Histopathological study of salivary gland tumors: a tertiary care hospital-based study

Introduction: Salivary gland tumors (SGTs) are relatively uncommon and show a wide variety of morphological heterogeneities. The incidence of SGTs is said to be affected by geographical and racial factors. Histopathological diagnosis plays a major role in the diagnosis of these neoplasms. Objectives: This study investigated the incidence of SGTs and histopathological features of various SGTs, aimed at knowing the epidemiological pattern of these tumors and comparing the results of our study with other studies of SGTs in the literature. Materials and Methods: A retrospective study was conducted on SGTs at the Pathology Department of the Government Medical College and Hospital for a period of 5 years. Clinical and demographic data were documented and analyzed concerning histopathologic type. Results: A total of 86 SGTs were identified, 65.12% of which were classified as benign and 34.88% as malignant. Most tumors occurred in the parotid gland (59.14%). Pleomorphic adenoma (PA) was the most common tumor (56.98%), followed by mucoepidermoid carcinoma (MEC) (17.44%). The tumors occurred more often in men (51.16%) than in women (48.84%). Conclusion: SGTs exhibit broad morphological heterogeneity and these tumors are rare. The parotid gland is the most common location, and PA is the most frequent benign tumor. MEC followed by adenoid cystic carcinoma is the most common malignancy of the salivary gland.

A study of histopathological spectrum of central nervous system lesions at a tertiary health care center of South Gujarat, India

Background: Central nervous system lesions can have varied aetiology like infectious, inflammatory and neoplastic. Establishing an accurate aetiology is essential for timely diagnosis and neurosurgical intervention. The annual incidence of tumours of CNS ranges from 10 to 17 per 100,000 people for intracranial tumours and 1 to 2 per 100,000 people for intraspinal tumours; the majority of these are primary tumours, and only one fourth to one half are metastastic. The present study attempts to provide preliminary data on morphological patterns of intracranial lesions and to study clinicopathological spectrum.Methods: The present study was carried out at a tertiary care center from January 2015 to September 2017. A total of 65 cases of CNS lesions were analyzed. In case of CNS tumours reporting were done according to WHO criteria for classification and grading.Results: Out of 65 cases studied, 51 cases (78.46%) were of neoplastic lesions and 14 cases (21.54%) of non-neoplastic lesions. Among 14 cases of non-neoplastic lesions 2 cases were of reactive/cystic lesions, 4 cases  were of infective lesions, and 8 cases were of congenital lesions. In the present study, out of 51 neoplastic cases most common cases were of astrocytoma.Conclusions: The exact histopathological diagnosis of Central Nervous system lesions is essential to predict the prognosis and treatment. Management strategies and prognosis of tumours depends on the correlation of factors like the types, grades of tumours, its location, size and stage of development.

Evaluation of prescription pattern and quality of life in postmenopausal osteoporosis: a cross sectional study

Background: Osteoporosis (OP) is a silently progressing metabolic bone disease that results in loss of mineralized bone and subsequent fractures with minor trauma. Fracture related pain and physical inability to perform activities of daily living can lead to psychological consequences that impair Quality of Life (QoF). However, much less is known about Indian scenario. Hence, our study becomes imperative. Aim of this study to the drug utilization pattern and to analyze Quality of life of postmenopausal women suffering from osteoporosis.Methods: An analytical cross-sectional study was done on 91 post-menopausal osteoporotic women. Drug utilization pattern was evaluated. Pre-validated QUALEFFO-31 questionnaire was administered to each patient to record patient’s perceived QoL. Scores were calculated according to the algorithm. Higher scores indicated poor QoL. The collected data was analyzed with SPSS software (version 23)and p value ?0.05 was considered as statistically significant.Results: The mean age group of presenting patients was 56.2±6.6 years. All the patients received Calcium and vitamin D supplements and non-steroidal anti-inflammatory drugs for pain relief. But only 33% of the patients received any one of the bisphosphonates (BP). For analysis, patients were grouped into Group-1(n=60) who did not and Group-2 (n=31) who did receive a BP. QOL analysis showed that pain domain was affected the most. Also, patients in Group 2 reported worse score in all the domains in comparison to Group 1 (P<0.05). It is likely that BP might need more time to show considerable effect or because it was added only to those patients who already had more complaints and could afford the high cost.Conclusion: BP in spite of being the drug of choice for OP is used less commonly in India. OP causes pain and physical debilitation with detrimental effect on mental health. Longer duration prospective studies are needed to study the association of QoL and use of BP in OP patients.

Oseltamivir induced sinus bradycardia: an area of potential concern

Oseltamivir was approved for the prevention and treatment of influenza in 1999 by the USFDA (US Food and Drug Administration). The use of Oseltamivir is increasing rapidly all over the world, especially after the 2009 “Swine Flu” pandemic. Less data is published as far as the cardiovascular side effects of Oseltamivir are concerned, but it could be associated with some serious cardiovascular side effects. This study presented a case series of 5 cases suspected to be suffering from seasonal influenza H1N1 (“Swine Flu”), who developed sinus bradycardia while they were on Oseltamivir therapy.

Cutaneous manifestations of anti retroviral therapy used for post-exposure prophylaxis

Health care workers are at increased risk of needle stick injuries. Blood borne diseases that could be transmitted by such an injury include HIV, Hepatitis B, HCV and many others. Post exposure prophylaxis should be immediately started within 72 hours and should be continued for 28 days. Currently two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are given along with one NNRTI (Non- Nucleoside reverse Transcriptase Inhibitor) including Efavirenz or Nevirapine. Multiple adverse effects have been reported with all the Anti- Retroviral Therapies including various cutaneous manifestations. A 22-year-old intern doctor studying in tertiary hospital of Ahmedabad had a needle stick injury with a needle contaminated with blood of HIV positive patient. Post Exposure prophylaxis was started within 72 hours consisting of fixed dose regimen of Tenofovir disprodoxil sulphate, Efavirenz and lamivudine. He was started with the drug within 2 hours and was prescribed one drug per day for next 27 days. On 22nd day he started having rash on his body which started on palms and soles. On 23rd day he saw severe facial edema along with edema on lips and rash spreading to other parts of the body. He was diagnosed with Hypersensitivity reaction and angioedema due to ART drug therapy. He was instructed to stop ART medications and was given antihistaminic for the symptoms. Patient's angioedema was relieved in 2-3 days and rash disappeared after 4-5 days. As he had already finished 23 days of therapy he was instructed to discontinue the drugs. No recurrence of rash or angioedema was noted. This case points out the severity of side effects in the normal healthy people taking ART as Post Exposure Prophylaxis. Apart from cutaneous manifestations, angioedema is a very grievous condition which doctors should always have lower threshold for diagnosis. Early diagnosis can prevent further complications. ART drugs have many complications and these patients should have intensive regular monitoring while on treatment. Also, proper education is required for needle cut injuries in health care workers.

Analysis of drug related electrolyte disturbances in emergency medicine department

Background: Electrolytes play an important role in various physiological functions of the body. Electrolyte disturbances are one of the most common problems encountered in critically ill patients. Drugs are also known to cause adverse electrolyte consequences. These drugs could be anti-hypertensive agents, hormones, antipsychotics or steroids. There is paucity of published literature on electrolyte disturbances caused by drugs. The purpose of our study was to evaluate the electrolyte disturbances caused by various drugs in critically ill patients.Methods: Following approval of the Institutional Ethics Committee, data collection was started. Adverse Drug Reactions (ADRs) presenting as an electrolyte disturbance in emergency medicine department or occurring in hospitalized patients in the Intensive care unit (ICU) of our hospital was be collected. ADRs resulting into electrolyte disturbances were identified and analysed in detail for demographic details, types of electrolyte disturbances, seriousness, severity, causality and preventability of ADRs. Fisher's exact test was done to find out the statistical difference between the electrolyte disturbances and different drugs.Results: Total 58 ADRs were reported as an electrolyte disturbance. Mean age of the patients affected was 52.48 years. Highest number of ADRs were observed in the age group of 61 to 70 years. Hypokalemia constituted 32 cases (55.2%) followed by hyponatremia (25.9%), hyperkalemia (6.9%), hypernatremia (6.9%), hypocalcemia (1.7%), hypomagnesemia (1.7%) and hypophosphatemia (1.7%). Insulin was associated with maximum cases of ADRs (27.6%).Conclusions: Electrolyte disturbances constitutes a major chunk of ADRs especially in critically ill patients. The physicians must be well-versed with the dynamics of fluid-electrolyte balance.

Analysis of adverse drug reactions in a tertiary care emergency medicine department: prevalence, preventability and reporting

Background: Adverse drug reactions (ADRs) are negative consequences of drug therapy. ADR results in diminished quality of life, increased physician visits, hospitalizations, and even death. Hence a study was planned to detect and analyze ADR encountered in emergency medicine department.Methods: Data was collected over a period of 1 year after taking approval from IRB (Institutional Review Board) and written informed consent from patients. ADRs presenting as a cause of hospital admission or developed during hospitalization were analyzed.Results: A total of 229 ADRs were analyzed. Majority of ADRs were found in the age group of 40-60 Years. The M: F Ratio was 1.10:1. According to Wills and Brown Classification, majority of the ADRs belonged to Type A. According to Hartwig and Siegel classification of severity of ADRs, 18.78% of the ADRs were severe in nature. According to Schumock and Thornton preventability score, majority (64.19%) of the ADRs were not preventable, whereas 17.03% were definitely preventable. 120 (52.40%) of the ADRs were serious in nature Anti-infective were the most common drug class (30.13%) followed by CVS (24.03%) group of drugs. About (57.64%) ADRs fall in the category of probable/likely. Regarding their Outcome, 44.10% of the ADRs were recovered and 43.23% were recovering.Conclusions: Anti-infective were the most reported drug class to cause ADRs in a tertiary care emergency medicine department. Causality assessment according to WHO-UMC and Naranjo’s causality assessment criteria reported to be Probable. Whereas modified Schumock and Thornton scale preventability scale showed that majority were not preventable.

Amlodipine drug therapeutic failure: a rare case report

Drug Therapeutic failure is a rare condition which is underreported in recent scenario. It is important for the chronic diseases like Hypertension where it could lead to fatal outcome. In our case report elderly male patient taking tablet Amlodipine once daily as antihypertensive medication and had 2 years without any events. Patient came to the emergency department with the complaint of altered sensorium and elevated blood pressure. The mechanism for sudden increase in blood pressure (Decreased Therapeutic Response) in patient with ongoing treatment with amlodipine could be due to sympathetic over activity (e.g. stress), pharmacokinetic variation or counterfeit drug.

Case report of rehabilitation of a subject with post polio syndrome.

Post-Polio Syndrome (PPS) affects polio survivor’s years after the initial polio attack. They report new musculoskeletal symptoms. The purpose of this case report was to determine the effect of a physical therapy intervention on these symptoms in a 53 year old male subject with residual poliomyelitis of left lower limb more than right. Strengthening and aerobic exercises along with lifestyle modification advices were found to be beneficial with respect to all outcome measures taken after 4 and 12 weeks of program, with deterioration in none. This is a first case report documenting benefits of physical therapy following PPS in India. Its findings support the use of exercise in subjects with late effects of poliomyelitis and provide clinically valuable knowledge regarding the treatment efficacy of PPS exercise regimens.

Primary tuberculosis of thyroid gland – a case report.

Tuberculosis of the thyroid gland is very rare disease and isolated involvement of thyroid is even more rare. There are about 200 cases of thyroid gland tuberculosis had been reported worldwide .In India das et al repotred 21 cases thyroid tuberculosis . Almost all cases were secondary to some primary foci elsewhere in the body.The diagnosis is usually very difficult as the clinical presentation has no distinct characterstics. Clinically it may resemble thyroditis or goiter or some malignant etiology. On histo pathological evaluation, presence of necrotizing epitheloid cell granuloma along with langhan giant cells are diagnostic of thyroid tuberculosis. Further demonstration of acid fast bacilli in Z N staining confirms diagnosis.

Results of Posterior Dislocation of Elbow Associated with Bony and Soft Tissue Injury

Elbow trauma is challenging to manage by virtue of its complex articular structure and capsuloligamentous and musculotendinous arrangements. We included 17 patients with elbow dislocation and associated injuries in this study. The study protocol included early elbow reduction and planned fixation of the medial or lateral condyle, coronoid and radial head. The sample was 73% male and 27% female with mean duration follow-up of 8 months, and mean age of 37 years. The mean Mayo Elbow Performance Score was 96 points at conclusion of follow-up, indicating an excellent result in 14 patients. Whenever the radial head was excised, we performed a strong transosseous ligamentous repair of the medial and lateral collateral ligaments. Fixation of the coronoid is essential for elbow stability. A small avulsed fragment can be fixed using an ACL jig. We found this technique very useful. Early planned intervention, stable fixation, and repair provide sufficient stability and enhance functional outcomes.

Diagnosis of acute humoral rejection using immunofluorescence in renal allograft biopsies- one step towards better understanding!

Immunofluorescence (IF) studies are important diagnostic tool in understanding pathogenesis involved in graft injury. Acute humoral rejection (AHR) associated with circulating donor-specific cytotoxic antibodies, is a poor prognosticator for graft survival. It can be diagnosed by staining for C4d antibody using indirect IF technique. C4d staining required to diagnose AHR was made mandatory for reporting renal allograft biopsies in 7th Banff conference. We present 2 years experience of IF studies using C4d polyclonal antibody on 546 renal allograft biopsies belonging to two groups of patients; 464 from group A (tolerance induction protocol) and 82 from group B (controls). We observed C4d focal positivity in 4 (0.9%) biopsies from group A and 4 (4.9%) from group B. We conclude that it is advisable to collect simultaneous core biopsy samples for IF studies and light microscopy to give better definition of allograft injury and thereby support in clinical management.

Moyamoya syndrome in a child with down syndrome.

Secondary Moyamoya disease, also known as Moyamoya syndrome has been rarely associated with Down syndrome. In pediatric patients, the usual presentation is that of ischemic stroke. Here is reported a 4-year-old child with Down syndrome and Moyamoya syndrome who presented with acute-onset right hemiplegia. A high index of suspicion is necessary to make the diagnosis.

Rendu Osler Weber syndrome with bilateral, multiple and diffuse pulmonary Arterio-Venous malformations.

Rendu Osler Weber syndrome is a rare vascular disorder and presents with diagnostic problems because of varied and sometimes misleading clinical presentations and radiological findings. A case report of Rendu Osler Weber syndrome in which the diagnosis was suggested in view of presence of pulmonary Arterio-Venous malformations is described. The article also indicates the role of special imaging modalities like contrast echocardiography and pulmonary angiography in approaching the case.

Soto's syndrome with bilateral hydronephrosis and hydroureters.

Soto's syndrome, also known, as cerebral gigantism is a rare syndrome characterized by large size, large head and early psychomotor delay. Major diagnostic criteria include facial dysmorphisms, advanced bone age and developmental delay. Herein, a case of Soto's syndrome with rare finding of bilateral hydronephrosis and hydroureters is being reported.

Effect of probenecid on serum rifampicin levels.

Serum Rifampicin levels were determined by a microbiological assay using Staphylococcus aureus in 22 cases of leprosy after administering the drug with and without probenecid. Most of the patients showed higher serum rifampicin levels when probenecid was given along with rifampicin. Six patients showed statistically significant increase in the serum levels of the drug when given in the dose of 300 mg along with 1 g of probenecid one hour before breakfast and these levels were comparable with those obtained following administration of 450 mg of rifampicin alone two hours after breakfast. Thus administration of probenecid preceding rifampicin may be employed to reduce cost of drug as well as hepatotoxicity in patients requiring rifampicin for long duration.