobic and anaerobic organism pre-operatively and post-operatively. An increase in the incidence of anaerobic urinary tract infection from 2% pre-operatively to 14% post-operatively following transurethral instrumentation was documented. It was concluded that transurethral instrumentation increases the incidence of anaerobic urinary tract infection and patients having symptoms of urinary tract infection following such procedures with sterile urine for aerobic bacteria should be studied and treated appropriately for anaerobic urinary tract infection.

Primary adenocarcinoma of the urinary bladder--a case report with review of literature.

Primary adenocarcinoma of the urinary bladder is a rare neoplasm. We present the clinicopathological and immunohistochemical analysis of a case in a 50 year old male. The histogenesis of the tumour and a review of literature is also discussed.

Follicular growth rate and lack of influence of oestradiol valerate, testosterone propionate and aminoglutethimide phosphate on ovarian follicular development in the musk shrew, Suncus murinus L.

Growth rate of follicles and effects of administration of oestradiol valerate (EV), testosterone propionate (TP) and aminoglutethemide phosphate (AGP) on the development of ovarian follicles of the adult musk shrew were investigated. The follicular growth rate was estimated by mitotic index before and 2 hr after colchicine treatment to the shrews. Mitotic index of granulosa cells increased linearly with the increase in the follicular diameter. The calculated mean duration of mitosis was 0.48 hr. The mean time taken for follicle to pass from primary follicle stage to preovulatory stage was estimated to be 12 days. Treatment of both the steroids EV and TP, failed to produce any noticeable effect on the atretic follicle of the musk shrew. The results indicate that neither EV or TP, nor the potent steroid inhibitor AGP had any influence on the growth of large follicles in this primitive eutherian mammal.