Histoplasmosis masquerading as tuberculosis: A report of three cases in immunocompetent children

The most common cause of granulomatous lymphadenitis in countries like ours is mycobactrium tuberculosis followed by atypical mycobacterial infection, fungal infections, parasitic infection, cat scratch disease, lymphogranuloma venereum (inguinal lymphadenopathy), and leprosy Here, we present three cases of lymphadenopathy due to histoplasmosis in immunocompetent children. Two of them presented with fever, lymphadenopathy, initially diagnosed as granulomatous lymphadenitis consistent with tuberculosis on FNAC and were put on antitubercular drugs. However, their condition gradually became worse. As the patients continued to deteriorate, subsequent lymph node biopsies were done and diagnosed as histoplasmosis. Third case presented with acute loss of vision with hepatosplenomegaly and lymphadenopathy. Initially considered as acute leukemia, but eventually established as histoplasmosis. Histoplasmosis should be considered as one of the possible causes of granulomatous lymphadenitis in children.

Utility of tru-cut biopsy in diagnosis of palpable pediatric soft tissue neoplasms

Context: Soft tissue neoplasms are infrequent in children with sarcomas accounting for approximately 7% of all pediatric malignancies. Morphologic diagnosis is challenging due to overlapping features. Subtyping and categorization of these lesions are difficult on fine-needle aspiration cytology (FNAC) alone owing to tumor heterogeneity and limited material in some cases. Tru-cut biopsies obtain adequate tumor tissue for ancillary studies besides conventional histology. Aim: The study aims to explore the role of tru-cut biopsy to arrive at a definitive diagnosis. The study also highlights the correlation between FNAC and histopathology on tru-cut biopsy besides explaining the significance of a panel of immunohistochemistry (IHC) markers for histological categorization and subtyping. Materials and Methods: A total of 61 children from infancy to 18 years were included in the study. Closed biopsy procedures like FNAC and tru-cut biopsy were performed, and the tru-cut biopsy specimen was subjected to a panel of immunohistochemical markers. Results: Fisher's exact test for sensitivity and specificity towards detection of malignancy was 83% and 86%, respectively for FNAC. For tru-cut biopsy, sensitivity was 94% and specificity was 91%. The two-sided P value (<0.0001) was extremely significant. Cohen's Kappa coefficient value for tru-cut biopsy was 0.772 suggesting a substantial strength of agreement. Tru-cut with IHC had a Kappa value of 0.866 suggesting greater agreement with histopathology. Conclusion: Tru-cut biopsy is a simple, safe, and reliable adjunct to the FNAC. Instead, immunohistochemistry enhances the diagnostic accuracy.

Low-grade myofibroblastic sarcoma of maxillary sinus and buccal mucosa: Two rare cases and review of the literature

Low-grade myofibroblastic sarcoma (LGMS) represents an atypical tumor composed of myofibroblasts with a predilection for the head and neck, especially in the tongue and oral cavity, with a high tendency to local recurrence and metastasis, even after a long period. LGMS arising from maxillary sinus and buccal mucosa are not very common. To the best of our knowledge, only 55 cases of low-grade myofibroblastic sarcoma have been reported and only four cases of LGMS of maxillary sinus and three cases of LGMS of buccal mucosa have been reported in world literature. We report two cases of LGMS of the maxillary sinus and buccal mucosa, discussing clinical, histological, inmunohistochemical and therapeutic features.

Occurrence of II and V staphylococcal cassette chromosome mec types among coagulase-negative staphylococci from Northeastern part of India

Introduction: Coagulase Negative Staphylococci, the most commonly isolated pathogen are becoming emerging threats to the community as well as to the nosocomial environment. The present study underscores the distribution of Staphylococcal cassette chromosome mec (SCCmec) types among Methicillin resistant Coagulase Negative Staphylococci from the environmental origin. Methods and Materials: Environmental and food sample (n = 460) from different location of northeastern region of India were collected for a period of one year and were phenotypically and genotypically screened using cefoxitin disc and PCR techniques for mecA and mecC gene detection. All the MR-CoNS isolates possessing mecA gene were subjected to 16srDNA sequencing for species identification. SCCmec typing was determined by evaluating using primer sets from type I to type V. Antibiotic susceptibility testing was performed for all the isolates. Statistical analysis with chi-square test using SPSS-21 statistical software. Results: Methicillin resistance shown by one hundred forty three isolates were carried out for molecular analysis, among them 53.84% serves as mecA carrier. Distribution of Staphylococcus haemolyticus was more frequent and was found that SCCmec types II and V were predominant among the study isolates. Linezolid was the drug of choice for the CoNS isolates. Statistical analysis showed an insignificant result for the tested antibiotics and SCCmec types. Conclusion: This study therefore interprets the relative importance of SCCmec types among MR-CoNS isolates.

Rotavirus and other Diarrheal Disease in a Birth Cohort from Southern Indian Community.

Objective: To describe the incidence, severity and etiology of diarrheal disease in infants and young children residing in an urban slum community in Southern India. Setting: Three contiguous urban slums in Vellore, Tamil Nadu. Participants: 452 children participating in a birth cohort study on diarrheal disease; 373 completed three years of follow-up. Outcome measures: Diarrheal incidence (obtained by twice-weekly home visits) and severity (assessed by the Vesikari scoring system), and etiological agents associated with diarrhea (through examination of stool specimens by bacteriologic culture, rotavirus enzyme immunoassay, PCR for norovirus and microscopy for parasites). Results: A total of 1856 diarrheal episodes were reported in 373 children. The overall incidence rate of diarrhea was 1.66 episodes per child year for three years, with 2.76 episodes per child year in infancy. The incidence peaked during the months of July and August. Severe diarrhea formed 8% of the total episodes. Rotavirus was the most common pathogen detected, being identified in 18% of episodes. Good hygiene status resulted in 33% protection against moderate-to-severe diarrhea. Conclusions: This study highlights the burden of diarrheal disease and the important etiological agents of childhood diarrhea in Southern India. Promotion of hygienic behavior through health education may help reduce diarrheal incidence in this and similar communities.

Efficacy of stem cell in improvement of left ventricular function in acute myocardial infarction - MI3 Trial.

Background & objectives: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 108 autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. Methods: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). Results: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 108 (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. Interpretation & conclusions: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.

Tubo-ovarian Actinomycosis: A case report with brief review of literature.

Pelvic actinomycosis is an uncommon condition, often associated with the use of intrauterine contraceptive device (IUCD). Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. Ovarian actinomycosis is even rarer. Here, we present a 24-year-old woman using an IUCD for 3 1 / 2 years with right-sided adnexal mass, which was diagnosed postoperatively as tubo-ovarian actinomycosis. Many times, an appropriate management is overlooked or delayed due to its non-specific and variable clinical and radiological features. Sometimes, it can even mimic an advanced pelvic malignancy. Therefore, the gynecologist should consider the possibility of this infection to spare the patient from morbidity of radical surgical procedure.

Is seroprevalence of anti-IGM CMV among blood donors relevant in India?

BACKGROUND: Infection with cytomegalovirus (CMV) is more common in developing nations and the people belonging to the lower socioeconomic section of the society. The immunosuppressed population for whom CMV-seronegative blood products are requested is increasing due to advances in medical care. AIM: To study the prevalence of CMV antibodies among the different sexes and age groups in healthy blood donors. MATERIALS AND METHODS: A retrospective study was done on 5600 serum samples stored frozen in a repository for CMV antibodies using the ELISA technique. RESULTS: Five thousand three hundred and fifty (95.5%) were male and 250 (4.5%) were female. Four cases (0.071%) out of 5600 samples were positive for anti-IgM CMV with 95% Confidence Interval (95% C.I) of 0.02 - 0.17. CONCLUSION: In a developing country like India, screening for IgM antibody on a routine basis may not be feasible, given the likely positive yield to be low and the cost being high. It is recommended that in a tertiary care hospital, blood units to be transfused to neonates, organ transplant recipients, those suffering from malignancies and other immunocompromised patients should be screened for anti-IgM CMV or preventive strategies like universal leucodepletion to be implemented to decrease the transmission of CMV in these groups of patients.

Rheumatological manifestations of leprosy.

Rheumatological manifestations are common in leprosy. A study was conducted among 30 patients to observe the prevalence and spectrum of rheumatological manifestations in leprosy. Seventeen patients were referred from leprosy clinic from 287 consecutive leprosy cases and 13 patients presented de novo at the rheumatology clinic and later diagnosed to have leprosy. In the first group, the most common manifestation was small and large joints polyarthritis resembling rheumatoid arthritis found in 64.7% cases and in the second group tenosynovitis (38.5%) was the commonest. Rheumatoid factor was positive in 60% cases.

Comparative evaluation of diabetic and non-diabetic stroke--effect of glycaemia on outcome.

Though there are extensive data on diabetic retinopathy, neuropathy and peripheral vascular disease, there are not enough data on diabetic stroke. Present study was carried out to evaluate distinctive feature of diabetic and non-diabetic stroke and to compare early mortality between two groups. Four hundred and fifty consecutive stroke cases categorised into group I of 171 known diabetic and 279 non-diabetics. Reactive hyperglycaemia seen in cases with HbA1c below 7.0% were put into group II. Patients were evaluated clinically. Evidence of peripheral vascular disease, retinopathy and other target organ damage were assessed. Glycaemic parameters monitored include fasting plasma glucose (FPG), random plasma glucose (RPG) and HbA1c. Total serum cholesterol was taken as the main risk factor in both groups though lipid profile was done in all cases. CT scan was done in all cases and a repeat one when needed. Out of 450 cases 171 were diabetic and 279 cases were non-diabetic. There was female preponderance in diabetic. Average age of diabetic stroke was lower than non-diabetic, 51.2 years as against 67 years. History of previous stroke was higher in diabetic (15.8%) than non-diabetic (5.7%). There was higher incidence of transient ischaemic attack in diabetic (22.8%) than non-diabetic (7.5%), which was highly significant (p<0.001). Hypertension and hypercholesterolaemia (> 175 mg/dl) were two important risk factors in 70.9% and 30.9% respectively in group I compared to 47.6% and 21.1 % respectively in group II, both of which are significant (p<0.001). Ischaemic stroke were higher in group I(69%) as compared to group II (45.8%) which was significant (p<0.001). Lacunar infarct were more in group I (73.7%) than group II (61.7%). Haemorrhagic stroke was higher in group II (52.7%) than in group I (30.4%). Apart from recent event CT scan showed evidence of old lacunar infarct in 36.8% cases of group I compared to 21.1% of group II. During follow-up mortality within 4 weeks was higher in haemorrhagic stroke of group I (55.8%) compared to 49.6% in group II which is significant (p<0.05). For ischaemic stroke mortality in group I was 26.3% compared to 14.8% in group II which is very significant (p<0.001). Out of total mortality in group I, 35.08% had high HbA1c. Increased risk of stroke in diabetic is probably related to hypertension and lipid abnormalities. Increased mortality from abnormal glycaemic control needs to be evaluated further.

A study of bone mineral density in diabetes mellitus in eastern India.

To measure bone mineral density in diabetic patients at the time of clinical diagnosis of diabetes mellitus and to find out correlation, if any, with microvascular complication of diabetes mellitus and glycosylated haemoglobin, a study was conducted at Medical College and Hospital, Kolkata among 138 cases of diabetes and 212 controls. All patients were screened for ophthalmoscopy, routine blood and urine examinations. Bone ultrasound attenuation study of the calcaneus was performed in all cases. The bone ultrasound attenuation result was compared to a mean normal population result and expressed as Z score and T score. The age of diabetic patients varied from 11 years to 70 years. Of 138 diabetics, 32 (23.18%) had type 1 diabetes and rest type 2 diabetes. Forty-two diabetic patients had retinopathy, 42 nephropathy and 48 had neuropathy. Glycosylated haemoglobin was above 7% in 124 patients. The broadband ultrasound attenuation of type 1 diabetics ranged from 38 to 95 dB/MHz and in type 2 it was 35 to 104 dB/MHz. There was no statistically significant correlation between neuropathy, nephropathy, retinopathy and bone mineral density status. It was also found no correlation between glycosylated haemoglobin values and ultrasound attenuation.

Alginate immobilization of Spirulina platensis for wastewater treatment.

Immobilization of cyanobacterium Spirulina platensis in sodium alginate (1.5 %) gave the best quality of bead and 15-16 beads were formed per mL of aqueous solution of alginate. The immobilized cells were used in a batch process for treatment of diluted sewage. After 8 days, 95 % of BOD5, 77 % of COD, 90 % of ammonia, and 94 % of TSS were removed.

Plasma plasminogen activator inhibitor-1 activity in normoglycemic hypertriglyceridemic north Asian Indian subjects: a preliminary case-control study.

BACKGROUND: Recent evidence suggests that increased activity of plasma plasminogen activator inhibitor-1, an important component of the insulin resistance syndrome, plays a crucial role in the pathogenesis of atherosclerosis. METHODS AND RESULTS: In this case-control study, relationships between plasma plasminogen activator inhibitor-1 activity, serum triglyceride levels and hyperinsulinemia were explored in 40 non-diabetic patients with primary hypertriglyceridemia (Group 1) and 40 non-diabetic normotriglyceridemic controls (Group 2) matched for potential confounders like smoking and physical activity. Mean values of fasting serum insulin levels were increased in Group 1 (p>0.05). Hyperinsulinemia was observed in 14 (17.5%) individuals in Group 1 and 11 (13.8%) individuals in Group 2. Mean plasma plasminogen activator inhibitor-I activity in Group 1 (9.8+/-8.4 IU) was higher than in Group 2 (7.0+/-7.7 IU), though the difference was not significant (p>0.05). However, when only subjects with elevated levels of plasma plasminogen activator inhibitor-1 activity were taken into account, mean values were significantly higher in Group 1 (p<0.05). The plasma plasminogen activator inhibitor-1 activity was higher in subjects with body mass index >25 in both the groups, significantly so in males (p=0.05). Hyperinsulinemic subjects with a body mass index >25 and raised serum triglyceride levels had higher mean values of plasma plasminogen activator inhibitor-1 activity (18.42+/-11.15 IU) than subjects with similar characteristics and normal triglyceride levels (14.22+/-8.20 IU, p<0.05). CONCLUSIONS: Though in the current study a trend for hyperinsulinemia and high plasma plasminogen activator inhibitor-1 activity was observed in hypertriglyceridemic subjects, a larger study is needed to achieve significant differences and correlations. Obese male subjects, irrespective of their lipid profile, are at risk for thrombotic events in view of their significantly higher plasma plasminogen activator inhibitor-1 values. Procoagulant tendency is further enhanced if hypertriglyceridemia and hyperinsulinemia are added on to obesity.