Humanities in medicine: experience at Pondicherry Institute of Medical Sciences, India

A few institutes in India have started a programme of Humanities in Medicine (HiM) on a small scale. In 2014, the Pondicherry Institute of Medical Sciences (PIMS) decided to begin an HiM programme for undergraduate students and this has been conducted successfully for the last three years. The major strengths of the programme have been its formal integration within the curriculum and the contributions of a large number of enthusiastic, talented and motivated faculty. In this report, we wish to trace the evolution and implementation of the HiM programme in our institution

Isolated deletion of the long arm of chromosome 20 del(20q12) in myelodysplastic syndrome: a case report and literature review

Isolated deletion of the long arm of chromosome 20 [del(20q12)] is a rare abnormality in patients with de novo myelodysplastic syndrome. It is characterised by refractory thrombocytopenia, minimal haematological dysplasia and a lower risk for progression to acute myeloid leukaemia. Its distinction from chronic autoimmune thrombocytopenia, although clinically and morphologically difficult, is critical. We report a case of refractory cytopenia and unilineage dysplasia in an elderly woman with isolated del(20q12), identified via fluorescence in situ hybridisation analysis of her bone marrow. In order to avoid a misdiagnosis, we suggest that cytogenetic analysis be performed on all patients suspected to have myelodysplastic syndrome with predominant thrombocytopenic presentation.

Pyrexia in a patient with megaloblastic anemia: a case report and literature review

Deficiency of vitamin B12 and/or folic acid as a cause of pyrexia, though known, is rarely reported in literature. We aimed to report a case in a 51 year old woman, who presented with fever and pancytopenia and was diagnosed to have megaloblastic anemia secondary to vitamin B12 and folate deficiency. The pyrexia subsided following the intramuscular injection of vitamin B12 and oral folic acid administration. All the other infective, inflammatory/autoimmune, endocrine causes of pyrexia were excluded by appropriate investigations. Therefore, we suggest that all physicians be aware of megaloblastic anemia as a treatable cause of pyrexia in order to avoid unnecessary costly investigations and antibiotic usage

An unusual cyst of the lateral neck in a child - a thymic cyst: a case report

A case of a thymic cyst in a child is reported and the literature reviewed. A 7 year old girl presented with a swelling in the neck on the left of one months' duration. There was no history of fever, pain or dysphagia. CT revealed a cyst in the anterior triangle of the neck between the carotid sheath and thyroid. The cyst was excised, the histopathology revealed a thymic cyst. Thymic cysts are an unusual cause for lateral neck cysts; are commonly seen in childhood, and are more common in males. Our patient was a young girl who did not have pressure symptoms. Usually unilocular, they resemble branchial cysts or lymphangiomas. Thymic cysts are the rarest of the congenital neck masses. They present as asymptomatic cysts in early childhood. Thymic cysts should be considered when confronted with a unilateral infrahyoid lateral neck cyst. There are no radiologically diagnostic features, and diagnosis is made on biopsy

Actinomycotic osteomyelitis of the maxilla and nose: a case report

A rare case of osteomyelitis of the maxilla and nose caused by actinomyces is reported and discussed. A young adult presented with a history of unilateral nasal discharge and obstruction since childhood. Examination revealed a discharge covered red mass in the left nasal cavity anteriorly. CT scan showed necrosis and sequestrum of the left frontonasal process of the maxilla, and a widened nasolacrimal duct and lacrimal fossa. Surgery showed granulation tissue and a soft tissue mass in the lateral wall of the nose extending upto the lacrimal sac. The frontonasal process of the maxilla was lying loose in the granulation. HPE revealed sequestrum of the bone and chronic infection due to actinomyces. He was then given oral Penicillin 800mg twice a day for three months. The case highlights the fact that though Actinomyces is a common commensal in the mouth, it can rarely cause osteomyelitis of the nose

Congenital neuroblastoma with liver metastasis presenting with Hashimoto Pritzker disease.

A two-month-old female child presented with discrete skin-colored papules on the forehead and scalp. She was earlier diagnosed to have neuroblastoma of the adrenal gland which had metastasized to the liver. Histological sections of the skin lesion showed a nodule composed of sheets of cells with abundant eosinophilic cytoplasm and an occasional grooving of the nucleus. These cells were CD 68 positive. Eosinophilic abscesses were seen in between the neoplastic cells.

Ectopic cervical thymoma--the great mimic: a case report.

Ectopic cervical thymoma is a rare tumour that probably arises from thymic tissue trapped during the migration of the thymus into the anterior mediastinum from the third and fourth pharyngeal pouches. As it occurs in the region of the thyroid gland it mimics thyroid lesions and can cause confusion to the clinician, sonologist and cytologist. Misinterpretation of frozen sections can also occur if knowledge of this entity is not present. We are reporting a case of this rare entity in an elderly lady who presented with a neck mass that mimicked a thyroid lesion. Ectopic cervical thymoma should be considered in the list of differential diagnosis of neck masses in the elderly.

Calcifying pseudotumor of scrotum: a case report.

Calcifying fibrous pseudotumors of the testicular and paratesticular soft tissue are relatively rare. We would like to report the first documented case of calcifying fibrous pseudotumor of the tunica vaginalis in Indian medical literature. This is a case of a 55 year old male who presented with a painless scrotal mass of 10 years duration. Histological sections showed dense hyalinised bands of collagen with focal collections of plasma cells and lymphocytes. Multiple round to oval concentrically laminated psammomatous bodies were seen.

Kimura's disease--cytodiagnostic pointers: a case report.

Kimura's disease is an entity which is common in Asia with predilection for males. Earliest reports were from China. Kimura et al reported the case in detailfrom Japan 1948. Cytological diagnosis of Kimura's helps in allaying fears of malignancies in clinicians and patients. When all the cytological features are seen, this diagnosis should be borne in mind, and the differential diagnosis should be ruled out. Here we report 2 cases of Kimura's disease diagnosed on cytology and confirmed on biopsy. The etiology of Kimura's is unknown but a hypersensitivity etiology has been proposed.

Case report of parathyroid carcinoma with raised urinary catecholamines: a diagnostic dilemma.

Parathyroid carcinoma is often misdiagnosed as thyroid carcinoma clinically and also with fine needle aspiration cytology. Moreover in cases misdiagnosed as thyroid carcinoma pre operatively, raised urinary catecholamines may mislead to a diagnosis of MEN2 A. We report a case of a patient admitted to the surgery department ofour hospital with a swelling in the thyroid region, raised urinary catecholamines and urinary VMA levels, with hypercalciuria and elevated parathyroid hormone levels. It was clinically suspected as thyroid carcinoma with parathyroid adenoma and associated MEN 2A syndrome.

Giant cell tumour of talus--a case report.

Giant cell tumour of the talus bone is rare and is usually seen in skeletally mature adults. Here a case of giant cell tumour of the talus in a skeletally immature boy of 15 years is reported. The patient presented with swelling and tenderness of the left ankle with an osteolytic lesion seen in the talus on x-ray. A trephine biopsy followed by left talar excision was done. Following the biopsy report the patient underwent arthotomy and joint clearance. There was no recurrence noted at six months follow-up.

Case report of orbital lymphoma associated with polycystic disease: a coincidence?

The most common known extra renal malignancy associated with polycystic kidney disease (PKD) is of pancreatic origin. Here we report a case of orbital lymphoma in a patient with PKD. This might just be a co-incidence or there might be some genetic interaction.

Community prevalence of hepatitis B infection and modes of transmission in Tamil Nadu, India.

BACKGROUND AND OBJECTIVE: There have been very few community based studies on prevalence of hepatitis B virus (HBV) infection in India. We undertook this study to determine the prevalence of HBV infection in a southern State of India, Tamil Nadu and to describe the important factors related to transmission of the virus in the community. METHODS: Analysis of stored blood samples from a representative population of Tamil Nadu from an earlier community cluster survey on sexually transmitted diseases (STD) prevalence using proportionate to population size (PPS) technique was done. Serum markers of HBV viz., hapatitis B surface antigen (HBsAg), hepatitis B e antigen (HBe Ag) and antibody to surface antigen (anti-HBs) were performed. RESULTS: 1981 subjects were screened in the study. HBsAg prevalence was 5.7 per cent (CI 4.6- 6.8) with 23.5 per cent (25/106) of these having positive HBe-antigen. Community seroprevalence (HbsAg + anti-HBs) of hepatitis B infection was 27.4 per cent (CI: 25.3-29.5) with the highest prevalence of 32.7 per cent (CI: 30.2-35.2) noted in the 15-20 yr age group. Significant independent association (OR 1.4; P=0.006) was detected with family history of exposure to HBV infection by logistic modeling. Other risk factors noted to have significant association were use of disposable needles during injection (OR 0.5; P=0.02) in men, smoking (OR 3; P=0.04) and use of condom (OR 0.6; P=0.08) in women. INTERPRETATION AND CONCLUSION: This community based study shows a high prevalence of hepatitis B infection in the state of Tamil Nadu with the highest prevalence being in the younger (15-20 yr) age group. High prevalence rate in childhood with e-antigenemia seen in 23.5 per cent of HBsAg positive subjects suggest childhood transmission. Poor injection practices and high-risk sexual behavior were found to be additional risk factors for transmission of the disease in the community.

Adrenocortical oncocytoma--a case report.

Oncocytic tumours of adrenal gland are rare lesions with approximately twenty-five cases being documented in literature. A majority of them are nonfunctional and benign. We report a case of adrenal oncocytoma in a 44-year-old male, who underwent a laparotomy for a large mass in the abdomen, which was located above the left kidney. Routine histopathological examination was suggestive of a benign tumour with cells resembling oncocytes. However, immunohistochemistry and electron microscopy helped to confirm the diagnosis of an adrenocortical oncocytoma.