Leiomyoma of the palatine tonsil - report of a rare and unusual tumor at this site

A leiomyoma is a remarkably rare cause of a benign, one-side tonsillar enlargement. The diagnosis is essentially histologic and will not normally be suspected clinically. Immunohistochemistry is needed for substantiation of the morphology and confirmation. We submit this illustrative case report.

Assessing Success Of Vaginal Birth After Cesarean By FLAMM Model In A Retrospective Observational Design

Background: After year 2000 cesareanrates have increased from 15% to 30-50% worldwide. Practice of Trial of labor after cesarean has decreased from last two decades of 20thcentury. Predictors of vaginal birth after cesarean are not uniform and not suitable equally for all populations. FLAMM model was tested in this study for its predictability for a successful vaginal birth after previous one cesarean. Material And Methods:For an observational, retrospective study 72 patient files admitted in 2018 in Obstetric Department of C R Gardi Hospital were included which fulfille d criteria of having second pregnancy after cesarean for non recurrent indications like fataldistress, failure of induction of labor, pre-eclampsia, eclampsia, twins and others. Indication of contracted pelvis, rupture uterus, previous classical cesarean section; and multiple pregnancy, medical complications and obstetric complications in this pregnancywere excluded. FLAMM scoreparameters; cervical dilatation, effacement, presence of previous vaginal birth before cesarean, indication of it and age of woman wereused. Observations of successful and failed trial were done by scoring system. Chi square test was used to compare data. Study variables were success of trial in various FLAMM parameters. Result:Higher scores in cervical dilatation (p<0.001), effacement (p<0.001) and prior vaginal delivery (p=0.03) were significantly associated with a successful outcome. Higher theaggregate FLAMM score, higher were chances of successful trial. A non-recurrent indication other than non-progress of labor for previous cesarean had no statistical association with success of trial. Aggregate score of 6 and more has 100 % predictability for a successful vaginal birth. Conclusion:Prediction by FLAMM model resulted in 62. 5%successful trial. FLAMM model maybe used for near to accurate prediction of successful trial of labor after cesarean.

A comparative study of PSI and Curb-65 scoring systems in predicting ICU admissions and mortality in cases of community-acquired pneumonia

Background:Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite advanced diagnostic modalities and treatment options, CAP is the fourth leading cause of death in developing countries.Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia. Aim: To compare the efficacy of PSI and CURB 65 scoring systems inprognosticating the ICU admission and outcome in cases of CAP. Methodology: This wasan observational study conducted at a tertiary care hospital in westernMaharashtra.A hundred patients of CAP fulfilling the inclusion criteria were enrolled in the study, classified as per CURB 65 and PSI system and their outcome compared. Result: The study subjects comprised of 100 patients (64 men and 36 women) of CAP. Twenty-four patients needed ICU admission.In both PSI and CURB-65 risk scoring systems, the need for intensive care unit (ICU) admission and mortality rates increased progressively with increasing scores.PSI class ≥IV and CURB 65 ≥III had 77.52% and 40.24% sensitivity and 88.46% and 69.48% specificity respectively in predicting ICU admissions. The PSI class ≥IV had more sensitivity and specificity in predicting ICU admission than CURB-65.CURB 65 class III and IV had sensitivity86.59% and 89.64% and specificity 89.64% and 97.54% respectivelyin predicting mortality, while PSI class IV and Vhadsensitivity68.92% and 72.58% and specificity 24.74% and 54.86% respectively. CURB 65 had more sensitivity and specificity than PSI in predicting mortality. Conclusion: The PSI is better in predicting the need for ICU admission and CURB 65 is a better predictor of mortality in cases of community-acquired pneumonia.

Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma

Background: The treatment of esophageal carcinoma may demand multiple approaches including combination of radiotherapy and chemotherapy, particularly cases which are considered unresectable, such as upper third esophageal cancers, locally advanced middle and lower third cancers. Methods: This was a prospective, randomized, open-label, single-center study conducted between December 2014 and July 2016. Patients of either sex aged more than 18 years with the confirmed diagnosis of previously untreated advanced esophageal carcinoma were included in the study. Eligible patients were randomized to receive one of the treatments (chemo-radiotherapy [cisplatin] or radiotherapy alone). Response criteria included dysphasia free survival (DySF), disease free survival (DFS), and overall survival (OS). Tolerability was also assessed. Results: A total of 31 patients (chemo-radiotherapy, n=13; radiotherapy alone, n=18) were enrolled in this study. At one year, the probability of remaining dysphagia free was 40% and 20%, respectively for chemo-radiotherapy and radiotherapy alone groups; and the probability of OS was 64% versus 21%, respectively. The median DFS was 12 months and 5 months for chemo-radiotherapy and radiotherapy alone group, respectively. There were no significant differences in both the groups in EBRT, total treatment duration and duration of EBRT. No patient reported thrombocytopenia or nephrotoxicity. Conclusions: Concurrent chemo-radiotherapy with cisplatin can improve dysphasia and OS in patients with esophageal carcinoma.

Case report- a case of Creutzfeldt-Jakob disease

Creutzfeldt-Jakob Disease (CJD) is a rare invariably fatal neurodegenerative disease believed to be caused by an abnormal isoform of cellular infectious glycoprotein called prion protein. Though it is arare disease; yet it is the most common among prion diseases. Clinical presentation consists of rapidly progressive loss of memory, cognitive & visual disturbance, lack of coordination, myoclonus, cerebellar, pyramidal and extra pyramidal signs, akineticmutism & with progression of disease deterioration in higher mental functions become more pronounced. Periodic sharp triphasic wave complexes on EEG, high signal abnormalities in caudate nucleus and putamen on diffusion weighted (DW) or FLAIR MRI of Brain and positive 14-3-3 protein in CSF substantiate the diagnosis of CJD but definitive diagnosis is established by brain biopsy or autopsy materials. We report a case of 58-year old female patient who was admitted with complaints of rapidly progressive dementia, cognitive disturbance, blurring of vision and myoclonic jerks. Initial MRI brain and CSF findings were normal. Differential diagnoses that can present with rapidly progressive dementia and thereby mimic sporadic Creutzfeldt-Jakob disease were considered after review of literature. In EEG triphasic wave complexes were seen, repeat DWMRI after two weeks showed bilateral hyper-intensities in basal ganglia involving caudate nucleus and putamen, suggesting a diagnosis of probable CJD on the basis of center for disease control and prevention (CDC) criteria. The case is reported because of its rarity and also to emphasise that patients with rapidly progressive dementia, associated visual and cognitive disturbances and myoclonus should be investigated with DW MRI, EEG&CSF for diagnosis of CJD.

A case of lateral medullary syndrome with unilateral selective thermoanaesthesia

A 42-year-old female was admitted to tertiary care teaching hospital with history of headache, vertigo, difficulty in swallowing both liquids and solids, vomiting, gait ataxia, drooping of left eyelid, inability to feel hot and cold on right side of body and diplopia of forty-fivedays’ duration. Clinical examination and neuroimaging were suggestive a posterior circulation stroke, with lateral medullary syndrome.The patient had selective thermoanaesthesia on the right side, including the face, which is an atypical finding, given the clinical setting.

A Clinical Study on Correlation of Non-Invasive Diagnostic Tests in Evaluation and Management of Patients with Symptomatic Benign Prostatic Hyperplasia

Introduction: The gold standard for diagnosing bladderoutlet obstruction is pressure flow study but it is associatedwith side effects of high cost, invasiveness, infection, limitedavailability. So non invasive diagnostic tests becomes a goodoption. The diagnostic accuracy of these non invasive tests,however, remains uncertain. So this study was conductedto know the role of non invasive diagnostic tests likeInternational prostate symptom score (IPSS), Uroflowmetry(UFR), prostate volume, bladder wall thickness, post voidresidual urine in symptomatic patients with BPH in theirevaluation and in the planning of management.Material and methods: The present study included 108 malepatients above 50 years suffering from symptomatic BPH whoattended urology OPD at SVIMS, Tirupati. IPSS, Urinaryflow rates, bladder wall thickness, prostate volume, post voidresidual urine and urodynamic study have been recorded inthese patients at the time of enrollment into study.Results: One hundred and eight men between 50 – 79 years ofage with mean age of 62.4 years participated in this study. Allthe patients were divided into two groups as either obstructedor un obstructed based on Abraham – Griffith numbercalculated from the urodynamic study. Bladder wall thickness,Q max, Post void residual urine and prostate volume allhad statistically significant values between obstructed andun obstructed patients. However, there was no statisticalsignificant differences between age, IPSS in both the groupsConclusion: This study shows that in a subset of patientswith BPH with predefined inclusion and exclusion criteria,it should be possible to define obstruction with simple noninvasive parameters, without using invasive pressure flowstudy

Adiponectin correlates with obesity: A study of 159 childhood acute leukemia survivors from India.

BACKGROUND: Acute lymphoblastic leukemia survivors are predisposed to obesity. However, the exact underlying mechanisms are not known. AIMS: The study was done to assess the role of biomarkers of obesity in acute leukemia survivors. SETTINGS AND DESIGNS: This is a cross‑sectional study conducted at All India Institute of Medical Sciences in survivors of acute leukemia who had completed treatment at least 1 year before enrollment in this study. MATERIALS AND METHODS: Obesity was studied by determining the body mass index. Potential biomarkers were studied by assessing serum leptin, resistin, and adiponectin by enzyme‑linked immunosorbant assay, and the results were compared in obese versus nonobese survivors. STATISTICAL ANALYSIS: Descriptive analysis for baseline demographic factors and Student’s t‑test for comparing the mean levels of biomarkers among the obese and nonobese survivors. RESULTS: One hundred and fifty‑nine acute leukemia patients were enrolled in this study with a median follow‑up of 36.8 months. The median age was 10 (range: 3–18) years, and 123 (77.3%) patients were males. The overall prevalence of overweight/obesity was 26.4%, and this was similar in acute myeloid leukemia and acute lymphoblastic leukemia sub‑groups (26.2% vs. 27.3%, P = 0.9). Mean serum leptin and resistin were similar in obese and nonobese leukemia survivors (3.7 vs. 2.85 pg/mL, P = 0.064; 8.01 vs. 9.33 ng/mL, P = 0.36). However, mean serum adiponectin was significantly lower in obese leukemia survivors (7.97 vs. 11.5 μg/mL, P = 0.023). CONCLUSIONS: Obese leukemic survivors had lower serum adiponectin levels than nonobese survivors. However, serum resistin and leptin levels were similar in the two groups.

Study of Antioxidant Enzymes, MDA and Lipid Profile in Cerebral Malaria.

Cerebral malaria (CM) is the most important complication of falciparum malaria. However, its pathophysiology is not understood. Malaria infection is accompanied by increased production of reactive oxygen species (ROS) and the malaria parasites are sensitive to oxidative damage. So, we conducted a case-control study to estimate antioxidant activity, lipid peroxidation in 36 patients with CM. In present study, catalase (CAT), reduced glutathione (GSH) and lipid peroxidation product malondialdehyde (MDA) were increased significantly and superoxide dismutase (SOD) was decreased significantly in CM patients at the time of admission with respect to control group. After treatment, SOD activity was increased and MDA level was decreased; rest of the parameters did not show any significant change. So, the antioxidant enzyme has a prognostic role in CM.

jefA (Rv2459), a drug efflux gene in Mycobacterium tuberculosis confers resistance to isoniazid & ethambutol.

Background & objectives: Drug efflux pumps have been contributing factor(s) in the development of multidrug resistance in various clinically relevant bacteria. During efflux pump gene expression studies on mycobacteria, we have found a previously uncharacterized open reading frame (ORF) Rv2459 to be overexpressed in drug stressed conditions. The objective of the present study was to investigate the role of this ORF as a drug efflux pump, which might add new information in our understanding about the alternative mechanisms of drug resistance in mycobacteria. Methods: The open reading frame Rv2459 of Mycobacterium tuberculosis encoding a probable drug efflux protein has been cloned using pSD5 E.coli-Mycobacterium shuttle vector and overexpressed in M. tuberculosis H37Rv. This ORF was named as jefA. Overexpression of this gene in clones has been verified by real-time reverse transcription PCR. Minimum inhibitory concentrations (MICs) of recombinant as well as non-recombinant clones were determined by resazurin microtitre assay plate method (REMA) with and without efflux pump inhibitors carbonyl cyanide m-chlorophenylhydrazone (CCCP) and verapamil. Results: In recombinant strains of M. tuberculosis, the overexpression of this gene led to an increase in MIC of anti-tubercular drugs isoniazid and ethambutol when tested by REMA. In the presence of CCCP and verapamil, the recombinant strains showed decrease in MIC for these drugs. Bioinformatic analysis has shown a close relation of JefA protein with drug efflux pumps of other clinically relevant bacteria. In homology derived structure prepared from nearest available model, it was observed that amino acids forming TMH 1, 8 and 11 participated in ethambutol specificity and those forming TMH 2, 7 and 10 participated in isoniazid specificity in JefA. Interpretation & conclusion: The increased transcription of jefA leads to increased resistance to ethambutol and isoniazid in M. tuberculosis via efflux pump like mechanism and contributes in the development of resistance to these drugs. JefA amino acid sequence is well conserved among clinically important bacterial genera, which further provides evidence of being a potent drug efflux pump. The involvement in drug resistance and very little homology with any of the human proteins makes JefA important to be included in the list of potential drug targets.

Study of dihydropteroate synthase (DHPS) gene mutations among isolates of Pneumocystis jiroveci.

BACKGROUND & OBJECTIVES: Pneumocystis jiroveci (also known as P. carinii) causes fatal pneumonia in patients with AIDS and other immunocompromised patients. Co-trimoxazole (trimethoprim + sulphamethoxazole, TMP-SMZ) is the drug of choice for treatment and prophylaxis. Widespread use of sulpha medication has raised the possible selection of resistant P. jiroveci strains worldwide. Non-synonymous polymorphisms associated with sulpha resistance have been observed in P. jiroveci dihydropteroate synthase (DHPS) gene at codons 55 and 57. In view of this, we investigated mutation at DHPS locus amongst P. jiroveci isolates obtained at a tertiary care hospital in north India. METHODS: Microscopic examination of P. jiroveci in 69 clinical samples obtained from patients suspected to have P. carinii pneumonia (PCP), was performed by Grocott's Gomori methenamine silver and direct fluorescent antibody staining. Molecular studies were carried out by polymerase chain reaction (PCR) using major surface glycoprotein (MSG) as the target gene. Investigations for DHPS mutations were carried at specific 55th and 57th codon using PCR-RFLP (restriction fragment length polymorphism) assay. RESULTS: Microscopic examination detected P. jiroveci in four cases and MSG gene was amplified in five cases. Further, amplification of DHPS gene was successful in four of the five cases positive by MSG gene PCR. No point mutation was observed and all four isolates presented wild-type sequences at DHPS gene by RFLP analysis. INTERPRETATION & CONCLUSION: Although our findings suggest that in Indian subpopulation, point mutations in DHPS gene of P. jiroveci are not as common as in other parts of the developed world, further studies are needed.

Nutrient dynamics and decomposition rates during composting of sulphitation pressmud by different methods.

Decomposition rates and nutrient contents of sulphitation pressmud (SPM), either alone or by mixing with cow dung and rice straw, under the aerobic (heap and NADEP), anaerobic (pit) and vermicomposting methods were compared. Loss in Organic C and C/N ratios of the decomposing materials indicated the heap and NADEP methods faster for the composting of SPM alone and SPM + cow dung and vermicomposting method for SPM + rice straw registering significant reductions in Organic C ranging from 45.0 to 61.0% from the respective decomposing materials at termination time (119 days). The heap and NADEP methods recorded C/N ratio of SPM alone as low as 11 and 12 and SPM + cow dung as 12.0 and 13.9 at termination stage. Vermicomposting method brought the C/N ratio of SPM + rice straw to 16.4 as compared to 18.6 to 29.8 with the other methods. Irrespective of the composting methods, CO2 evolution from the decomposing materials was higher in early period (up to 28 days). Among methods, NADEP and heap methods recorded more CO2 evolution in early period while vermicomposting method showed more CO2 evolution at the later intervals in comparison to the other methods. Nutrient content in the decomposing materials at different intervals depended on their initial contents. Total N in the composts were statistically comparable, however, the composts of SPM alone recorded relatively more N than SPM + cow dung and SPM + rice-straw prepared by the respective methods. Total P and K contents of the composts increased with time irrespective of the composting methods. Composts of SPM alone recorded significantly more total P than SPM + cow dung and SPM + rice straw at 62, 91 and 119 days while SPM + rice straw recorded more total K than the composts of other materials. Total P in the composts did not differ with the composting methods, but total K in composts of SPM alone was relatively more with heap and NADEP methods, in SPM + cow dung with pit method and in SPM + rice straw by vermicomposting method. Total S in the composts decreased with time and both the aerobic methods showed more reductions than pit and vermicomposting methods.

Expression of delta1-pyrroline-5-carboxylate synthetase gene during drought in rice (Oryza sativa L.).

The 45-days-old seedlings of drought resistant (N-22, CR143-2-2) and susceptible rice (Oryza sativa L.) genotypes (Panidhan, Pusa-169) were subjected to osmotic stress in PEG-6000 solution of -10 and -16 bar and the relative water content (RWC), proline content, and pyrroline-5-carboxylate synthetase (P5CS) activity and its P5CS expression were studied. A gradual decrease in RWC was observed in tolerant genotypes, whereas the decrease was drastic in susceptible ones. Proline content and P5CS activity increased both in susceptible and tolerant genotypes; the increase was higher in tolerant genotypes. Higher proline levels in tolerant genotypes were due to increased P5CS activity. The EcoRI, BamHI and XbaI restricted DNA of N-22 and Panidhan genotypes were hybridized with Arabidopsis P5CS sequence and a single band (approx 2.4 kb) was observed, however, P5CS expression was more in N-22 as compared to Panidhan.

Utilization of composted sugar industry waste (pressmud) to improve properties of sodic soil for rice cultivation.

Sulphitation pressmud (SPM) and its composts were prepared by heap, pit, NADEP and vermicomposting methods and their effects were compared with soil properties and growth, yield and nutrient uptake by rice in a sodic soil under pot conditions. Application of 15 t ha(-1) SPM and its different composts significantly increased the plant height and dry matter accumulation at different intervals, grain and straw yields and N, P and K uptake by the crop over the control. NADEP compost of SPM alone recorded the maximum and significant plant height by 8.5 to 19.3% and plant dry matter by 14.6 to 32.8% over the raw SPM at different intervals. NADEP composts of SPM alone and SPM + rice straw were also found to be superior than raw SPM by recording 34.8 and 27.8% more grain yield respectively. The SPM composts prepared by NADEP and SPM by vermicomposting methods significantly accumulated higher N and K in rice grains and straw, while NADEP compost of SPM and SPM + rice straw recorded more P in grains and straw than raw SPM. Application of SPM and its composts reduced the pH, EC and bulk density of the soil after rice harvesting, though the reductions were not significant in comparison to the control. However, these treatments increased the soil organic C by 33.33 to 69.0%, available N by 41.4 to 74.8%, available P by 47.1 to 97.8%, available K by 11.8 to 59.2% and available S by 10.3 to 90.7% over the control. NADEP composts, in general, were found to be superior than the raw SPM and other composts in residual soil nutrient content after rice crop.

Tuberculous osteitis of clivus.

Tuberculous osteitis of clivus is rare. Its diagnosis is difficult because of the rarity of the site and the non-specific nature of the disease. Management consists of confirmation of diagnosis by biopsy and chemotherapy with anti-tubercular drugs. Meningitis may complicate the clinical course, increase morbidity and mortality.

Respiratory failure in acute intermittent porphyria.

We report two patients of acute intermittent porphyria (AIP) who presented with acute respiratory failure. Only one such previous report could be found. Occasionally, neuropathy may be the presenting feature in AIP which may progress to respiratory embarrassment. The cause of this neuropathy has been hypothesized to be direct neurotoxicity of delta-ALA by interaction with GABA receptor, altered tryptophan metabolism and may be heme depletion in nerve cells.

Amyotrophic lateral sclerosis associated with pregnancy.

Amyotrophic lateral sclerosis (ALS) is the most common, progressive motor neurone disease but is rare in the obstetric population. Only 4 cases have been described in the English literature since 1975. We describe a 29 year old woman who presented with ataxia, lower limb weakness and dysarthria 4 weeks after the birth of her first child. The symptoms had onset during the pregnancy but had not been considered remarkable. There were clinical features of upper and lower motor neurone involvement without any sensory loss. MRI of brain and spine was normal. CSF analysis was negative. EMG studies confirmed the presence of widespread anterior horn cell dysfunction compatible with ALS. The patient was commenced on Riluzole and has progressed clinically, at 12 months post diagnosis.

Analysis of the activity of promoters from two photosynthesis-related genes psaF and petH of spinach in a monocot plant, rice.

The subunit III of photosystem I and ferredoxin-NADP(+)-oxidoreductase are encoded by nuclear genes, namely psaF and petH. The activity of their promoters from spinach has been evaluated in transgenic tobacco earlier. Evaluation of the activity of these Dicotyledoneae-specific promoters has been carried out in a monocot system (i.e. rice) by transient gene expression system, based on electroporation-mediated gene delivery into protoplasts from leaves and roots. It has been found that various promoter deletions show higher activity in leaf protoplasts and elements for quantitative response are widely distributed. Transgenic rice has also been produced with a petH promoter and gus reporter gene construct. Although petH promoter is a weak promoter in comparison to the 35S promoter, it expresses well in green tissues and could be useful for plant genetic engineering.