“Endolymphatic sac tumour”: A case report with review of literature

Endolymphatic sac tumour (ELST) is a non-metastasizing low grade adenocarcinoma of endolymphatic sac origin. It is also known as Heffner tumour, low grade adenocarcinoma of endolymphatic sac origin and aggressive papillary middle ear tumour. These tumours are closely associated with Von Hippel Lindau (VHL) disease. Here we report a case of Endolymphatic sac tumour in a 63 yr old lady who presented with left sided facial palsy. Since the tumour was highly vascular and required preoperative embolization, initial clinicoradiological diagnosis was Jugulotymphanic paraganglioma. Histopathology showed features of Endolymphatic sac tumour, which was confirmed by immunohistochemistry. Since this tumour is locally aggressive low grade adenocarcinoma, the diagnosis is difficult in advanced cases where there is erosion of petrous temporal bone or the lesion shows extension into cerebellopontine angle as in our case. Since the association of this tumour with VHL disease is well established, it is important to screen all the patients of VHL disease for this lesion and also all the patients of ELST should be screened for other lesions of VHL disease to aid in early diagnosis and treatment. The case is presented here for its rarity and difficulty in initial diagnosis.

Evaluation of serum calcium level in total thyroidectomy patients

Background: Thyroidectomy remains to be one of the most common surgeries done and has been associated with few specific complications. One major complication of thyroidectomy is hypocalcemia, which often occurs as a result of inadvertent intra-operative injury to parathyroid glands. Transient hypocalcaemia, which is usually noticed after surgery, resolves well most of the times as it respond to replacement therapy in few days. Aim of the study: To study the incidence of transient hypocalcemia occurring in patients undergoing total thyroidectomy Materials and methods: The methods for the study included screening of patients who presented with thyroid swelling alone or along with pain, hoarseness of voice and dysphagia symptoms. Such patients were studied in detail clinically and investigated as per proforma detailed below. Hematologic and biochemical investigations were done. All patients were subjected to ultrasonographic evaluation and thyroid function tests initially. Following which they had undergone a fine needle aspiration biopsy for histological diagnosis. Patients who were suspected to have malignancy were made to undergo other imaging modalities as CT. Results: 28% of cases developed hypocalcaemia by 6 hours while 24% of cases had hypocalcemia after 72 hours. Post-operatively only 5 patients had developed symptoms of hypoparathyroidism. These were found to have reduced calcium levels at both 6hrs and 72 hours of surgery and hypocalcemia had resolved in 5 patients by 72 hours who had drop in 6 hours post-operatively. Conclusion: The maximum incidence of clinically symptomatic hypocalcemia was found in the age group of more than 35 to 65 and those cases had reduced serum calcium levels measured at both 6 hours and 72 hours.

A comprehensive study of fistula in ano

Background: A fistula-in-ano is an abnormal hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Treatment of fistula-in-ano remains challenging. Surgery is the treatment of choice, with the goals of draining infection, eradicating the fistulous tract, and avoiding persistent or recurrent disease. Aim: This study was intended to investigate the factors determining the course of fistula in ano and its recurrence of patients with fistula in ano came to Govt. Stanley Hospital for 1 year. Materials and methods: 45 patients were selected who were diagnosed as fistula in ano admitted in Govt. Stanley Hospital during June 2015 to May 2016. The anatomy and type of fistula was detected by MRI. Patients underwent definitive treatment. Data regarding the objectives of the study were collected and outcomes of the treatment evaluated by following up the patient for 6 months. Results: Majority of patients (82%) belonged to 31 -60 years of age. Male: Female ratio was 4:1. Most of the fistulas were low anal 41 (91%). About 34 (76%) of external openings were posterior. Fistulectomy was performed in 31 cases, fistulotomy for 10 cases, seton for 4 cases and the operated wound healed in a range of 2 weeks to 8 weeks. Delayed healing was associated with complex fistulas, intersphincteric and transphincteric fistula takes longer time to heal about 4 to 5 weeks (P = 0.007). Fistula of tubercular etiology took minimum 3 weeks to heal (P =0.047). 13 % of cases showed recurrence. Transphincteric fistulas had recurrence rate of 33%. Fistulas with lateral openings had recurrence rate of 67%. Conclusion: Fistulectomy is the commonest and best procedure to get rid of the infective pathology. Fistula in ano has a well recognised incidence of recurrence after surgical treatment

Prevalence of biofilm-producing Staphylococcus epidermidis in the healthy skin of individuals in Tamil Nadu, India.

Purpose: Staphylococcus epidermidis is a major commensal bacteria. Various strains of S. epidermidis are capable of forming biofilms by attaching to several surfaces. Biofilm-forming ability of this organism is found to be associated with many hospital-acquired infections and can even impair wound healing. S. epidermidis strains producing polysaccharide-biofilms possess the intercellular adhesion (ica) operon while strains forming the protein adhesion-mediated biofilms possess the accumulation associated protein (aap) gene. We screened for biofilm-forming S. epidermidis in the skin of healthy individuals in Tamil Nadu in order to determine the risk of acquiring S. epidermidis infections in hospital settings. Materials and Methods: Skin swabs were taken from seventy two subjects residing in Chennai with healthy skin who showed no visible signs of skin lesions or allergies. S. epidermidis was isolated from 58 samples out of the 72 collected. The presence of ica operon in S. epidermidis isolates was determined by PCR and biofilm production was examined using quantitative tissue culture plate assay. Results: Majority of the samples (47/72; 65.3%) showed pure S. epidermidis growth, (14/72; 19.4%) showed pure Staphylococcus aureus growth and the remainder (11/72; 15.3%) showed mixed growth. Biofilm-forming S. epidermidis were found in the majority of samples (53/58; 91.4%) and ica operon was detected in 19 samples out of 58 (32.8%) which is a significantly higher percentage when compared to other studies conducted at different parts of the globe ( P = 0.0003). Conclusion: We inferred that ica operon and biofilm-forming S. epidermidis are common in the healthy skin of individuals in Tamil Nadu. Measures have to be taken to reduce the risk of hospital-acquired S. epidermidis infections.

Ethnomedicinal plants used to cure diarrhoea and dysentery in Pachalur hills of Dindigul district in Tamil Nadu, Southern India.

The people residing in Pachalur hills in Dindigul district of Tamil Nadu mostly depend on the vegetation around them for the prevention as well as the treatment of diseases and ailments. Information on ethnomedicinal uses of plants, their doses and mode of administration have been collected from the local traditional medicine practitioners (Vaithiyar) as well experienced men and women. The paper deals with 54 ethnomedicinal plants of 52 genera belonging to 31 families used by the villagers for diarrhoea and dysentery in Pachalur hills. Most of these plants are commonly available in natural sources and some were obtained from local dealers. Isolation of active principles, pharmacological investigations, and the potent anti–microbial activity should be studied on these medicinally important species. Attention should also be made on proper exploitation and utilization of these medicinal plants.

Chondroectodermal dysplasia (Ellis van Creveld syndrome): a report of three cases with review of literature.

Chondroectodermal dysplasia is a rare mesenchymal - ectodermal dysplasia first described in 1940 by Richard W.B. Ellis and Simon van Creveld now known as Ellis van Creveld syndrome. It is also known as Mesvectodermal dysplasia. Majority of cases were characteristically seen in one particular inbred population from the Amish community of Lancaster County, Pennsylvania, U.S.A. The syndrome manifests with several skeletal anomalies, oral mucosal and dental anomalies, congenital cardiac defects and nail dysplasia. Ellis van Creveld syndrome may be differentiated from other chondrodystrophies like achondroplasia, chondroplasia punctata, asphyxiating thorasic dystrophy and Morquio's syndrome. The presence of oral mucosal and dental alterations like notching of the lower alveolar process, fusion of the upper lip with gingival mucosal margin, occasional presence of neonatal teeth, oligodontia and conical shape of anterior teeth will confirm the diagnosis of Ellis van Creveld syndrome and hence its importance to dentists.

HIV-1 drug resistance among untreated patients in India: Current status.

HAART has dramatically improved survival and quality of life among people living with HIV and AIDS globally. However, drug resistant mutations of HIV are a great challenge to the benefits of HAART. Antiviral resistance can be mediated either by changes in the molecular target of therapy (the primary mechanism observed in HIV-1) or in other viral proteins that indirectly interfere with a drug's activity. Drug resistant mutations easily evolve in the presence of sub-optimal adherence. With the introduction of generic HAART, there has been a steep increase in the number of patients put on HAART in India. It should also be noted that since most patients pay for medications out of their own pockets, interruptions in therapy due to monetary constraints are not uncommon. There is little information on HIV drug resistance in resource constrained settings like India where the predominant circulating HIV-1 sub-type is C. The transmissibility of drug-resistant forms of the virus is also a major concern especially when formulating treatment guidelines. This article reviews published data available on the patterns of HIV-1 drug resistance among treatment naïve in India.

Prevalence of oral lesions in relation to habits: Cross-sectional study in South India.

BACKGROUND: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions. No study has been conducted in this part of Tamilnadu regarding the prevalence of oral lesions in relation to habits. METHODS: A hospital based cross-sectional study was carried out at Ragas Dental College, Chennai. Already existing data of two thousand and seventeen consecutive patients from sub-urban areas of Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months in 2004, who underwent oral examination and interviewer based questionnaire was used. RESULTS: Oral soft tissue lesions were found in 4.1% of the study subjects. The prevalence of leukoplakia, OSF and oral lichen planus was 0.59%, 0.55%, and 0.15% respectively. The prevalence of smoking, drinking alcoholic beverages and chewing was 15.02%, 8.78% and 6.99% respectively. Smoking and chewing were significant predictors of leukoplakia in this population. DISCUSSION: The prevalence of leukoplakia, OSF and oral lichen planus in our study population is similar to those found in other populations. The prevalence of consumption of alcoholic beverages in our study population was higher when compared to the Indian National Sample Survey study. However the prevalence of smoking and chewing was found to be lower. Smokers were more likely to develop smoker's melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.

Evaluation of salivary nitric oxide levels in oral mucosal diseases: A controlled clinical trial.

Lichen planus is a common dermatologic disease to manifest in the oral cavity. Recurrent aphthous ulcers are the most common ulcers of the oral cavity causing discomfort to the patients. These two diseases have different clinical manifestations which require appropriate treatment after correct diagnosis. Though numerous etiological factors have been proposed for these diseases, their true etio-pathogenesis is not yet established and therefore all therapies are palliative and none is effective universally. In light of this, the role of nitric oxide as a mediator in the etio-pathogenesis of these diseases was considered. The present study was undertaken to note the salivary nitric oxide levels as measured through its product nitrite in oral mucosal diseases like lichen planus and recurrent aphthous ulcers and also to ascertain whether salivary nitric oxide level has a role to play as a pathophysiological mediator in these diseases

Facial hemiatrophy--a report of 5 cases.

Progassive hemifacial atrophy is an uncommon and poorly understood degenerative condition characterized by atrophic changes involving the entire one side of the face, head and associated structures and typically appearing during the growth spurts to young adulthood. The condition involves both soft tissues and bone of the affected side. Intraorally the tongue, lips and salivary glands may be involved. Developing teeth may also show incomplete root development deleyed eruption. The couse of the condition is obscure or unknown although speculation has considered trophic malfunction of the cervical sympathetic nervous system, a history of prior trauma has been documented in some cases, although other reports have considered a viral or borrelial infection. It is usualy sporadic but a few familial cases have been reported suggetsting a possible hereditary influence and many investigators believe it to be a localized from of scleroderma. Five cases of Hemifacial Atrophy (Parry Romberg Syndrom) has been reported and discused.

Salmonella meningitis. [case report]

Salmonella infections in children occur mainly as gastroenteritis which is a self limiting disease. Typhoid is the next common form; where antiiotics are warranted. Rarely; localised infections can occur especially in the younger age groups. The patient in this case had salmonella meningitis which is a rare form of salmonella infection with a bad prognosis