Lineage switch of acute myeloid leukemia to T-Cell acute lymphoblastic leukemia – A unique case report

“Lineage switch” is term described when leukemic cells on relapse exhibit a new phenotype, where losses of one lineage defining markers with simultaneous gain of another lineage defining markers occur. Relapse of acute leukemia is although a very common event, lineage switch occurs and reported very rarely in such cases. The pathogenesis involved in this phenomenon remains unclear; however plasticity of hematopoietic progenitor affected by intrinsic and extrinsic environmental cues can be a possible explanation. In most of the cases at the time of relapse conversion of B-acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML) occurs. Here, we presented an unusual case of 10 year old boy with AML switched to T-ALL upon relapse, which is very rare and not well documented till date in literature. The diagnosis was further supported by morphologic, cytochemistry and flowcytometric immunophenotyping (FCM-IPT). Prognosis and survival of such cases remains poor even by the use of standard chemotherapy.

Intra-natal Care Practices in Rural Areas of Gaya District, Bihar

Context: Antenatal care (ANC) effectively reduces infant and maternal mortality rates mainly by promoting institutional deliveries. In view of this, the Government of India introduced Janani Suraksha Yojna (JSY) in 2005 and Janani Shishu Suraksha Karyakram (JSSK) in 2011. Aims: To estimate the proportion of home and institutional deliveries in the district, assess the impact of JSK and JSSY on institutional deliveries, and identify the different intranatal care providers. Settings and Design: This cross-sectional study was conducted in the Gaya district, Bihar. A total of 657 females of the reproductive age group (15-49 years) were included in the study. Methods and Material: Predesigned, pre-tested & semi-structured questionnaire was used to collect information on place of delivery, type of delivery, knowledge regarding JSY and JSSK schemes and source of information Statistical analysis used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: Out of 519 deliveries, 63% were institutional and 37% were home deliveries. About 91 and 11.4% of respondents were aware of JSY and JSSK schemes. There was a significant association between those who opted for institutional delivery and awareness regarding JSY and JSSK services. Conclusion: Despite awareness and running of various government programs, the percentage of institutional deliveries is still less. An increase in institutional deliveries at primary care level through JSY and JSSK will not only decrease the Out of Pocket expenditure of the population but also help build faith in the government health facilities. Most read articles by the same author(s) Mahendra Singh, Surekha Kishore , Bhavan Jain, Sanjeev Kishore, Pradeep Aggarwal, Shikhar K Verma , Prevalence of Diabetes Mellitus and its associated risk factors , Indian Journal of Community Health: Vol. 32 No. 1 (2020) Chandramani Singh, Bijit Biswas, Naveen KG, Haripriya Hari, Sanjay Pandey, Bijaya Nanda Naik, Epidemiological investigation of a food poisoning outbreak: a study among hostel dwelling students and resident doctors of a tertiary healthcare facility of India , Indian Journal of Community Health: Vol. 33 No. 3 (2021) Bhavan Jain, Seema Jain, Harivansh Chopra, Sunil Kumar Garg, Ganesh Singh, Chhaya Mittal, Impact of Sociodemographic factors on prevalence of overweight and obesity among adolescents of urban Meerut , Indian Journal of Community Health: Vol. 30 No. 1 (2018) Raj Shekhar, Ditipriya Bhar, Chandramani Singh, Awareness, Knowledge and Practices of Contraceptive Methods among Married Males of Slums of Phulwarisharif block of Patna District, Bihar , Indian Journal of Community Health: Vol. 31 No. 2 (2019)

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Objective: To evaluate the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods: This was a prospective, randomized, double-blinded placebo-controlled study done over a period of two years. A total of 60 participants undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously for Group K and Inj. Normal Saline 10 mL was given intravenously for Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results: There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N (P value <.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP)) were statistically and clinically not significant in both the intraoperative and postoperative periods between the groups. Conclusion: Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.

Role of BCG and Measles vaccination in protection against COVID-19 infection and severity of the disease: A pilot case-control study

Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to understand the role of vaccination with Bacillus Calmette朑uerin (BCG) and measles administered as part of MMR vaccine on COVID 19. Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used. Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to independently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)]. Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted.

Effectiveness of modified mattress suture closing technique over conventional lower segment caesarean section closing technique

Background: The objective of this study was to compare the thickness of the scar and relative thinning of the uterinewall following conventional LSCS closing technique versus new closing technique (modified mattress Suture) and any additional surgical procedure in each group.Methods: A total of sixty patients undergoing primary caesarean for obstetric indications and who were willing for the study were included. In 30 patients uterus was closed by conventional double layer technique (the first layer is suturing with absorbable suture in a continuous running fashion. After first layer is complete, a second continuous stitch is used to invert the first layer, inverting stitch may be horizontal or vertical using same suturing material) and in 30 patient uterus was closed by new modified mattress technique. In both groups same suture material (vicryl 1-0) was used. Measurement of the thickness of scar site and corresponding posterior wall thickness was done following 6 months of caesarean section.Results: The possible parameters of better technique i.e., the mean scar thickness is more and relative as well as percentage thinning is less with this new technique of uterine closure although statistically not significant. Conclusions: Modified mattress suture technique is a single step procedure and gives the feel of double layer uterine closure. Hence the time taken, material. Used and the cost involved will be less along with excellent hemostasis.

Adverse outcomes in SAR-CoV-2 (COVID-19) and SARS virus related pregnancies with probable vertical transmission

The global severe acute respiratory syndrome-related coronavirus SARS-CoV-2 (COVID-19) pandemic has had an unprecedented impact on all aspects of daily life and healthcare. Information on the infection risks for pregnant women and their offspring have so far been limited to small case series, until a large UK report on 427 SARS-CoV-2 infected pregnant women was published. Previous SARS epidemic experiences were drawn upon. Diagnostic use of real time polymerase chain reaction (RT-PCR) and IgG and IgM antibody tests are fraught with concerns of non-validation and false negative results, as are sampling methodologies. Virtually no information on controls accompany these reports. Infection of the mother and baby has serious implications for obstetric and neonatal care. Information on early and late stage pregnancy infection and the relationship to severity of infection on fetal development is both useful and clearly warranted. An increasing number of reports centre around mildly infected women showing no evidence of fetal infection while a few reports suggesting vertical transmission require further validation. Vertical transmission from mother to baby however small would have profound health implications for obstetric and neonatal care and fetal abnormalities. Some data suggesting intrapartum vertical transmission from mother to baby cannot be dismissed given the lack of controls and limitations of diagnostic viral tests. This analysis covers some key early reports addressing pregnancy outcomes following SARS-CoV-2 infection. (AU)

Awareness, Knowledge and Practices of Contraceptive Methods among Married Males of Slums of Phulwarisharif block of Patna District, Bihar

Background: Even though India was the first country to launch family planning programme, population growth rate of India is still higher. Males are often the dominant decision makers of the family. Many studies regarding contraception has been done on females but the same is lacking on males. Aims & Objectives: The aim was to assess the level of awareness and practices about the contraceptive methods and factors associated with awareness and use among the married males in slums of Phulwarisharif block of Patna. Material & Methods: A cross-sectional study was conducted among 212 married males aged 18 to 60 years over a period of 3 months in slums of Phulwarisharif, Patna. Data were collected by interview of study subjects using predesigned and pretested questionnaire. Descriptive statistics and chi-square test were applied using SPSS software. Results: Among 212 married males 91.5 % have heard of at least one contraceptive method, while only 42.45% have ever used any contraceptive method. The major source of knowledge among 194 aware participants were friends and family members (78.9%). Age, duration of marriage, number of children and position in the family were associated with level of awareness. Conclusion: Despite of high awareness about contraceptives low utilization and limited knowledge was observed among the married male participants.

Molecular approach for ante-mortem diagnosis of rabies in dogs

Background & objectives: The ante-mortem diagnosis of rabies is of great significance in establishing the status of infection in dogs, especially since they are involved in exposure to human beings. The present study was, therefore, undertaken to elucidate the most appropriate secretion/tissue for reliable diagnosis of rabies in 26 living dogs suspected to be rabid. Methods: In the present study 26 dogs suspected to have rabies were included for ante-mortem diagnosis of rabies in clinical samples of skin and saliva by molecular approach viz. heminested reverse-transcriptase polymerase chain reaction (HnRT-PCR). Skin and saliva samples were collected from 13 dogs each. Results: Of the 13 clinically suspected dogs, fluorescent antibody technique (FAT) confirmed rabies in nine cases of dogs. Of these nine true-positive dogs, eight cases could be confirmed by HnRT-PCR from skin. Of the other 13 dogs clinically suspected for rabies, FAT confirmed rabies in 10 cases. Of these 10 true-positive dogs, rabies was detected ante-mortem by HnRT-PCR from the saliva in seven dogs. Thus, rabies was detected from skin with 90 per cent sensitivity, 100 per cent specificity and 92.85 per cent accuracy. With saliva, rabies was detected with a sensitivity of 76.92 per cent, specificity of 100 per cent and accuracy of 62.50 per cent. The positive predictive values were 100 per cent for both skin and saliva samples while negative predictive values were 80 and 50 per cent, respectively. Interpretation & conclusions: Skin biopsy may be more appropriate clinical sample as compared to saliva for ante-mortem diagnosis of rabies in dogs. HnRT-PCR can be employed for molecular diagnosis of rabies from skin in live dogs.

Knowledge, Awareness, and Practices Among Patients with Thyroid Swelling Attending Cytology Clinic in a Medical College, Meerut.

Background: Thyroid disorders are believed to be a common health issue in India, as it is worldwide. However, there is a paucity of data on the knowledge, awareness, and practices (KAP) among these patients. Materials and methods: A crosssectional study was conducted in a medical college of Meerut, Uttar Pradesh. Total 200 patients were evaluated during the period from 2011 to 2012. Results: Total 200 patients with thyroid swelling were evaluated. Sixty percent patients did not know that thyroid is a normal gland in body while 50% did not knew about hyper/hypothyroidism. There are many misconceptions regarding thyroid disorders, such as 79.5% patients thought that hypothyroidism causes excessive weight gain. Conclusion: This study shows that patients with thyroid disorders lack knowledge. Education should take place at all levels and should include doctors and decision makers, health workers, and citizen groups. The results of this study will help the physician to concentrate on these specific issues during their interaction with the patients.

Food and feeding pattern of Channa punctatus in two different habitats at Tarai region of Uttarakhand.

A comparative study was conducted for the food items and feeding pattern of Channa punctatus in pond environment and in reservoir of Tarai region in Uttarakhand state.Observation was made for body length, gut length, food and feeding frequency and qualitative and quantitative analysis of gut content.Both, body length and gut length were in higher side with a ratio of 1:2.1 for the natural fish stock of reservoir. Gut content mainly consists of crustacean, insects, mollusks, small fishes and semi-digested material. There was significant difference for the percent occurrence of the food items (p < 0.01) of natural stock of reservoir and pond reared stock. The study revealed that seasonal variability of natural food items in different habitats and their biological diversity put impacts on the biological needs in terms of food and feeding pattern of the same fish species.

Laparoscopic common bile duct exploration for extraction of a round worm.

A 35 years old lady presented with fever, biliary colic, mild jaundice, indigestion and flatulence. The upper abdominal ultrasonography revealed cholecystitis with sludge and a round worm in the common bile duct. Laparoscopic cholecystectomy and exploration of the bile duct for the removal of round worm was performed. The post-operative period was uneventful and the patient was discharged fit on the 4th post-operative day.

Simultaneous continuous ambulatory peritoneal dialysis catheter implantation and inguinal hernia repair.

Continuous ambulatory peritoneal dialysis is a new modality of treatment for end stage renal disease. Although this procedure is largely underutilised in India, in Manipur this procedure is routinely offered to patients of end stage renal disease. Continuous ambulatory peritoneal dialysis catheter implantation was started in Manipur in May, 2001. Till now continuous ambulatory peritoneal dialysis catheter has been implanted in 116 cases. Out of this 3 patients had associated inguinal hernia. Inguinal hernia is a relative contra-indication for continuous ambulatory peritoneal dialysis. Still the inguinal hernia was repaired in the same sitting with the catheter implantation. The procedure is described along with the outcome.

Clinical Evaluation of an Indigenous Paclitaxel-Eluting Stent in De NovoCoronary Artery Stenosis.

BACKGROUND, Drug-eluting stents have enabled considerable reduction in restenosis in patients subjected to angioplasty. However, in view of high cost of drug-eluting stents, efforts to develop medicated stents at reduced cost using alternative polymers in Indian setting are imperative. Hence a multi-center study was undertaken to evaluate the safety and efficacy of the indigenously developed paclitaxel-eluting RELEASE-T stent. METHODS, The study included 100 patients (male:86, Female:14) who were undergoing angioplasty for various indications at four centres viz. Delhi, Hyderabad, Pune and Warangal. The age range was 29 - 76 years; 37 patients were diabetic. All patients were pre-treated with aspirin 150-325 mg plus clopidogrel 75 mg daily four days before procedure or clopidogrel alone. Aspirin was continued indefinitely. RESULTS, Direct stenting ws done in majority of patients. One patient, in whom stent could not be delivered, received only baloon angioplasty. Sixty-four patients had stenting of left anterior descending artery. The stent diameter ranged from 2.5 to 3.5 mm, and the length, 15 to 20 mm. All patients were followed up at 1,3 and 6 months. There was two deaths: one had subacute thrombosis on both stents, and the other (who was HIV positive) had sudden cardiac death. The 6-month rate of major adverse cardiac events was 4% and target lesion revascularization rate ws 2%. CONCLUSION, This ulti-locational study brings out that the use of indigenously developed paclitaxel-eluting stent is safe and clinically efficacious.

Follicular dendritic cell tumour of tonsil - is it an under-diagnosed entity?

Neoplasms of follicular dendritic cells are uncommon and while majority of them occur in lymph nodes, they are increasingly recognized at varied sites such as abdominal viscera. Tonsil is the most common extra nodal site for occurrence of FDCT in the head and neck region. We describe three cases of follicular dendritic cell tumour occurring in the tonsil.

Study of spermatozoa and their relationship with fertility in men of Arunachal Pradesh.

172 semen samples were collected from a cross section of the infertile population of North-East India, consisting mainly of tribal people and were analysed and evaluated for different parameters. Significant negative correlations were found between sperm count and motility, sperm count and morphology and between motility and abnormal morphology in this series. The percentage of abnormal morphology was very high and prospective study on the aetiology of this factor in these tribal people is warranted.

Study of drug utilization pattern in dental OPD at tertiary care teaching hospital.

Irrational prescribing is a global phenomenon. The objective of the study was to find out the prescribing practices of dental prescribers in a tertiary care teaching hospital with special emphasis on the utilization of antimicrobial agents. A prospective study was conducted in the month of March 2000. A total of 491 prescriptions were collected randomly. Prescribing pattern was analyzed using WHO basic drug indicators. The average number of drugs for prescription was 2.4. 78.8% of all prescriptions contained antimicrobial agents. It was most commonly prescribed (40.37%) group of drugs followed by anti-inflammatory and analgesics (33.8%). Fixed dose combination of ampicillin and cloxacillin was most commonly prescribed antimicrobial agents. Prophylactic use of AMA (78%) was more than therapeutic purpose (21.9%). Prophylactic use of antimicrobial agents was irrational in all the cases as duration for the use of antimicrobial agents was 5.1 +/- 0.5 days. Fixed dose combinations (45%), drugs by brand name (98.5%) were frequently used. Drug prescribed from Essential Drug List was maximum when one drug was prescribed. Results indicate that there is a scope for improving prescribing habits and minimizing the use of antimicrobial agents. This could be facilitated by periodic education to the prescribers.

Role of supravital staining of urine sediment and bright field microscopy in diagnosis of acute renal failure in bedside medicine.

BACKGROUND: An early accurate etiological categorization of acute renal failure (ARF) into acute glomerulonephritis (AGN), acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) is very important in clinical medicine. METHODS: To evaluate the efficacy of a simple, cheap supravital staining method developed in our laboratory, we examined urine of 32 cases of ARF at their initial presentation in oliguric phase, which were later biopsied. The stain consisted of 1% crystal violet and 0.5% safranin in normal saline. The coverslip preparations of coded and stained urine sediments were examined under ordinary bright field microscope (BFM) by two independent observers. RESULTS: The renal biopsy showed 12 cases of AGN, 12 ATN and 8 AIN. The diagnosis could be predicted by supravital staining method in 75% cases with 95% uniformity among two observers with a sensitivity of 85.7% for AGN followed by AIN (80%) and ATN (75%). CONCLUSION: Thus this simple supravital staining technique can be used with ordinary BFM for accurate urine sediment analysis in cases of ARF in bedside medicine.

Prevalence of coronary risk factors in non-insulin dependent (type 2) diabetics.

OBJECTIVES: A cross sectional study was conducted to find the prevalence of coronary risk factors in non-insulin dependent diabetic (NIDDM) patients and to compare and co-relate these risk factors in type II diabetics with and without electrocardiographic and/or symptomatic evidence of coronary heart disease (CHD). METHODS: One hundred sixty-seven consecutive NIDDM patients (77 males, and 90 females) attending the diabetic clinic at Dr. RML Hospital, New Delhi were studied. Only known NIDDM cases, already on treatment and without any history of ketosis or congestive heart failure were included. Coronary risk factors comprising of age, gender, duration and treatment for diabetes, smoking, physical activity, hypertension, truncal obesity, lipids, microalbuminuria (semiquantitative) and glycemic control have been particularly ascertained in all the cases. The data was analysed using 'Epi Info version 6.0'. RESULTS: The mean age of patients was 53.12 year and 8.86 year was the mean duration of diabetes. 28.6% of the diabetic men were found to be currently smoking and/or consuming alcohol, 82% were involved in sedentary physical activity and 20.4% had family history of CHD. Central obesity was observed in 46.7% of the cases; more so in females. 31.74% of cases were hypertensive; more females than males had hypertension (33.8% vs 30%). Poor glycemic control (HbA1c > = 9.5%) was seen in 16.8% of the cases. In about 52.5% of the total group hypertriglyceridemia was noted. Microalbuminuria could be found in 35.93%. CHD was diagnosed in 15.57% of cases in this study. CONCLUSIONS: The present study revealed that high levels of serum cholesterol (p = 0.000004), LDL (p = 0.00003), HbA1c (p = 0.002), microalbuminuria (p = 0.000006) and hypertension (p = 0.00006) are significant associates of CHD in NIDDM (both the sexes). Among the female NIDDM cases, in addition BMI (p = 0.01), Waist-hip ratio (WHR) (p = 0.003) and low HDL level (p = 0.008) are important correlates of CHD. Multiple logistic regression analysis was used to allow for confounding between variables. Microalbuminuria alone entered the 'best' model for CHD prediction. Other risk factors, though significant, provided inadequate models for CHD prediction.

Micronutrient deficiency disorders amongst pregnant women in three urban slum communities of Delhi.

OBJECTIVE: To assess the prevalence of three micronutrient deficiency disorders (MDDs), i.e., iron deficiency, iodine deficiency and vitamin-A deficiency individually and in combination amongst pregnant women. METHODS: A hospital based study was conducted amongst 829 pregnant women of II and III trimester attending antenatal clinic, Rural Health Training Center (RHTC), Najafgarh, New Delhi. Anemia was assessed by the presence of clinical signs and by hemoglobin levels. Iodine deficiency disorders (IDD) were assessed by clinical examination of thyroid gland and by urinary iodine excretion levels. Iodine content of the salt consumed by the pregnant women was also assessed by iodometric titration method. Vitamin A deficiency (VAD) was assessed by the presence of clinical symptoms of nightblindness. Current dietary intake, morbidity conditions on the day of survey and anthropometric measurements of pregnant women were also documented. RESULTS: Prevalence of anemia, IDD and VAD amongst pregnant women was 78.8%, 22.9% and 4.8%, respectively. One per cent of the pregnant women had concomitant presence of all the three MDDs. Pregnant women having combined prevalence of IDD and anemia, IDD and VAD, and VAD and anemia was 15.1%, 0.18% and 2.69%, respecively. Eighty nine per cent of the pregnant women were consuming salt with iodine content of more than 15 ppm which was recommended at household level. Results on dietary intake showed that 18%, 34%, 85% and 57% of the pregnant women were consuming less than 50% of calories, proteins, iron and b-carotene, respectively as compared to their RDA. Forty per cent of the pregnant women were suffering from various morbidity conditions on the day of survey. CONCLUSIONS: The prevalence of micronutrient deficiencies amongst pregnant women of urban slum communities is high.