Primary antiphospholipid syndrome in children: experience from two tertiary centres in South India

Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by the presence of episodes of vascular thrombosis, recurrent fetal loss and other clinical features in the presence of antiphospholipid antibodies. The aim of the study was to analyze the clinical manifestations and immunologic profile of children presenting with APS.Methods: Authors did a retrospective case record study of patients admitted with thrombotic events between September 2013 and August 2018 and identified patients with positive antiphospholipid antibodies. Children who had clinical features of active lupus were not included.Results: The clinical and immunologic profile of 7 pediatric patients presenting with APS over 5 years from 2013 to 2018 were analysed. Symptoms secondary to vascular thrombosis were limb swelling, stroke, gangrene of toes and Budd Chiari syndrome.Conclusions:APS though rare should be considered in the differential diagnosis of children presenting with thrombotic events. They need long term anticoagulants to prevent further episodes.

A Retrospective Study Of Urine Cytology Samples As Per The Paris System

Background: The Paris system (TPS) for reporting urinary cytology was published in 2016 with the goal of standardization of reporting urine cytology. The primary objective of this exercise was early detection of high grade urothelial carcinoma (HGUC). Materials and methods: A retrospective study was done to classify as per TPS, all urine cytology samples received in the period between 01 Jan 2016 to 31 Dec 2016 at a tertiary care hospital. All preserved slides of urine cytology were retrieved from the archives, reviewed by two experienced pathologists (PSM&PSG) and reclassied into various categories as specied by TPS. Biopsy reports of patients, where available, were compared against the cytology reports. Results: A total of 432 stained urine cytology smears (prepared from 200 urine samples) of 72 different patients (56 males and 16 females) were studied. A total of 24 samples were categorized as Category I, 159 as Category II, 07 as Category III, 02 as Category IV and 08 as Category VI. There were no cases in category Vand VII. Conclusion: TPS is an objective tool for reporting urine cytology specimens and is particularly useful in identifying HGUC cases. The detection rate of low grade urothelial carcinoma (LGUC) by this system is low, in keeping with ndings of similar studies.

Evaluation of dermatoglyphic patterns using digital scanner technique in skeletal malocclusion: A descriptive study

Skin is the largest human organ, which performs a dynamic role in life. The ectodermal layers of the skin found on the palm with intricate lines are stable throughout life and have grabbed scientific attention. Any disturbances during their formation might possibly have the likelihood of a person developing malocclusion. Aims and Objectives: The aims of this study were to evaluate and compare the dermatoglyphic pattern with various skeletal malocclusions. Materials and Methods: The study was carried out on 40 outpatients reported with an age group of 18–20 years divided into four groups as follows: Group: I – 10 (Class I occlusion), Group: II – 10 (skeletal Class I malocclusion), Group: III – 10 (skeletal Class II malocclusion), and Group: IV – 10 (skeletal Class III malocclusion). The fingerprints were recorded using scanner exclusively designed for diagnostic purpose of the study. The collected data were analyzed using SPSS statistics software Version 23.0 to find which groups had significant differences. Results and Conclusion: Increased frequency of arch pattern was present in participants with Class I malocclusion, and loop patterns were observed in those with Class I occlusion and Class III malocclusion and whorl patterns in Class II malocclusion with P < 0.05. Dermatoglyphic pattern remains constant throughout life and it can be used as a noninvasive aid in determining the development of malocclusion at a very early age.

A Study on C-Reactive Protein in Metabolic Syndrome

Background:Metabolic syndrone is associated with, obesity,diabates mellitus,dyslipedemia hypertension, and insulin resistance, C-reactive protine, CRP is one of the risk factors for caronary artery disease. It is a sensitive marker for inflammation. Aim: Toassess the CRP in patients with obesity. Methods: In our study we have examined 798 subjects during the year 2016 and 2017. After taking the detailed history physical exmination was done. Blood pressure was recorded twice. Height and weight was caliculated to determine the BMI. Trained para medical persons were involved in this procedure. Blood sampleswas send for CRP, cholesterol, HDL cholesterol and LDC cholesterol, triglycenides, uric acid and fasting blood sugar. Results: Average age of male was 55 years female was 52 years in classI obesity lipid profile and c-reactive proteins are normal lipids and C-reactive protiens are elivated in class III obesity paients. CRP level are increased in 39.5% in class III obese patients. Serum cholestrol and triglycerides also increased in class III obese patients. Conclusion: In our study lipids and C-reactive protiens are increase with class II and class III obese patients

A Study on Lipid Profile in Hypothyroidism in South India

Background:Hypothyroidism is a syndrome characterized by clinical and biochemical manifestations which results from decreased production of thyroid hormones. Aims and Objectives: To Study Lipid Profile of patients with hypothyroidism. Methods: This study conducted in 80 hypothyroidism patients in different areas in Andhra Pradesh Between Jan 2013 to Dec 2015. Hypothyroidism is diagnosed by estimation of T3T4TSH. Serum Cholesterol , serum triglycerides HDL cholesterol and LDL cholesterol were estimated. About 93% of thyroid hormone in thyroxin (T4) and 7% is Triido thyronin (T3). There are 3 deiodinase enyymes (D1 D2 & D3) D1 and D2 are responsible for peripheral conversation of T4 to T3.Results: The maximum incidence of age is between 20-40 years with 65%. The age group is almost same in males and female. Sex incidence is (5:1) males female ratio is 1:5. TSH is more than 12 mu/L in 80 patients The mean serum cholesterol value is more than 245 mg/dl The mean value for serum HDL is 42 mg/dl and LDL is 130 mg/dl . The mean value for serum triglyceride is 250 mg/dl. Among thyroid hormones T3 is between 50 to 70 ng/dl (normal is 95-195 ng/dl) T4 is 2-4 mcg/dl (normal is 5-11 mcg/dl) and TSH is >12 micro units/ml (normal is 0.4 to 4 micro units/ml).The Serum cholesterol is high in 50 patients (60%) 20 patients (25%) has border time and 10 patients (15%) desirable level according to ATPIII guidelines by NCEP. S. triglycerides level was high in 55 patients (70%). Conclusion: Hypothyroidism causes increased total cholesterol increases LDL and increased. triglycerides. This Dyslipidemia cause coronarys artery disease . So the treatment with L- thyroxine is indicated to prevent coronary artery disease.

Problem of fused kidneys – Our observations

Genitourinary tract tops the list of developmental anomalies – 30-40% of malformed individuals. These developmental anomalies comprise a diversity of abnormalities ranging from complete absence to aberrant location

orientation

shape

form

fusion

number and vascular attachments. Amongst these wide range of anomalies

fusion anomalies are not uncommon. Horseshoe kidney is the commonest fusion anomaly which accounts for about 0.25% of the population. Unilateral fused kidney with inferior ectopia is the next most common fusion anomaly with an incidence of 1:1000. The other fusion anomalies are Sigmoid or S – shaped kidney

Lump kidney

L shaped kidney

Disc or doughnut kidney and Unilateral fused kidney with superior ectopia. These fusion anomalies are clinically important because they are malrotated

abnormally placed with anomalous blood supply. They are predisposed to various complications like hydronephrosis

infection

urolithiasis and neoplasm. This is a study of 10 patients who presented with fusion anomalies

in the department of Osmania Hospital

Afzalgunj during the period of 2013-2015. The clinical presentations

modalities of arriving at diagnosis

associated complications and the management are discussed.

A study of primary megaureter Our experience

Amongst the congenital anomalies of the Ureter, Megaureter is one of the commonest, next only to the various types of duplications. Though every dilated and large ureter can be described as Megaureter, Primary obstructive megaureter is the entity wherein the dilated ureter is associated with a short, juxtavesical, narrow, adynamic segment and is not associated with reflux. This is a study of 8 patients who presented with primary obstructive megaureter in the department of urology, Osmania General Hospital, Afzalgunj during 2013-2015. Apart from the clinical presentation of this disorder, the modalities of arriving at the Diagnosis, the associated complications and the management are discussed

Dorsal onlay buccal mucosal graft urethroplasty in inflammatory stricture of urethra – Our experience

Urethral stricture is a common disease with changing etiology and changing practices in management. Management options were grossly determined by cause, site, length of stricture and also by other factors like prior attempts of repair and local genital skin condition. Treatment options vary from dilatation, optical urethrotomy to various types of urethroplasty. Substitution urtethroplasty is done using various types of graft materials like skin, buccal mucosa, bladder mucosa or colonic mucosa. Over the past 10-15 years buccal mucosa grafts have been increasingly used in the urethral reconstruction. Barbagli technique (Dorsal onlay technique) has the advantages of no sacculation which is seen with ventral onlay grafts, good neovascularity and less shrinkage (10%) rate. We have presented the results and complications of doral onlay buccal mucosa graft urethroplasty (Barbagli technique) in 20 cases performed over a period of 30 months in our institution. Our study showed a success rate of 80% at the end of 2yrs follow up, comparable with other studies, with a restructure rate of 20%. None of our patients developed urethrocutaneous fistula and urethral diverticulum.

Our experience with ileocystoplasty for augmentation of tuberculous bladders

Augmentation cystoplasty has traditionally been used in the treatment of low capacity, poorly compliant or contracted bladders. Various bowel segments can be used for augmentation with its own advantages and disadvantages like ileum, sigmoid, cecum, ileo cecal, stomach etc. The surgical technique involves detubularisation and reconfiguration of bowel to create a patch. A successful clinical outcome depends on creating a large capacity, low pressure reservoir to store urine. Present study was retrospective study conducted from November 2010 to March 2014 on 7 patients (5 men, 2 women with mean age 32 years). Early complications: wound infection in 3 cases, wound dehiscence in 2 cases, urinary leakage in 1 case. Late complications: recurrent UTI in 2 cases, increased mucus production in one case, bladder stone formation in one case. All were grade I to III according to Clavien- Dindo classification. No major (grade IV or V) complications. As in our experience ileocystoplasty for augmentation of tuberculous bladder is a safe and effective procedure.

Role of MRI in post traumatic posterior urethral distraction defects in comparison to RGU/ MCUG

Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.

Incidental papillary carcinoma of thyroid in Graves’ disease.

Traditionally Grave's disease was considered as protection against thyroid cancer. The incidence of papillary carcinoma thyroid in grave’s disease is 2.4%. Thyroid cancer occurring in grave’s disease has higher frequency of persisting or relapsing disease than thyroid cancers occurring in matched euthyroid control patients. Here we present a case of papillary carcinoma in a Grave’s disease patient presented with nodular goiter.

Serum ALT: LDH Ratio in Typhoid Fever and Acute Viral Hepatitis.

In 100 consecutive children aged below 18 years with confirmed typhoid fever, 29 had moderate hepatitis. Serum alanine amino transferase: lactate dehydrogenase (ALT: LDH) ratios of these 29 children at the time of hospitalization were compared with that of 29 children with acute viral hepatitis. The serum ALT: LDH ratio levels (expressed in multiples of upper limit of normal) was found to be less than 9 in typhoid hepatitis and more than 9 in acute viral hepatitis. Serum ALT: LDH ratio helps to differentiate typhoid hepatitis from acute viral hepatitis.

Role of antibiotics in periodontal therapy.

Loeshe in 1976 propounded the ‘Specific Plaque Hypothesis’ and efforts have been done since, to formulate a periodontal treatment regimen based on targeting of specific microorganisms. Antibiotics have gained importance as an arsenal in the treatment of periodontitis. This review takes a concise view on the role of antibiotics in periodontics. This review puts importance of antibiotics in a nutshell as a quick reference for the general practitioners in treating periodontal diseases. The selection and indication for the use of antibiotics is given with a note on resistance

Obesity: a Preliminary Report of an Introductory Service- Learning Course on the Role of Pharmacy Sudents in Health Promotion

Lifestyle diseases such as obesity have been neglected in developing countries partly due to a more urgent focus on infectious diseases in these countries. The incidence of obesity is on the increase in developing countries; with a marked rise in childhood obesity. The present health-promotion activity employed service-learning principles by which final year pharmacy students prepared a piloted computer-based quiz using a pre- and post- test design along with other learning material; for participants who attended the 2007 Sasol National Festival of Science and Technology (SciFest). Interactive models; posters and information leaflets were used in explaining the prevention and control of obesity to learners. The results showed that the pre-existing knowledge of the participants was good. There was a further improvement after the educational intervention. Activities such as this are important in heightening awareness of obesity in learners as it is likely to reduce the incidence of obesity later in life. Furthermore; the activity also served to increase awareness of the role of pharmacists in the prevention of lifestyle diseases such as obesity

Tuberculosis associated hemophagocytic syndrome in infancy.

An infant presented with prolonged fever, generalized lymphadenopathy, splenohepatomegaly, anemia and seborrheic dermatitis. Investigations including bone marrow findings confirmed the diagnosis of hemo-phagocytic syndrome (HPS) and the infant succumbed. Liver biopsy features of epithelioid granuloma and positive AFB culture of gastric aspirate confirmed the diagnosis of tuberculosis (TB). This rare association of HPS and tuberculosis in infancy is reported.

Pneumoparotitis with subcutaneous emphysema.

We report an adolescent with recurrent bilateral parotitis with pneumoparotitis and subcutaneous emphysema due to self pneumoinsufflation by a Valsalva like maneuver. Investigations for recurrent parotitis did not yield any clue. His la belle indifference, prolonged school absence and the presence of sibling rivalry helped us identify the psychological cause.

Antibody testing in Indian children with celiac disease.

BACKGROUND: We prospectively evaluated the usefulness of IgA tissue transglutaminase antibodies (IgA tTG) in the initial diagnosis of celiac disease (CD) and compared its diagnostic potential with that of IgA anti-endomysial antibodies (IgA EMA) and anti-IgA and IgG gliadin antibodies (AGA and AGG, respectively). METHODS: Sera of 23 untreated children fulfilling the revised ESPGHAN criteria for diagnosis of CD (Group I; mean age 10.8 y); 19 disease controls (Group II; mean age 8.5 y) presenting with chronic diarrhea, short stature or both; and 22 healthy children (Group III; mean age 8.8 y) were studied. These were tested in a blinded manner for AGA, AGG, IgA tTG (guinea pig as antigen) and IgA EMA. RESULTS: In Group I, IgA EMA was positive in 19, IgA tTG in 17, AGA in 14 and AGG in 17 patients. In Group II, these tests were positive in 1, 0, 2 and 14 patients, respectively and in Group III, in 0, 0, 0 and 1 child, respectively. Analyzing data from Group I and II, IgA EMA, IgA tTG, AGA and AGG had sensitivity rates of 83%, 74%, 61% and 74%, respectively; the specificity rates were 95%, 100%, 89% and 26%; positive predictive values were 95%, 100%, 88% and 55% and negative predictive values were 82%, 74%, 65% and 45%, respectively. CONCLUSION: IgA tTG is useful for the diagnosis of CD, with sensitivity and specificity rates comparable to those of EMA and this test is well suited for use in tropical countries like India.

Management of acute diarrhoea in children.

Acute diarrhoeal disease is one of the major killers in children in the developing countries. A management protocol consisting of "Triple A" (assessment, analysis of clinical presentation and action plan protocol) approach has been found to be rewarding in our set-up. The matter has been dealt with by the authors in this article in its proper perspective.

Bilateral congenital choanal atresia.

Our experience with the diagnosis and management of bilateral choanal atresia is presented. Four patients were treated by endoscopic transnasal approach followed by stenting with portex endotracheal tube for four to six weeks. Meticulous postoperative care particularly stent management is crucial for successful treatment of choanal atresia.

Time course of in vitro maturation of intra-erythrocytic malaria parasite: a comparison between Plasmodium falciparum and Plasmodium knowlesi

The schizont maturation assay for in vitro drug sensitivity tests has been a standard method employed in the global baseline assessment and monitoring of drug response in Plasmodium falciparum. This test is limited in its application to synchronous plasmodial infections because it evaluates the effect of drug on the maturation of parasite especially from ring to schizont stage and therefore synchronized P. falciparum cultures are required. On the other hand, P. knowlesi, a simian malaria parasite has a unique 24-h periodicity and maintains high natural synchronicity in monkeys. The present report presents the results of a comparative study on the course of in vitro maturation of sorbitol synchronized P. falciparum and naturally synchronous P. knowlesi. Ring stage parasites were incubated in RPMI medium supplemented with 10-15 percent pooled homologous serum in flat-bottomed 96-well micro plates using a candle jar at 37°C. The results suggest that the ideal time for harvesting the micro-assay plates for in vitro drug sensitivity test for sorbitol-synchronized P. falciparum and naturally synchronous P. knowlesi are from 26 to 30 h and from 22 to 25 h, respectively. The advantages of using P. knowlesi in chemotherapeutic studies are discussed