Atrophic kidney-like lesion: A rare benign entity and mimicker of thyroid follicular-like carcinoma of kidney

Atrophic kidney like lesion (AKLL) is a recently described benign entity with only 14 cases reported so far. Genitourinary Pathology Society proposed inclusion of AKLL as a provisional entity in 2021. It mimics thyroid follicular-like carcinoma of kidney as it has a follicular architecture. We report a case of an 18-year-old female with detection of renal mass, while the patient was being investigated for abdominal pain. Mediastinal nodes were also enlarged with detection of necrotizing granulomas on biopsy. Histology revealed a tumor enveloped by a thick capsule with smooth muscle fibers, varying sized follicles, interspersed atrophic tubules, and calcifications. Immunohistochemically, the “cystic follicles” show WT1 +/PAX8 -/CK7-phenotype, while atrophic tubules present between “cystic follicles” harbor WT1 -/PAX8 +/CK7 + phenotype. Morphological diagnosis and differential diagnosis will be discussed.

Immunoglobulin G4 related pancreaticobiliary disease: Report of two cases highlighting the diagnostic criteria

Two cases of immunoglobulin (IgG4)-related biliary and pancreaticobiliary disease are reported to define its diagnostic features. Case 1 presented with obstructive jaundice and showed IgG4-related disease (RD) involving right and left hepatic duct, common bile duct and gallbladder. Case 2 presented as periampullary mass. Both patients underwent surgical intervention. However, certain clinical and radiological features were present in these cases indicative of the possibility of IgG4-RD.

Correlation of 2D-Echocardiography Findings in Young Patients of Myocardial Infarction with Prevalence of Risk Factors

Background: The prevalence of Coronary Artery Disease (CAD) has progressively increased in India during the later half of the last century. Projection based on the Global Burden of Disease Study estimate that by the year 2020, the burden of atheroembolic cardiovascular disease in India would surpass that in any other region in the world. Objectives: To Correlation Of 2D-Echocardiography Findings In Young Patients Of Myocardial Infarction With Prevalence Of Risk Factors in Ghaziabad, Uttar Pradesh area, From May 2010 to April 2011. Materials and methods: 50 patients of aged 18 – 45 yrs with acute myocardial infarction were evaluated on the basis of age, sex, socioeconomic status, family history of coronary artery disease, smoking, obesity, history of hypertension, diabetes, dyslipidemia, ECG and Ejection Fraction on 2DECHO. Results: Mean age of study group was 36.2. Male were more affected than female. Prevalence of family history of coronary heart disease was 35%. 55% of patients were smokers. 20% of patients were obese. 75% patients had dyslipidemia. 25% had history of hypertension and 20% were diabetic. Goel A, Goel D, Yadav Y, Gupta SK. Correlation of 2D-Echocardiography Findings in Young Patients of Myocardial Infarction with Prevalence of Risk Factors. IAIM, 2016; 3(10): 221-227. Page 222 64% of patients in present study had anterior wall MI. Left Ventricle End Diastolic Diameter (LVEDD) mean 49.84 mm. Left Ventricle End Systolic Volume (LVESD), mean was 38.36 mm. Interventricular Septum thickness (IVS) mean was 9.86 mm. 56% had moderate LV dysfunction. MR mostly present in EF less than 40%. 12% cases had presence of pericardial effusion. 66.66% smokers have MR on 2D-Echocardiography. Conclusion: The Incidence of Myocardial Infarction is rising in young individuals owing to change in lifestyle pattern, eating habits, more stress and workload. Incidence remained highest in Males as compared to females. Highly associated risk factor in young myocardial infarction patients are dyslipidemia and smoking. Other traditional risk factors associated with myocardial infarction like diabetes, hypertension, obesity are also very much correlated and their incidence is also seems to be increasing. The role of 2D-Echocardiography in establishing the diagnosis, location, and extent of MI, in diagnosing mechanical complications of infarction, and in providing prognostic information that is important for risk stratification.

Why mental health services in low- and middle-income countries are under-resourced, under-performing: An Indian perspective.

The inadequacies of mental health services in low- and middleincome countries are often attributed to inadequate allocation of resources. This may not be entirely true. The experience in India suggests that a top–down approach to planning, divorced from the ground realities, poor governance, managerial incompetence and unrealistic expectations from low-paid/ poorly motivated primary healthcare personnel play an important role and may result in the failure of even adequately funded programmes. The ambitious National Mental Health Programme (NMHP), launched in 1983 and aimed at providing basic mental health services through the existing primary healthcare system, using the Bellary model, failed to achieve any of its targets over the subsequent decades. In early 2001, the NMHP was radically revamped. It was re-launched as part of the Tenth Five-Year Plan (2002–07) and the budgetary allocation was increased more than 7-fold. However, the programme faltered due to techno-managerial underperformance and the initial momentum was lost. The reasons for this failure are analysed and possible remedial strategies suggested. While the experience documented in the paper is country-specific and relates to India, it may hold useful lessons for other low- and middle-income countries.

Two-tier system of epilepsy evaluation: a useful method for developing countries.

PURPOSE: To test the usefulness of a simplified and clinically oriented, the Epidemiological Classification (EC), in determination of seizure types and appropriate drug selection in epileptic patients at the primary care level. METHODS: The EC was applied to all epileptic patients over 5 years then compared with the currently recommended international classifications of seizures and epilepsy (ICES/ICEES). RESULTS: A total of 1176 patients were enrolled with 2:1 male preponderance and 88% had onset of disease below 30 years of age. Based on EC, 682 (58%) had partial, 333 (28.3%) had generalized and 161 (13.7%) had undetermined seizures semiology. When ICES was applied, seizure typing was same in 86.2%, 68.5% and 26.7% patients of partial, generalized and unclassified seizures respectively. About 87% patients in generalized and partial seizure semiology had no change in selected antiepileptic drug even after the ICES, but 53.6% patients in undetermined group had change in selected AED. Only, 146 patients (12.5%) found to have symptomatic cause for seizure(s) on applying the EC system. After utilizing the ICEES on 1030 patients (87.5%) of "unknown etiology" cases after the EC system, almost 86.5% patients could be classified to a definite etiological class. CONCLUSION: The EC was found useful for determination of seizure type and appropriate AEDs selection at the primary care level. The ICES/ICEES works better at the tertiary care level. This "two-tier" system can be more effective for overall epilepsy management in developing countries with limited facilities.

Clinical, radiological and neurophysiological spectrum of JEV encephalitis and other non-specific encephalitis during post-monsoon period in India.

AIMS: To study the spectrum of encephalitis during the post-monsoon period in a tertiary care centre of India. METHODS: Clinical, neurophysiological and radiological features of patients with encephalitis are reported in this communication. The patients were subjected to clinical examination, CT or MRI scan, EEG, motor and somatosensory evoked potentials in both upper and lower limbs bilaterally and concentric needle electromyography. The laboratory studies for Japanese encephalitis (JE) comprised virus isolated, IgM capture ELISA, mercaptoethanol test and hemagglutination inhibition titre in paired sera against JE virus. Patients were classified into JEV encephalitis and non-specific encephalitis. On the basis of radiological features, they were classified into group I (thalamic or basal ganglia involvement), group II (brainstem involvement only) and group III (normal MRI). The outcome was defined into poor (bedridden), partial (dependent for daily activities) and complete (independent) recovery at the end of 3 months. RESULTS: Out of 26 patients (Age 7-70 years, mean 24.8 years), laboratory evidences of JEV infection was present in 14 patients and one patient had herpes simplex encephalitis. The patients with JEV encephalitis had more severe illness as evidenced by lower GCS score, higher frequency of anterior horn cell involvement, movement disorders and more extensive MRI changes. The EEG and MEP changes were also more frequently abnormal in the JEV group. On radiology, 15 patients had thalamic or basal ganglia involvement (group I), 3 isolated midbrain involvement (group II) and 8 had normal MRI (group III). Laboratory evidence consistent with JE were present in 11 out of 12 patients in group I and 3 out of 8 in group III, however, there was no laboratory evidence of JE virus infection in patients with isolated brainstem involvement. There was overlap in the neurologic and systemic manifestations in all the 3 radiological groups as well as in the groups with and without laboratory evidences of JEV infection. CONCLUSION: The observed overlap in neurological and systemic involvement in different subgroups of encephalitis may be due to JE or JE-like viral infection. The possibility of strain variation, change in virulence of organism or immunity of host needs further studies.

Role of Combined Approach with Radiotherapy and Metallic Stent in Palliation of Advanced Cases of Carcinoma Esophagus -APilot Study

Carcinoma esophagus presents with dysphagia and in 60% of patients, the aim of treatment is palliation. ThIs study was done to evaluate the feasibility and role of planned combined approach using radiotherapy with metallic stent in palliation of malignant dysphagia. Ten patients with histologically proven, locoregionally advanced esophageal carcinoma were selected. All patients underwent external radiotherapy followed by brachytherapy. The self-expanding metallic stent was placed under combined endoscopic and fluoroscopic guidance. A predetermined questionnaire to assess dysphagia, pain, reflux symptoms and quality of life was administered before the procedure, and thereafter at monthly intervals until death or last follow-up. 10/10 patients had grade III dysphagia at presentation. 4/10 patients underwent stent placement prior to any radiotherapy (group A), 4/1 0 patients had stent placement after external radiotherapy (group 8) and 2/1 0 had stent after completion of brachytherapy (group C). There was no difficulty in placing the stent despite the post-radiotherapy ulcerations and stricture in all the patients in group 8 and C. 8/8 patients in groups A and 8 had no difficulty in placing esophageal bougie for brachytherapy. The mean follow-up after stent placement was 9 months (4-24 months). There was complete disappearance of dysphagia in 4/4 patients in group A, 2/4 patients in group Band 0/2 patients in group C. The rest of patients had significant improvement in dysphagia score by atJeast two grades. For dysphagia grade. the mean progression free interval was recorded as 5 months for group A, 3 months for group Band 2 months for group C. Combining radiotherapy and metallic stent is a safe, simple and effective means to palliate malignant dysphagia. This raises an issue whether all patients with advanced carcinoma esophagus should preferably be pre planned for stent placement followed by radiotherapy for best results.