Right Sided Haemorrhagic Pleural Effusion Secondary to Pancreatitis

A 28-year-old male patient, painter by occupation came to the department of pulmonology of Rajarajeswari Medical College, Kambipura, Karnataka, with complaints of right sided chest pain since 4 months, dry cough since one month and loss of appetite with significant weight loss. The patient was a chronic alcoholic and a non-smoker. History revealed that he was admitted in a primary health care centre for one week with similar complaints 3 months back and chest radiographs were taken. The radiograph showed right sided massive pleural effusion for which diagnostic thoracocentesis was done, which revealed haemorrhagic fluid. Pleural fluid analysis showed lymphocytic predominance; there after, repeated thoracocentesis was done in the same primary health centre and up to 5 litres of haemorrhagic pleural fluid was aspirated. Routine blood reports were within normal limits.

Establishing peer support groups for diabetic retinopathy in India: Lessons learned and way ahead

Purpose: Complications of diabetes mellitus (DM) are a public health problem globally. DM management entails medication and self-management. Peer support groups (PSGs) can improve self-management and promote healthy behavior. The objectives of this study were to design, establish, and evaluate two PSG models for people who had been screened for diabetic retinopathy to assess self-reported lifestyle changes, satisfaction with meetings and barriers to attendance. Methods: Peer groups were established using a pre-tested facilitator's guide in 11 locations in 3 states. Group members were oriented on diabetes management and lifestyle changes to improve control. Attendees' experiences were ascertained through semi-structured interviews and self-report. Data were analyzed using MS Excel 2017. Results: Eleven PSGs were established in 3 states, in 10 community health centers and one eye hospital. 53 sessions were held and 195 people attended on 740 occasions. Lifestyle changes most frequently reported between first and second visits were taking medication regularly and dietary modification. Attendance declined in the eye hospital group. 83% of CHCs members were satisfied or very satisfied compared with 37% of eye hospital (EH) members. The barriers included distance and lack of family support. Conclusion: PSGs held in CHCs were more sustainable than those in an eye hospital, and group members were more satisfied and more likely to report positive lifestyle changes. Findings were self-reported and hence a major limitation for the study. Further studies should focus on obtaining objective measures of control of diabetes and risk factors for diabetic retinopathy from members attending peer support groups in CHCs.

Comparative Antidiabetic Potential Assessment Of Herbal Formulation Of Gymnemic Acid And Curcumin

Standardization of polyherbal formulations with respect to bioactive phytocompounds is the need of the time for registration and marketing authorization in developed countries. This has prompted to prepare and evaluate a standardized bioactive phyotcompounds conintaining formulation. The study aims at development and screening of a standardized antidiabetic suspension containing active isolated phytoconstituents targeting better therapeutic effect with reduced bioburden. Suspension of isolated gymnemic acid and curcumin (GCS) was prepared, evaluated and authenticated by TLC and HPTLC. Antidiabetic efficacy of GCS was screened against alloxan induced diabetes on rats following 28 days of treatment comparative to Hyponidd tablet and Madhumehari granules. Body weight, relative organ weight, blood glucose, cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) level was measured. The formulation having pH 6.0, refractive index 1.41 and 45.58 mg/ml total solid content showed high alcohol and water soluble extractive value. The GCS treatment normalized liver and kidney weight, decreased body weight gain, TC, TG, LDL and VLDL level along with an increase in HDL level. Study outcome signifies similar antidiabetic potential of standardized formulation GCS compared to marketed Polyherbal formulation with antihyperlipidemic activity signifying as a promising natural and safe remedy for the prevention of diabetic complications.

Ultrasound-guided fine-needle aspiration cytology of hepatic mass - A minimally invasive diagnostic approach

Background: Ultrasound-guided fine-needle aspiration (FNA) is a safe, simple, accurate, rapid, and an effective method for approaching a hepatic lesion. Objectives: The objectives of this study were as follows: (1) To assess the utility of ultrasound-guided FNA cytology (FNAC) in the diagnosis of hepatic mass, (2) to categorize hepatic masses into benign and malignant lesions to assess the nature of mass, and (3) to study the cytomorphological features of various liver lesions. Materials and Methods: The study was conducted in the department of pathology between January 2014 and April 2016. Ultrasound-guided FNAC was performed on 62 patients with hepatic mass lesions. The patients with hemangioma and hydatid disease of the liver diagnosed by ultrasonography were excluded to prevent undue complications. Results: There were 39 (62.9%) males and 23 (37.09%) females with a mean age of 52.5 years ranging from 10 to 85 years. Samples were adequate in 57 (93.5%) and inadequate in 5 (6.5%). Of 57 adequate samples, five show inflammation, two were benign, and 50 were malignant. Of the inflammatory lesions, pyogenic liver abscesses in 3 (5.26%) and amoebic liver abscesses in 2 (3.51%). Benign lesion included hepatic adenoma in 2 (3.51%). Of the malignant lesions, metastatic adenocarcinomas was in 22 (38.60%), hepatocellular carcinomas was in 10 (17.54%), metastatic deposits of poorly differentiated carcinoma was in 10 (17.54%), metastatic squamous cell carcinoma was in 5 (8.78%), hepatoblastoma was in 2 (3.51%), and cholangiocarcinoma was in 1 (1.75%) case. All the hepatocellular carcinomas in our study occurred in males (4 of 4). Conclusion: Ultrasound-guided FNAC of the liver has a significant role in diagnosis of palpable and non-palpable hepatic mass. It is a rapid, highly accurate, safe, and cost-effective diagnostic method which avoids invasive diagnostic procedures.

Hepatitis C virus infection in a tertiary care hospital in Mumbai, India: Identification of a mixed and novel genotype

Purpose: Hepatitis C virus (HCV) is a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). HCV being a ribonucleic acid virus has considerable sequence variability. Assessment of viral load and genotype is necessary for designing treatment strategies and monitoring for viral resistance among HCV-infected cases. HCC is the most common form of liver cancer, often occurring in people with chronic hepatitis B or C. We undertook this study to observe genotype distribution of the virus in HCV patients from Mumbai. Materials and Methods: Between January 2017 and December 2017, the study was conducted on 120 chronic hepatitis outpatients from a tertiary care hospital, Mumbai, after obtaining ethics approval. All these diagnosed cases of HCV were subjected to molecular diagnosis in a research institute, Mumbai, by real-time polymerase chain reaction-based techniques. Results: Males were more preponderant than females with HCV infection, and the highest number of HCV-infected cases was observed in the age group of 41–50 years. Genotype 3 (n = 70; 58.3%) accounted for the highest number of cases followed by genotypes 1b (n = 29; 24.2%) and then 1a (n = 14; 11.7%). Mixed genotypes 1b + 3 and individual genotype 4 were found in two cases each (1.7%). A total of three samples (2.5%) were found with untypeable genotype. Conclusion: The major HCV genotype observed was 3 which is difficult to treat with direct-acting antivirals, owing to the more rapid progression of liver disease, increased rates of steatosis (non-alcoholic fatty liver disease), a higher risk for cancer (HCC). We believe this study is the first one to address the prevalence of mixed genotypes and untypeable genotype from India.

Dosimetric evaluation and clinical outcome in post-operative patients of carcinoma vulva treated with intensity-modulated radiotherapy.

BACKGROUND: To compare dosimetric parameters of intensity‑modulated radiation therapy (IMRT) with 3D conformal radiotherapy (3DCRT) in post‑operative patients of vulvar cancer and to assess clinical outcome and toxicity with IMRT. MATERIALS AND METHODS: A total of 8 post‑operative patients of vulvar cancer were treated with IMRT. All patients were also planned by 3DCRT for comparison with IMRT. The two plans were compared in terms of conformity index, homogeneity index, tumor control probability (TCP) and normal tissue complication probability (NTCP) for the planning target volume and organs at risk (OAR). RESULTS: IMRT resulted in significantly lesser doses to rectum, bladder, bowel and femoral head as compared with 3DCRT plans. Mean conformity and homogeneity indices were better and within range with IMRT. The TCP was comparable between the two treatment plans and NTCP for rectum, bladder, bowel and femoral head was significantly less with IMRT as compared with 3DCRT. Treatment was well‑tolerated and none of the patients developed Grade 3 or higher toxicity. CONCLUSION: IMRT yielded superior plans with respect to target coverage, homogeneity and conformality while lowering dose to adjacent OAR as compared with 3DCRT. Thus, IMRT offers a reduction in NTCP while maintaining TCP.

Role of neoadjuvant concurrent chemoradiation in locally advanced unresectable pancreatic cancer: A feasibility study at tertiary care centre.

BACKGROUND: Pancreatic cancer has an extremely poor prognosis and prolonged survival is achieved only by resection with macroscopic tumor clearance. There is a strong rationale for a neoadjuvant approach, since a relevant percentage of pancreatic cancer patients present with non‑metastatic but locally advanced disease. The objective of the present study was to assess the effect of neoadjuvant chemoradiation therapy (NACRT) on tumor response, down staging and resection, toxicity and any survival advantage. MATERIALS AND METHODS: A prospective pilot study was carried out from January 2009 to June 2011 in which 15 patients of locally advanced unresectable pancreatic cancer were included. All patients were treated with NACRT protocol with oral Capecitabine and 3D conformal radiotherapy (3DCRT) of 30 Gy in 10 fractions. The patients were restaged 3 to 4 weeks after the completion of NACRT and explored for resection. RESULTS: Out of 15 patients, fourteen were evaluable. Four patients underwent surgery, 5 had partial response but remained unresectable, 2 patients had stable disease and 3 had progressive disease. Most of the toxicities were slight and were in grade 1 to 2. None of the patients developed grade 3 or 4 gastrointestinal or hematological toxicity. The median survival was 15 months for resected patients and 8.6 months for unresected patients, respectively. The 2 year actuarial overall survival was 34.6%. CONCLUSION: All patients with locally unresectable pancreatic cancer should be offered chemoradiation therapy, in hopes of down staging the tumor for possible resection and achieving higher survival.

Anti-Urolithiatic Effect of Cow Urine Ark on Ethylene Glycol-Induced Renal Calculi

Purpose To investigate the anti-urolithiatic effect of cow urine ark (medicinal distilled cow urine) on ethylene glycol (EG) induced renal calculi. Materials and Methods 36 male Wistar rats were randomly divided into 6 equal groups. Group I animals served as vehicle control and received distilled water for 28 days. Group II to VI animals received 1% v/v EG in distilled water for 28 days. Group II served as EG control. Group III and IV (preventive groups) received cow urine ark orally for 28 days in doses of 1 mL/kg and 2 mL/kg, respectively. Group V and VI (treatment groups) received 1 mL/kg and 2 mL/kg cow urine ark orally, respectively from 15th to 28th days. 24-hour urine samples were collected on day 0 and 28. Urine volume and oxalate levels were measured. On day 28, blood was collected for biochemical parameters. Animals were sacrificed and kidneys were harvested, weighed and histopathologically evaluated for calcium oxalate (CaOx) crystals. To calculate the percentage of inhibition of mineralization, simultaneous flow static in-vitro model was used. Results EG significantly increased urine oxalate, serum creatinine, blood urea level; kidney weight and CaOx deposits. Provision of cow urine ark resulted in significantly lower levels of urine oxalate, serum creatinine, blood urea and CaOx depositions as compared to Group II. (p value < 0.05) It also significantly restored kidney weight. (p value < 0.05) Cow urine ark inhibited 40% and 35% crystallization of CaOx and calcium phosphate, respectively. Conclusion Cow urine ark is effective in prevention and treatment of EG induced urolithiasis in Wistar rats. .

Integrated positron emission tomography/computed tomography fusion imaging: an emerging gold standard in lung cancer.

Positron emission tomography (PET) has emerged as an important diagnostic tool in the management of lung cancers. Although PET is sensitive in detection of lung cancer, but FDG (2-deoxy-2- 18 fluro-D-glucose) is not tumor specific and may accumulate in a variety of nonmalignant conditions occasionally giving false positive result. Addition of CT to PET improves specificity foremost, but also sensitivity in tumor imaging. Thus, PET/CT fusion images are a more accurate test than either of its individual components and are probably also better than side-by-side viewing of images from both modalities. PET/CT fusion images are useful in differentiating between malignant and benign disease, fibrosis and recurrence, staging and in changing patient management to more appropriate therapy. With analysis and discussion it appears that PET/ CT fusion images have the potential to dramatically improve our ability to manage the patients with lung cancer and is contributing to our understanding of cancer cell biology and in development of new therapies.

Human neurocysticercosis managed at Nepalganj Medical College, Teaching Hospital, Kohalpur, Nepal.

INTRODUCTION: Neurocysticercosis is the most common parasitic infection of the central nervous system. It is endemic in Central Europe, South Africa, South America and parts of Asia including Nepal. OBJECTIVE: This study has been conducted with the objectives to know the diagnostic criteria for neurocysticercosis and the outcome of treated cases. METHODOLOGY: This retrospective study was done at Nepalganj Medical College, Teaching Hospital, Kohalpur, by reviewing the record of the patients managed as case of neurocysticercosis in one financial year. RESULTS: All patients presented with seizure as a main symptom started in adult life. The mean age was 21 years; 80% were male and 20% female. The diagnosis seemed to be based on clinical presentation, CT scan findings and high index of suspicion. All were put on albendazole, steroids and anticonvulsant drugs; 93% was discharged when fits got controlled, one patient left against medical advice. Follow up record was not available to comment on resolution. CONCLUSION: Neurocysticercosis is difficult to diagnose and has a significant socioeconomic impact because of chronic morbidity, variable mortality, decreased productivity of affected persons, and high cost of medical diagnosis and treatment. It is therefore suggested to develop criteria for diagnosis of neurocysticercosis to be followed at national level.

Situs inversus with dextrocardia with multiple cardiac lesions in adult.

Situs inversus with dextrocardia is the malposition most likely to occur with structurally normal heart; generally discovered on routine chest x-ray or physical examination performed for other reasons. These persons experience normal longevity of life and have similar risk of getting acquired disease as that of other person of same age and sex group. Symptoms related to acquired disorder may also lead to discovery of such cardiac malposition. Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is very low globally but its figure in Nepal is not known. We report an adult of 43 years age having situs inversus with dextrocardia associated with multiple cardiac lesions i.e. ventricular septal defect, aortic regurgitation, mitral regurgitation and tricuspid regurgitation. Key words: Situs Inversus Totalis, Dextrocardia, Congenital Cardiac Anomalies, Nepal.

Keratitis due to Colletotrichum dematium--a case report.

Colletotrichum dematium has been rarely reported from India before. The present case, a farmer, developed peripheral corneal ulcer five days following trauma with plant. At presentation his visual acuity was 6/60 (unaided) and 6/24P with pinhole. Slit lamp and fluorescent stain examination revealed paracentral corneal ulcer with irregular margins, stromal infiltration and multiple epithelial defects. Microbiological examination of corneal samples confirmed the initial diagnosis of fungal corneal ulcer and the fungus was identified as C.dematium. Patient was treated with topical natamycin and ciprofloxacin. Patient left against medical advice and was lost to follow up. This report emphasizes that Colletotrichum keratitis may not be rare. Early diagnosis may help in institution of specific therapy early in the disease.

Isolated tuberculosis of the appendix.

Although appendicular involvement in intestinal tuberculosis has been reported in 1.5-3% cases, the prevalence of isolated tuberculosis of appendix is a comparative rarity. We report a patient with provisional clinical diagnosis of appendicitis, who was found to have tuberculosis of appendix on histopathology, after interval appendicectomy. He had no detectable tubercular focus elsewhere in the body. Post-operatively, he was treated with anti-tubercular regimen with uncomplicated clinical recovery.

Kikuchi Fujimoto disease with unusual features.

An uncommon case of Kikuchi Fujimoto disease with unusual associated serologic-autoimmune abnormalities and aseptic meningitis is reported for its rarity.

Mumps with cerebellar encephalitis.

A 30 years male patient, having typical symptoms of mumps, presented with acute cerebellar ataxia two days after the onset of parotid enlargement. The neurological symptoms showed complete recovery over the subsequent six weeks, suggestive of para-infectious cerebellar demyelination due to mumps.

Effect of postweaning nutritional and environmental restrictions on discrimination learning in albino rats.

Charles Foster littermate albino rats (72) were randomized into 9 independent groups in a 3 x 3 factorial design by varying nutrition and environment each at three levels: normal nutrition, 25% nutritional restriction and 50% nutritional restriction; normal environment, 3-week environmental restriction and 6-week environmental restriction. The nutritional and environmental restrictions were imposed from the 30th day of life for 6 weeks. The animals were subsequently tested for black/white original learning followed by reversal discrimination learning in a T-maze. The results indicated significant main effects for nutrition and environment on indices of learning ability. However, the nutrition x environment interaction was not significant. Post hoc analysis revealed that moderate and severe nutritional restriction as well as long-term environmental restriction caused significant discrimination learning deficits. Short-term environmental restriction failed to produce significant effect on learning behaviour. The results are discussed in context of environmental stress effects, altered brain mechanisms and psychological changes such as increased drive level and emotionality of the animal.

Body mass index of tannery workers in Kanpur, India.

During two cross sectional surveys in 1988 and 1994 the body mass index among tannery workers in Kanpur, India and its association with exposure to chemicals, dust and awkward ergonomic conditions, socio-economic and health status were studied. Fifty six per cent of the workers had in 1988 a BMI of less than 18.50, the cut-off value for malnutrition. In 1994 the proportion of malnourished workers had decreased to 41 per cent, being statistically significant lower than in 1988. Workers with a high exposure to lifting weights of more than 20 kg had significantly lower BMI than workers without this exposure. No other differences in mean BMI were found between workers without exposure to chemicals, dust and other awkward ergonomic conditions and workers with high or very high exposures, nor did the mean BMI of workers with occupational related conditions such as dermatitis, work related respiratory symptoms and low back pain differ from those without these conditions. There was no association between mean BMI and industrial modifications. In the 1994 survey workers who took sick leave in the year prior to the survey, workers of small/medium sized tanneries and workers without an ESI card had significantly lower BMI than workers without sick leave, workers of large tanneries and workers with an ESI card. Mean BMI of labourers with a monthly income of less than Rs 550 was significantly lower than that of tannery staff not engaged in leather work in this income group. No association was found between mean BMI and smoking, use of alcohol, educational level and income. The nutritional status of labourers in developing countries deserves more attention within the field of occupational health and safety.

Cytogenetic studies in ataxia telangiectasia & their use in prenatal diagnosis.

Cytogenetic studies were carried out in obligate ataxia telangiectasia (AT) heterozygotes, AT homozygotes and control subjects. Rate of chromosomal aberrations and the frequency of micronuclei were examined before and after radiation (100 rads). Significant differences in the rate of chromosomal aberrations and micronuclei were observed among heterozygotes, homozygotes and controls. The same methods were then applied for prenatal diagnosis of AT using amniotic cell culture in two families.