Study of Correlation of High-Resolution Ultrasonography and Ultrasonography Guided Fine Needle Aspiration Cytology in Diagnosis of Pure Neuritic Leprosy in a Tertiary Care Hospital

This study assesses the features of high-resolution ultrasonographic and ultrasound-guided FNAC of peripheral nerves and correlates the findings in clinically suspected cases of pure neuritic leprosy (PNL). As per the study protocol, clinically screened pure neuritic leprosy cases from January 2017 to June 2018 were subjected to high resonance ultrasonography and ultrasonography-guided FNAC. The aspirated material was stained with modified ZN stain for AFB. Nerves showed hypoechogenicity, loss or distorted echogenic rim, and fibrillary echotextures in ultrasonography. Epithelioid cells, epithelioid cell granuloma was found in the histopathology sections of FNAC specimens with the presence of AFB in some cases. From these findings it may be concluded that HRUS and ultrasound-guided FNAC could be incorporated as rapid and reliable diagnostic tools for PNL. It may enlighten the future path as an early indicator of neural damage and be critical and useful to prevent the disabilities.

Metabolic Syndrome in People Living with Antiretroviral Therapy: A Cross-Sectional Investigation from Pune, India

Background: Improved longevity of people living with HIV on highly active antiretroviral therapy and accelerated aging processes are considered contributory to Metabolic Syndrome. Objectives: The current study investigated metabolic syndrome (MetS) in people living with HIV (PLH) who were receiving antiretroviral therapy (ART) under the ongoing National AIDS Control Program. Methods: Clinic attendees(n = 3088) who were on ART for more than 6 months constituted the sampling frame, from which 378 study participants were randomly drawn and included in the analysis following the eligibility check. One hundred and fifty‑nine clinic attendees, initiated on ART in ≤6 months, provided an opportunity to estimate the prevalence of MetS in them. Sixty‑two PLH from this smaller group were enrolled. Results: MetS was found among 19% (73/378; 95% confidence interval [CI] 15.5%–23.7%) PLH who were on ART >6 months compared with 24% (15/62; 95% CI 14.2%–36.7%) in those who were on ART for ≤6 months based on harmonization criteria for the Asian population; the confidence intervals overlapped and apparently observed difference was not statistically significant. Adjusted for age, body mass index (BMI), protease inhibitor (PI)‑based ART regimen, duration of ART, insulin resistance (IR), reported family history of hypertension and residential setting, factors independently associated with MetS were PI containing ART regimen, IR, duration of ART intake and BMI. In the adjusted model, the odds of MetS were three times higher among PLH on PI containing ART regimen (95% CI of adjusted odds ratio; aOR 1.27–8.51) and those having IR (95% CI of aOR 1.48–5.07). The odds of MetS among PLH with BMI ≥23 kg/m2 was 4 (95% CI of aOR 2.08–6.81) times higher than those with lower BMI. Conclusions: MetS in PLH requires the attention of health‑care workers in India. Appropriate screening would help initiate early management.

Mindfulness-based interventions during the COVID-19 pandemic: a focused review

The coronavirus disease 2019 (COVID-19) pandemic has raised alarm all over the world, whereby the mental health crisis is on the rise and people are in quest for resolution. So, the present review paper is an attempt to evaluate the previous work on mindfulness, and, its impact during the COVID-19 pandemic. Mindfulness as a multidimensional construct teaches us to regulate our awareness of the present moment followed by an attitude of non-judgemental acceptance. This paradigm shift in the field of psychology has created wonders in psychotherapeutic practice. The current review aims to highlight the ‘why’ and ‘how’ of mindfulness as intervention that could reach every person, be it the COVID-19 sufferers or the COVID-19 warriors. It also provides an insight into the efficacy of mindfulness as an intervention itself or in adjunct to other psychotherapeutic treatments. Therefore, it calls forth the need to put mindfulness-based interventions during this pandemic situation.

A single-centre experience of scrub typhus in a tertiary care centre - a re-emerging infection

Background: Scrub typhus is a documented disease in Himachal Pradesh, but there have been few clinico-epidemiological studies in this area. The present study is done with IgM ELISA as a diagnostic test which has higher sensitivity and specificity as most of the previous studies had used Weil Felix test as a diagnostic test. Methodology: This was a prospective observational study. All the patients more than 18 years of age with positive IgM ELISA for scrub typhus with/without eschar were included. The clinical profile was observed. IgM scrub typhus was done by ELISA. Results: Total of 39 patients were observed between July 2016 to Dec 2016. Maximum patients were observed in August, September, and October. Fever with Headache was the most common presenting complaint. Eschar was present in 10 % patients. Complications were seen in 76.92 %. The mortality rate was 0 %. Conclusion: The varied presentations and high rate of complications require a high index of suspicion for Scrub Typhus. The general physicians should be sensitized for the early diagnosis and treatment to reduce morbidity and mortality.

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.

Differential expression of cyclin E, p63, and Ki-67 in gestational trophoblastic disease and its role in diagnosis and management: A prospective case–control study

Background: Gestational trophoblastic disease (GTD) constitutes a spectrum of tumors and tumor-like conditions, characterized by proliferation of pregnancy-associated trophoblastic tissue of progressive malignant potential. It is very difficult to differentiate these complex groups of lesions basing on histomorphology alone. Immunohistochemistry (IHC) with cyclin E, P63, and Ki-67 has a definite role in the identification of different trophoblasts and entities of GTD and also in the determination of biological behavior. Aims: The aim of this study is to find the differential expression of cyclin E, p63, and Ki-67 in normal placenta, hydropic abortus (HA), and various entities of GTD. Design and Settings: A prospective case–control study conducted in a government medical college. Methods: Total 96 cases, divided into Group A (48 histologically confirmed cases of GTD) and Group B (controls comprising 8 HA and 40 normal placentas of different trimesters), were studied. The histological samples were subjected to IHC using cyclin E, Ki-67, and p63. Statistical Analysis: Results were analyzed using SPSS statistical method. Results: Among the three immunomarkers used, Cyclin E and Ki-67 show statistically significant difference (P < 0.05) when compared between GTD and control groups, but it was insignificant for p63 (P = 0.369). Strong staining intensity of cyclin E and Ki-67 is seen in complete moles, choriocarcinoma, and placental site trophoblastic tumor. Conclusion: This study was done to evaluate the role of cell cycle regulatory proteins such as cyclin E and p63 and proliferation marker Ki-67 in the detection of various trophoblasts and differential diagnosis of the lesions associated with them.

Outcomes of rhegmatogenous retinal detachment surgery in eyes with pre-existing glaucoma drainage devices

Purpose: To evaluate the outcome of rhegmatogenous retinal detachment (RRD) surgery in eyes with preplaced glaucoma drainage device (GDD) with respect to intraocular pressure (IOP) control as well as success of retinal detachment (RD) surgery. Methods: It is a retrospective case series. The case records of patients who underwent RD surgery after GDD implantation from 2000 to 2014 were screened. The demographic data, ocular examination findings at all visits, details pertaining to retinal detachment and its repair, and the postoperative course was documented. Results: Twelve patients were included in study. The mean age of patients was 24.3 years (median 11 years; range 3-72 years). Male: Female ratio was 3:1. Mean duration between GDD and RD was 24 months (4 days-91 months). Of the ten eyes that underwent surgery, nine eyes underwent pars plana vitrectomy, and in one eye scleral buckling was done. GDD was removed only in one eye. At final follow-up, retina was attached with controlled IOP in 6 (60%) eyes, of which 5 (50%) had improvement in best corrected visual acuity. Conclusion: Pars plana vitrectomy was required in almost all cases for the management of RD in eyes with preplaced GDD. Retinal reattachment with good IOP control could be achieved in 60% of eyes. Removal of the drainage device was not essential for the effective management of the RRD in most cases. With multidisciplinary approach, close follow-up and timely intervention, vision can be preserved along with glaucoma control and successful retinal reattachment.

Status of Women Self Help Groups Among the Lodhas of Daharpur Village in Paschim (West) Medinipur, West Bengal, India: An Anthropological Perspective.

This paper is an attempt towards the construction on Lodha SHGs of Daharpur Sabar Palli of Narayangarh Block in Paschim Medinipur District. We have found 6 Self Help Groups constituted by Lodha Women. The members of each group is 10 and the monthly subscription for each member is 40/- in four groups while it is 50/- rupees in case of two groups. The six SHGs have their own names. The Netaji and Khudiram SHGs were established in 2005 and the other four groups were established in 2008. All groups are very active. Each member of every group took active part for their development. The educational qualification of SHG members was very low; only 4 women were educated out of 60 nos. Their socio-economic background is very poor; most of the members however have own homestead land. Some of them have agricultural land. Only two members of SHG got Patta Land from Govt. Our inferiors with the Lodha SHG members revealed that for the last four years the local Panchayat did not extended any help or cooperation for the promotion of the SHG which have made them marginalized. These SHGs were formed totally by the own initiative of the Lodha women. The study revealed marginalization of the Lodhas in the spheres of Self-Help-Group Formation. Finally, we give some suggestions for improvement and smooth running of the Lodha SHGs in the study area.

Laboratory Abnormalities in Patients with Organophosphorous Poisoning.

Organophosphorous (OP) poisoning is an ever increasing and troublesome situation in the developing countries and is a major health care challenge in the 21st century. Hundred patients who attempted suicide with organophosphates, admitted to the emergency services were included in the study. They were graded (grade 0,1,2,3) according to clinical findings and examined for parameters like RBS, serum urea, serum creatinine, liver function tests, serum amylase, serum cholinesterase and LDH . The APACHE (II) of the cases were determined and correlated with severity of the clinical manifestations. A significant decline in serum cholinesterase (ChE) with increasing grades of intoxication(p <0.05) was observed along with raised levels of random blood sugar, serum urea, creatinine, hepatic enzymes and amylase. APACHE(II) score, showed a significant rise with severity of the degree of intoxication (p<0.001) and a negative correlation with serum cholinesterase. The findings of this study highlighted usefulness of biochemical and clinical indices in the management of organophosphorous poisoning thereby recognizing the complications early and facilitating early management.

Impact of different starting doses of atorvastatin on reaching target low density lipoprotein cholesterol levels and health related quality of life in dyslipidemic patients.

Objectives : 1. To compare the percentage of patients that reach target LDL-C goals with 10 mg Vs. 20 mg of atorvastatin as a starting dose. 2. To compare Health Related Quality of Life (HRQOL) in patients on 10 mg Vs. 20 mg of atorvastatin. Methods : A prospective, double blind, parallel groups, unicentric study of patients of dyslipidemia, randomized to receive atorvastatin 10 mg (n=75) or atorvastatin 20 mg (n=75) once daily for 12 weeks. Safety reporting of incidence of adverse events was done. Results : Significantly more number of patients (P<0.05) reached target LDL-C levels at the end of 12 weeks in the 20 mg group (77.27% in the high risk group, 100% in moderately high risk group and 100% in the moderate risk group) when compared to 10 mg group (32% in the high risk group, 75% in moderately high risk group and 83.33% in the moderate risk group). Increase in HRQOL at the end of 12 weeks was also significantly greater (P<0.001) in 20 mg group (27.89%) vs. 10 mg group (19.26%). Conclusions : Selecting the starting dose of atorvastatin according to the patients risk category (by using the Framingham’s algorithm for calculating cardiovascular risk) and the percentage reduction in LDL required, will result in greater success in achieving LDL goals and better quality of life.

Emergence and dissemination of antibiotic resistance: A global problem.

Antibiotic resistance is a major problem in clinical health settings. Interestingly the origin of many of antibiotic resistance mechanisms can be traced back to non-pathogenic environmental organisms. Important factors leading to the emergence and spread of antibiotic resistance include absence of regulation in the use of antibiotics, improper waste disposal and associated transmission of antibiotic resistance genes in the community through commensals. In this review, we discussed the impact of globalisation on the transmission of antibiotic resistance genes in bacteria through immigration and export/import of foodstuff. The significance of surveillance to define appropriate use of antibiotics in the clinic has been included as an important preventive measure.

Extra-adrenal Paraganglioma: An Uncommon Cause of Secondary Hypertension in a Young Subject.

A 8 year boy was admitted with features of tuberculous meningitis. He was detected to have hypertension. Further investigations revealed an extra-adrenal paraganglioma. Tuberculous meningitis and paraganglioma could be chance associations. Paraganglioma is a rare and potentially lethal cause of secondary hypertension, very uncommon at this age. If left untreated it leads to complications arising from unrelenting hypertension. We report a case report on this very rare disease of paraganglioma presenting in an unexpected way.

A study of serum cholinesterase levels in organo phosphorous poisoning cases.

The study period is 11 months that is from 01-01-2007 to 28-11-2007, 35 cases of organ phosphorus poisoning were admitted at Mamata General Hospital, khammam, Andhra Pradesh, India. The cases were studied on various epidemiological parameters and Proforma prepared for detailed data. In our study the majority of victims were males, married, Hindu, Literate, from rural area, medium socioeconomic group and common age of victims is 21 to 30 years. The common mode of poisoning is suicidal, one is accidental poison in child and one is occupational as contact poison while spraying .No homicidal poison was reported in our study. Majority victims have consumed poison in day time, commonly abused poison is monochrotophos, and approximate amount of poison consumed by majority of the victims is 250 ml to 500 ml and majority were admitted within 3 to 6 hours of consumption of poison. The common motive of poisoning was suicidal in both male [24 cases] and female [10 cases], especially young victims from rural domicile with agricultural occupation. The majority of victims consumed poison in summer followed by winter season. The probable reason is rain dependent agricultural occupation, unemployment, joint family and medium socioeconomic status of population of this area.

Clinical relevance of HBV DNA load in patients with chronic hepatitis B infection.

BACKGROUND: Hepatitis B virus (HBV) DNA detection and quantification are now playing an increasing role in the assessment of disease activity and response to therapy. However, viraemia levels which define various stages of HBV infection have not yet been established. AIM: To define viraemia levels which describe various stages of chronic hepatitis B virus infection. METHODS: In a retrospective study, stored sera samples of chronic hepatitis B virus (CHB) infected patients registered at AIIMS liver clinic, from January 1996 to June 2005 were subjected to competitive, quantitative PCR analysis. RESULTS: The median HBV DNA load was lowest among carriers and highest among patients with chronic hepatitis B [0 (0-8) vs. 7 (0-12) log10 copies/ml, respectively; p<0.05]. As compared to chronic hepatitis patients the DNA load was also lower among cirrhotics [7 (0-12) vs. 4.5 (0-8) log10 copies/ml, respectively; p<0.05] and hepatocellular cancer patients [ 7(0-12) vs. 0 (0-8) log10 copies/ml, respectively; p<0.05]. Patients with carriers had a DNA load which was significantly lower than e antigen negative CHB [0 (0-8) vs. 6 (0-10) log10 copies/ml; p<0.05] or e antigen positive CHB [0 (0-8) vs 8 (0-12) log10 copies/ml; p<0.05]. A threshold of 3.5 log10 copies/ml had sensitivity and specificity of 83% and 58% respectively in differentiating carriers from e antigen negative CHB. There was a strong positive correlation of HBV DNA load with inflammatory grade (R=0.334; p=0.0001), fibrosis stage (R=0.276; p=0.001) and ALT levels (R=0.378; p=0.0001). 82% (9/11) of those who lost e antigen had a decline in HBV DNA levels to <5 log10 copies/ml, whereas only 12.5% (1/8) of those who did not lose e antigen had a decline in DNA load below this level. CONCLUSIONS: HBV DNA viraemia levels correlate positively with the inflammatory grade, fibrosis stage and ALT levels. Most patients who loose e antigen have a decline in DNA load to below 5 log10 copies/ml. Further prospective studies employing repeated measurements are required to define a threshold to differentiate between HBV carriers and e antigen negative CHB.

Characterization of Streptococcus pneumoniae ophthalmic, systemic & commensal isolates by pulsed-field gel electrophoresis & ribotyping.

BACKGROUND & OBJECTIVE: Streptococcus pneumoniae is common in ocular and systemic infections and is a part of normal nasopharyngeal flora. Very few studies regarding genetic analysis of S. pneumoniae isolates causing eye infections are available. This study was undertaken to do pulse field gel electrophoresis (PFGE) analysis and ribotyping of S. pneumoniae isolates obtained from eye infections, systemic infections and nasopharyngeal flora. METHODS: Sixty one well characterized S. pneumoniae isolates (38 from ophthalmic infections, 9 from systemic infections and 14 commensals) were characterized using PFGE of the whole genome after SmaI, restriction enzyme digestion and conventional ribotyping using Escherichia coli rRNA operon as the probe. Phylogenetic tree was drawn using unweighted pair group method analysis (UPGMA). RESULTS: The 38 S. pneumoniae isolates from eye infections belonging to 15 serotypes were placed in to 11 PFGE types and 15 ribotypes. The 9 systemic isolates (7 seotypes) were distributed in 7 PFGE types and 6 ribotypes. The 14 commensal isolates were placed in 11 serotypes, 5 PFGE types and 6 ribotypes. Most of the PFGE types and ribotypes consisting of ocular isolates also contained systemic and commensal isolates. INTERPRETATION & CONCLUSION: Considerable genetic similarity was observed between the isolates from ocular and systemic infections and those colonized in nasopharynx. PFGE analysis could differentiate majority of the isolates according to site of infections. There was a considerable DNA polymorphism within the studied bacterial population.

Personal apparel endangering life.

Survival after accidental pressure exerted over neck is not common. In the literature also only few cases are available. Further, the victims or their relatives seek medical assistance only if complications arise and also it is not mandatory on the part of treating private practitioner to report such cases to the police. Findings in the living on the 4th day after accidental compression of the neck by the personal apparel are described in this article. Red eyes due to scleral haemorrhages are the most striking feature and the position of knot with ligature mark is also well marked.

Finger nail abrasions in manual strangulation (throttling).

Autopsy surgeons, often observed that the nail abrasions produced over the neck of victims in manual strangulation are almost straight and do not resemble the shape of nails, which are semi-circular/cresentic. A study is undertaken to know the reason for the same. During the study it is observed that the skin gets stretched while the assailant is applying pressure and only then nails produce indentations. Once the pressure is removed the stretched skin reverts back to its original position. Thus the semicircular indentations caused over the stretched skin appear straight after the skin regains its original position.