Cystic hypersecretory carcinoma with invasion: Case series on a rare variant of carcinoma breast

Background: Cystic Hypersecretory Carcinoma (CHC) is a rare subset of breast carcinoma. It is part of a spectrum of cystic hypersecretory lesions which includes cystic hypersecretory hyperplasia (CHH), CHH with atypia, CHC in situ and CHC with invasion. Approximately 65 cases of cystic hypersecretory lesions have been reported; most of them were CHC in situ and only 19 cases of CHC with invasion have been reported so far. Case Presentation: We are reporting 2 cases of 47 and 62 year old women with a palpable breast mass for 6 and 1 month duration respectively. Trucut biopsy was carried out for both which showed high grade ductal carcinoma in situ with microinvasion in the first patient and the latter showed a tiny focus of invasive carcinoma. Simple mastectomy and modified radical mastectomy (MRM) were done for the respective cases; both showed dilated cystic spaces filled with eosinophilic secretions (thyroid colloid-like), lining neoplastic cells that showed variable degrees of proliferation, atypia and in situ carcinoma. There were foci of invasion in both cases and hence a morphological diagnosis of CHC with invasion was made. Conclusion: Owing to a smaller number of reported cases, little is known about the biological behavior, prognosis and molecular profile of cystic hypersecretory carcinoma.

Development and validation of a novel Middle childhood oral health impact scale (MCOHIS)

Purpose: The study was planned to develop and validate a novel middle childhood oral health impact scale (MCOHIS) for 6- to 9-year-old children in India. Methodology: A cross-sectional study design was employed to develop and validate MCOHIS in the sequential phases. A panel of ten pediatric dentists evaluated a pool of 36 items corresponding to the oral health-related quality of life (OHRQoL) of children. MCOHIS with 20 items under five domains was formulated and content validation was done. Cohen's kappa statistics was employed to measure the concordance between the child's self-report and the caregiver's proxy report. Concurrent validation was done among 130 participants from 13 districts of Tamil Nadu state, India. Discriminant validity was checked among another sample of 60 participants. Internal consistency and test-retest reliability of MCOHIS were assessed using Cronbach's alpha and Kappa statistics respectively. Results: MCOHIS had adequate content validation with Scale Level Content Validity Index / Average score of 0.94 for relevance. There was a statistically significant inter-rater reliability observed between the child's self-report and caregivers' proxy report in all items with a moderate to substantial agreement. Concurrent validation showed a statistically significant positive correlation with a Rho value of 0.712. There was a statistically significant difference noted in overall discriminant validity (P < 0.001). Acceptable internal consistency reliability was observed with Cronbach's alpha value of 0.75. Test-retest reliability showed a high stability coefficient of 0.98. Conclusions: MCOHIS was found to be a valid and reliable age-specific tool for assessing the OHRQoL of Indian children aged 6–9 years.

Ego defense mechanisms among pediatric dental postgraduate students in India A descriptive cross-sectional study

Background: Ego defense mechanisms (EDMs) act as a major factor for overcoming stressful situations in life. Aims: The study aimed to assess the various patterns and factors of EDMs employed by pediatric dental postgraduate students in India. Settings and Design: Cross-sectional design, web-based questionnaire survey. Methods: A cross-sectional questionnaire study on EDM was conducted among 246 pediatric dental postgraduates in India from July to October 2019. The modified form of the Defense Style Questionnaire-20 included 10 EDMs under three major patterns– Mature, Immature, and Neurotic. The questionnaire was sent to all pediatric dental postgraduates enrolled in the Indian Society of Pedodontics and Preventive Dentistry and reminders were sent every week for 6 weeks. Results: Among the 1041 pediatric dental postgraduates who received the E-mail, two hundred and forty-six students responded to the same. The respondents included 89 males and 157 females. The mature pattern was found to be the most commonly employed EDM (males-47.20%; females-51.60%). Sublimation (72.76%), a mature type of defense was found to be the most common EDM factor employed by the majority of the students. The immature pattern was higher among males when compared to females (males-14.60%; females-5.70%). Conclusion: Most pediatric dental postgraduates exhibited a mature pattern, followed by a neurotic and immature pattern of EDM. The mature pattern of EDM was displayed more by the female students than the male students. Sublimation was found to be the maximum expressed factor followed by acting out.

Awareness of coronavirus disease (COVID-19) pandemic among interns of a tertiary care hospital

Background: Coronavirus disease officially called as COVID-19, which was noticed during December 2019 (Wuhan) China, later became a major public health problem leading to pandemic affecting worldwide and causing morbidity and mortality, despite various control measures. This research was undertaken to assess the level of awareness of coronavirus disease (COVID-19) among interns of a tertiary care hospital. Objective: The objective of the study was to assess awareness of coronavirus (COVID-19) among interns of a tertiary care hospital. Materials and Methods: A cross-sectional observational study was conducted among 97 interns of a tertiary care hospital in Dharwad district, Karnataka, India. An online pre-designed and pre-tested questionnaire was developed using Google forms, with a consent form attached to it for voluntary participation, through which data were collected and the distributions of responses were presented as frequencies and percentages. Results: Awareness regarding coronavirus among 97 interns were assessed. Of which 41 (42.3%) were male and 56 (57.7%) were female. Newspaper and television were the primary reliable source of information about coronavirus. Cough (95.87%) and fever (90.72%) were the most common symptoms. The majority of the interns (90%) agreed that coronavirus could lead to pneumonia, respiratory failure, and renal failure. About 90% considered that it can be prevented by handwashing, wearing masks, and by maintaining distance. However, with respect to curability of the disease, the awareness was on a dismal note. Conclusion: Awareness of acquiring and transmitting coronavirus was found to be adequate, except for the curability aspects. Thus, it is the need of the hour to have timely updates about the disease and newer guidelines to restraint the ongoing pandemic of COVID-19.

A clinical study of new onset seizures in children aged 3-12 years

Background: Seizures are common in pediatric age group and less than 1/3rd of seizures in children are caused by epilepsy. Aim of present study was to analyze the etiological factors and clinical profile of new onset seizures in children aged 3-12 years.Methods: This was a prospective study done at a tertiary care center of south India. Authors analyzed 98 children aged 3-12 years presenting with new onset seizures. Proper history and investigations including EEG, and CT brain were done to confirm the etiology.Results: Out of 98 children 51 were 3-5 yrs of age and 47 were 6-12 years. 66.3% had generalized seizure and 33.6% had partial seizure. Partial seizure were more common in 5-12 years of age. Intracranial infections were the leading cause (73/98) which included neurotuberculosis (26/73), NCC (20), bacterial meningitis (12), cerebral malaria (8) and viral encephalitis (7). Intracranial infections' were the' leading cause in both age groups. Space occupying lesions were more common in 6-12 years (46.8%) as compared to 3-5 years (19.6%). NCC and Tuberculoma were the leading CT findings in both age groups. There was significantly high incidence of focal EEG changes in partial seizure group compared to generalized seizure group.Conclusions: Intracranial infections were leading cause of new onset seizures especially GTCS. Good clinical evaluation and judicious use of investigations should be ensured. CT brain and EEG are more likely to be informative in partial seizures than in generalized seizures.

Survey of Wetlands in and around Tiruppur District, Tamil Nadu, India

Wetlands are amongst the most productive ecosystem On the Earth [1,2], and provide many important services to human society. Wetlands are one of the most threatened habitats of the world. Wetlands in India, as elsewhere, are increasingly facing several anthropogenic pressures. Urbanization is the irreversible, and most dramatic, transformation of land affecting ecology and natural resources. This study was carried out to document the wetland status from June 2017 to March 2018 in and around Tiruppur district, TamilNadu. The study results demonstrated that there are 88 wetlands in and around Tiruppur districts and that they might be categorized in terms of dimension and state. Out of the 88 wetlands, 68% of the wetlands consist of land plots of less than 5 acres in size, followed by 26% of the wetlands consisting of 6-10 acres in size, 3% of the wetlands were approximately 11-15 acres in size while 3% of the wetlands were over 15 acres. According to the recorded usage of the wetlands, 42% were used for irrigation, 11% for irrigation and fisheries, 3% for recreational activities, and 44% for cattle cleaning, residential purposes including washing clothes, in the booming slums around the wetlands. For wastes dumped on wetlands, 2% were degradable wastes, 44% were non degradable wastes, and 54% were mixed wastes, including both degradable and non degradable waste. In Tiruppur town, 21% of the wetlands were enclosed by farm land, 8% were encircled by factories/companies, and 71% were surrounded by residential areas. During every summer season, 53% of the wetlands become dried out, 19% were partially dried up, and 28% of the wetlands retained their water holding capacity throughout the year. The results indicated that the decline of wetlands in and around Tiruppur district was due to waste dumping, construction near wetlands, lack of desilting and dredging, blocking of water channels, and the lack of strict laws. Apart from government regulation, creating wetland awareness, enlightened infrastructure development, sustainable water use planning, and implementation of zero discharge facilities practices are necessary in order to prevent the further deterioration on wetlands in Tiruppur district.

A comparative study of Ziehl Neelsen, Gabbet‘s and Fluorescent staining methods to detect acid fast bacilli in sputum samples

Tuberculosis remains world's leading cause of death from a single infectious agent. Pulmonary tuberculosis (PTB) is the most common presentation of tuberculosis. Here we compare Ziehl-Neelsen (ZN), Gabbet's and Fluorescent staining (FS) methods to determine efficiency and cost effectiveness of diagnosing pulmonary tuberculosis from sputum samples. Three smears from 148 sputum samples of PTB cases were prepared and stained by the above methods. Of the samples examined, 71.6% and 53.4% and 85.8% cases were detected by Ziehl-Neelsen, Gabbet's and Fluorescence staining respectively. Fluorescent staining was found to be more reliable and cost effective method particularly when dealing with large sample loads than Ziehl-Neelsen and Gabbet's staining technique.

Characterization of adrenal masses with non-enhanced CT and 18F FDG-PET in patients with primary malignancies

Background: Characterizing adrenal lesions in patients with a known primary malignancy has a vital role in treatment and prognostication. A study by Gufler et al proposed a scoring system based on density, contour, homogeneity and size and found a high accuracy in differentiating adrenal adenomas from metastasis in patients with a known malignancy. This study evaluates the sensitivity and specificity of this NECT scoring system and comparing it with that of 18F FDG PET.Methods: The study was conducted on patients with diagnosed malignancies with adrenal mass, referred for 18F-FDG PET-CT scanning as a part of work up or follows up between October 2014 and March 2016. Whole-body CT and PET images were obtained using standard protocol. NECT scoring and quantitative analysis of FDG uptake in the adrenal lesions (SUVavg analysis) is done separately.Results: Of the 50 patients studied, 33 patients had benign adrenal lesions and the rest had metastatic lesions. Most common site of primary was lung. NECT score yielded a sensitivity of 88.2%, specificity of 100% and positive predictive value of 100%. SUVavg analysis yielded a 100% sensitivity, specificity and positive predictive value. Comparison of the predictive power of the two tests showed a z score of 2.5 and p value of 0.0124.Conclusions: 18-FDG PET can be considered as a gold standard for differentiating between metastasis and benign lesions of adrenal glands in patients with known primary. NECT has a comparable specificity as that of FDG PET, however with lower sensitivity.

Hydatid cyst of bone.

Hydatid disease is an extremely uncommon differential diagnosis in the cystic/lytic lesions of bone. We present a rare case of echinococcal infection of femur which presented as pathological fracture in a middle-aged female and diagnosis was confirmed by histopathology. Hydatid disease of bone is often asymptomatic, and its diagnosis is usually made when lesions have become extensive.

Study of Morphology of Uterus Using Ultrasound Scan.

Background: The anatomical variations of uterus particularly those concerning the body of uterus are well known in medical literature. Knowledge of these variations is important in reproductive periods of life, as well as in deciding the surgical procedures involving caesarean section delivery. However there are some exceptional variations in the body of uterus thatmay puzzle the obstetrician and gynaecologist dealingwith gynaecological patients. Normal development of the female reproductive tract requires a complex series of events. Failure of any part of this process can result in congenital anomaly. Careful sonography and an awareness of the sonographic findings of early pregnancy in anomalous uteri should improve the detection of these anomalies. Recognition of such anomalies will also allow differentiation of those patients requiring repeat dilatation and curettage from those requiring laparotomy, as in the presence of a blind uterine horn or ectopic gestation. 3D ultrasonography permits the obtaining of planar reformatted sections through the uterus, which allow precise evaluation of fundal indentation& length of the septum. AimThis studywas undertaken to assess themorphology of uterus and evaluate the anomalies. Materials: 1500 subjects within the age of 15-45 were assessed using ultrasound scan and the anomalies were analyzed. Results: 5-7% cases involving the variations ofmorphology of the uterus were reported in this study, that 3DUS has recently become the only mandatory step in the initial investigation. Conclusion:With timely and accurate diagnosis, appropriatemanagement is likely to provide the best possible outcome for all such patients.

Variation in the Shape of Coronoid Process in Dry Mandible of Maharashtra Population.

Background: Knowledge about themorphological shapes of the coronoid process is useful for themaxillofacial surgeon. The Coronoid process can be easily harvested as a donor bone. It is also helpful in determining buccal vestibule during denture fabrication. Aim of the study: To find out the variation in shape of coronoid process and the intercoronoid distance in dry mandible of Maharashtra region. Material and Methods: One hundred and fifty seven (male 84 and female 73) dry mandible of Maharashtra region were studied for variations of shape in coronoid process of both sides and the intercoronoid distance . Results: Triangular shape coronoid process was found in 204 (64.97%), Hook shape in 66 (21.02%) sides. and rounded in 44 (14.01%) sides of mandible. Mean intercoronoid distance among males was found to be 9.2000 and 9.100 in females. Conclusions: It was found that most common shape of coronoid process found in our study was triangular. Mandible with hook shape coronoid process was almost equal in male and female mandible while triangular shape was slightly more in the male .

Boni Mores and Consent for Child Research in South Africa

Consent is required for almost all health research. In order for consent to be valid a number of requirements must be met including that the consent cannot be contra bonos mores or contrary to public policy. This principle has its roots in the common law and it is used to ensure that the consent to harm; or the risk of harm; is permitted or ought to be permitted by the legal order. Recently; it has also become a statutory requirement embedded in the consent obligations relating to non-therapeutic health research with minors. Section 71 of the National Health Act provides that the Minister of Health (or potentially his or her delegated authority) must provide consent to non-therapeutic research with minors. However; such consent may not be granted if 'the reasons for the consent to the research or experimentation are contrary to public policy'. Limited work has been done on how to determine when consent to health research with children would be contrary to public policy. This article attempts to begin the debate by describing the boni mores principle; setting out some of the general factors that could be used to assess whether consent is consistent with it and suggesting how they could be applied to health research.The article concludes by stating that simply requiring proxy consent for non-therapeutic health research with children is insufficient as it cannot always be assumed that proxy consenters will act in the best interests of the child. Thus the boni mores principle acts as a limit on autonomy in order to protect the child participant. It is further submitted that establishing when consent to health research is consistent with public policy requires an assessment of whether the research is consistent with constitutional values; prevailing legal norms regarding children; and an assessment of the legal convictions of the community

Variation In The Position Shape And Direction Of Mental Foramen In Dry Mandible.

Aim of the study: Purpose of this study was to find out the most common position shape and direction of mental foramen in dry mandible of Maharashtra region. Background: Study of mental foramen is important for dentists in administering regional anesthesia and performing periapical surgery in the mental region of the mandible. Material and methods: Seventy five adult dry mandibles of unknown sex are studied for position shape and direction of mental foramen. All mandibles are studied for position shape and direction of mental foramen. Results: The most frequent position of mental foramen was in line with the longitudinal axis of the IInd premolar tooth. The shape of mental foramen was round or oval. Conclusions: Knowledge about morphometry of mental foramen is important for various dental procedure involving periapical region.

Effect of dental treatments on salivary immunoglobulin A of children with and without dental caries: A comparative study.

Aim: To evaluate and compare the effect of dental treatment on the salivary immunoglobulin A (IgA) levels of children with and without dental caries. Materials and Methods: The study involved 30 children, among which 15 had caries and the other 15 were without caries. Salivary sample collection was done for all the children before dental treatment, and for the children with caries, the sampling was repeated 3-4 weeks after the dental treatment. The salivary IgA quantitation was done by enzyme-linked immunosorbent assay (ELISA), using Human IgA ELISA Quantitation kit, and the results were statistically analyzed by independent sample "t" test. Results:The salivary IgA level was significantly more in children with caries (13.07 ± 1.55 mg/100 ml) than in caries-free children (11.90 ± 1.58 mg/100 ml) in the pre-treatment phase. The salivary IgA level in children with caries was 13.52 ± 1.68 mg/100 ml in the post-treatment phase and it was not statistically different from the pre-treatment value. Conclusion: Mere quantitation of salivary IgA levels might have no reflection on the functional antibodies involved in caries process, and successful dental treatment alone does not alter the salivary IgA levels, suggesting a multifaceted approach to combat the cariogenic challenge.

The foramen meningo-orbital in Indian dry skulls.

Background & objective: Foramen meningo-orbital is present in greater wing of sphenoid bone close to superior orbital fissure. It provide route for an anastomosis between the orbital branch of the middle meningeal artery and recurrent meningeal branch of ophthalmic artery. Basic textbooks of anatomy stated that it was a rare occurrence but some recent studies indicate a more frequent incidence of this which shows side and gender variation. These discrepancies were verified in our research work. Methods: We studied 150 dried human skulls (100 male and 50 female) of known sex. Only patent foramina were included in the observation. Results: Incidence of foramen as whole was 44.33% (male- 37.5% and female- 58%). In 4%, it was present bilaterally. Average distance between lateral end of superior orbital fissure and foramen was 6.22 mm. Conclusion: Our study indicates that a foramen meningo-orbital is present as often as, mostly unilaterally and multiple foramina may exist and also it shows side and genders variation. Knowledge of it may be of surgical significance to ophthalmologist and neurosurgeons and for radiologist because it masquerading as an intraocular foreign body. Further detail study on this topic in other populations from different areas is required.

Dengue disease status in Chennai (2006-2008): A retrospective analysis.

Background & objectives: Dengue is one of the most important Arboviral diseases in man with outbreaks in Southeast Asia and India. We report a retrospective analysis of the dengue positivity in the referred samples for three years period (2006 to 2008) at the Department of Virology, King Institute of Preventive Medicine, Chennai, Tamil Nadu, India. Methods: Serum samples from 1593 suspected cases (968 male and 625 female) were obtained. Of the 1593 cases screened, 1204 (75.5%) were paediatric cases and 389 (24.4%) adults. The samples were subjected to MAC ELISA and IgG ELISA. Results: Of the 968 patients, 686 (43.0%) were positive, of which 579 (84.0%) were in the paediatric age group (<14 yr) and 107 (15.5%) were adults. The IgM positivity being 356 (36.7%) in males and 330 (52.8%) in females. Of the 686 positives, 113 (16.47%) were positive for both IgM and IgG denoting secondary infection. There was a noticeable increased occurrence during the cooler months and during the monsoon and post-monsoon months. Interpretation & conclusions: The dengue IgM seropositivity among the suspected cases indicates active dengue virus activity. Increase in the probable secondary infections especially in a country like ours where multiple serotypes are prevalent raises concern over probable increase in the incidence of the more serious DHF/DSS. Studies need to be done to identify circulating serotypes of dengue virus to design preventive strategies.

Effect of simultaneous exposure to lead and cadmium on gonadotropin binding and steroidogenesis on granulosa cells: an in vitro study.

Effects of lead (Pb) and cadmium (Cd) both alone or in combination on the binding of LH and FSH on isolated granulosa cells were studied. Granulosa cells isolated from proestrous rats were incubated (in vitro) with lead acetate and/or cadmium acetate (0.03 microM of Pb or Cd) for 1 hr. LH binding was dropped to 84% in Pb treated cells, 72.5% in Cd treated cells and 74.8% in combined metal treated cells compared to control. FSH binding dropped to 85.5% in Pb treated cells, 71.16% in Cd treated cells and 72.5% in combined metal treated cells compared to control. Activity of 17beta Hydroxy Steroid Dehydrogenase (17betaHSDH), a key steroidogenic enzyme was reduced by 52% in Cd and 37% in combined metal exposed cells whereas Pb exposed cells showed 31% reduction in the enzyme activity. Pretreatment with SH groups protectants (glutathione [GSH], dithiothretol [DTT]) and zinc caused an ameriolation in enzyme activity whereas Zn pretreatment showed an increase in gonadotropin binding in metal exposed cells. These results suggest that both Pb and Cd can cause a reduction in LH and FSH binding, which significantly alters steroid production in vitro and exerts a direct influence on granulosa cell function.