Testicular Volume of Boys Aged 5-17 Years in Relation to Sexual Maturity Rating and Clinical Onset of Puberty in an Urban Setting in Gujarat, India

Background : Assessment of Sexual Maturity Rating and Testicular Volume are indispensable in the routine assessment of puberty in boys. There is paucity of data in Indian population for Testicular Volume particularly in early adolescence. Aims : The aims of the study were to collect data for testicular volume,correlate testicular volume with Sexual Maturity Rating (SMR) and the clinical onset of puberty; and to identify Testicular abnormalities in boys aged 5 to 17 years in an Urban setting in Gujarat, India. Materials and Methods : A prospective observational study was undertaken in boys aged5 to 17years of age from Gujarat from April, 2019 to August, 2019. Mean Testicular Volume was measured with a Prader抯 orchidometer. Parameters like Age, Weight and Height were also measured and Body Mass Index (BMI) was calculated. Pubertal stage was categorized using Tanner staging. Data was statistically analyzed using Microsoft Excel and SPSS software. Results : 977 boys were included in the study. Mean age at SMR stage 2 was 11.22 years. SMR stage 2 was earliest seen at 6 years and latest at 15 years of age. 15% of boys in pre-adolescence, 60% in early adolescence and 94% in middle adolescence showed changes of Puberty. Precocious puberty was detected in 33 boys (3.38%). Delayed Puberty was detected in 4 boys (0.4%) and Undescended Testes in 4 boys (0.4%). Testicular Volume showed positive correlation with Weight, Height and BMI.

Role of Itolizumab in the Treatment of COVID-19 Patients, Admitted to ICU at a Tertiary Care Hospital

Background: Clinical studies have correlated severe deterioration of COVID-19 patients due to excessive and uncontrolled production of cytokines. There is a pressing need to explore therapies, which could prevent the cytokine storm rather than terminating it. Aims and objectives: The aim of the study is to evaluate the effect of itolizumab on clinical outcomes of patients with moderate-severe COVID-19 disease admitted to ICU. The primary aim of the current study is to find out any mortality benefit in 14 days. The secondary aim is to assess the morbidity outcomes in terms of reduction in inflammatory markers and also the duration of hospital stays to assess the prognostication. Materials and methods: It is a retrospective case-control study in which laboratory-confirmed COVID-19 patients admitted to ICU were taken. A total of 62 patients were recruited, 31 patients received itolizumab (cases/treatment group) and 31 patients didn’t receive itolizumab (designated as controls). Results: Among the total patients recruited, 68% of the study population was male and 32% were female. A total of 12 patients expired among cases and 13 expired among controls. Overall mortality in both groups was noted to be almost similar. The control group showed mortality at lower computed tomography (CT) scores compared to the cases. There is a significant reduction in inflammatory markers, like interleukins-6 (IL-6) and D-dimer in cases compared to the control group. Conclusion: In conclusion, treating patients with cytokine storms before they require intubation/mechanical ventilation is crucial to preventing deaths. Itolizumab has shown no clinical benefit in critically ill COVID-19 patients, however, timely initiation of itolizumab therapy may serve as a key therapeutic option in preventing the mortality and morbidity outcomes in moderate-severe COVID-19 patients.

Clinical-epidemiological Profile of Coronavirus Disease 19 Associated Mucomycosis (CAM) and Relation with Zinc and Iron Levels

Introduction: Coronavirus disease associated mucormycosis (CAM), perturbed a lot by reaching to epidemic proportions particularly during the second wave of the pandemic. Material and Methods: This was a retrospective, observational study of patients with COVID-19-associated mucomycosis admitted in April-May 2021 at a tertiary care teaching hospital. Demographic profile, clinical and laboratory parameters were recorded Multidisciplinary treatment including antifungals and surgical interventions were noted. Results: This study included 98patients of mucormycosis, diagnosed on the basis of clinical and radiological findings and later were confirmed by microbiological investigations. Out of 98 patients, 72 had rhino orbital, 24 had rhino-orbital- cerebral and 2 had pulmonary mucormycosis. Twelve had coinfection of covid 19 while 86 had developed mucormycosis within 3 weeks. Conclusion: CAM has posed as a continuum of challenges faced during the pandemic of covid 19. This rare and life threatening complication requires high index of suspicion for early diagnosis. Multidisciplinary involvement and timely interventions including antifungal pharmacotherapy, stringent glycemic control and surgical debridement can reduce the mortality. Mucormycosis is uniformly associated with low iron levels but role of zinc needs to be further studied

Invasive cystic hypersecretory carcinoma of the breast

ABSTRACT Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of ductal carcinoma, characterized by variably sized cysts lined by micropapillary fronds to proliferative pseudostratified columnar epithelium. It includes a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia to invasive CHC. Only 20 cases of invasive CHC have been reported to date. We report a case of a 49-year-old female who presented with a palpable breast lump and nipple discharge. Gross examination showed variable-sized cysts lined by solid grey white tumors. On microscopic examination, cysts were lined by micropapillary fronds with eosinophilic colloid-like secretion with a focus of invasion. A diagnosis of invasive CHC was made. Since there are limited case reports, our understanding of its biological behavior, prognostic factors, and genetic basis is limited.

A Prospective Study to Improve the Yield of Esophagogastroduodenoscopy at a Tertiary Hospital in India

Background: Esophagogastroduodenoscopy (EGD)is an efficient tool for diagnosis, screening and therapy. However, it must be used efficiently, to maximize value for costs and reduce complications. Many centers have adopted an open-access referral policy, resulting in increased costs, waiting times and clinical workload. When EGD is used for screening of common symptoms like dyspepsia by medical and paramedical personnel, the yield is less than 50%.We planned a study to differentiate disease from non-diseased findings and improve the diagnostic yield of EGD. Methods: The clinical history and examination of 150 patients of a tertiary care hospital in north India over 2 years wasrecorded. EGD when indicated by any clinician or desired by a patient was performed by a consultant, using topical anaesthesia.The outcome of the endoscopy was categorized as positive, if there was significant finding. Less severe and equivocal findings such as gastritis, duodenitis were not considered positive for the purpose of this study. Logistic regression (forward LR score) was used; the coefficient of regressionwas used to assign a score for each symptom. Results: Pain was the most common symptom; in 110 patients (77.3%) the endoscopy showed no significant findings. Significant findings were seen in 34 patients giving a diagnostic yield of 22.7%. Clinical features like weight loss, hematemesis, melena, dysphagia, anemia, abdominal distention, ascites, and abdominal lump significantly discriminated and pointed towards a positive endoscopic finding. Pain was not a good discriminating factor; dysphagia, presence of ascites and the presence of abdominal lump independently predict significant endoscopic findings. At a total score of 4 or less endoscopy could be avoided in 75 (50%) of the patients. A score of 5 yielded a sensitivity of 82% and specificity of 71%. For picking up a positive finding. All 11 patients with malignancy had a score >5. Conclusions: Our findings suggest selection of patients for EGD can be improved based on a scoring system. It also provides a basis for prospective studies which can lead to better use of resources in future.

Prevalence of Different Clinical Variants of Nephrotic Syndrome in Children 1–18 Years of Age in Tertiary Care Hospital of North India

Introduction: Childhood nephrotic syndrome has an incidence of 90–100 per million population of India. This study was conducted with the primary objective of studying the prevalence of different clinical variants of childhood nephrotic syndrome (new-onset steroid-sensitive nephrotic syndrome/infrequent relapsing nephrotic syndrome [IFRNS]/frequently relapsing nephrotic syndrome [FRNS]/steroid-dependent nephrotic syndrome [SDNS]/steroid-resistant nephrotic syndrome [SRNS]), while the secondary objectives were to estimate the prevalence of use of steroid-sparing drugs in those with FRNS and SDNS. Materials and Methods: A retrospective study of all patients referred to renal diseases clinic at Government Medical College, Jammu, was done. Records of 61 children of 1–18 years of age fulfilling the International Study of Kidney Disease in Children criteria for nephrotic syndrome attending to our nephrology clinic were reviewed over 1 year period. Standard definitions for new-onset nephrotic syndrome, IFRNS, FRNS, SDNS, and SRNS were used. Steroid-sparing drugs used were levamisole in FRNS and low-dose SDNS whereas cyclophosphamide, mycophenolate mofetil (MMF), and tacrolimus in high-dose SDNS. Results: Among nephrotic syndrome, patients mean age of presentation was 5.95 years, with M: F ratio of 1.77:1. Infrequent relapsers (27.9%) were the most prevalent clinical variant followed by steroid-dependent nephrotic syndrome (24.6%) and new-onset nephrotic syndrome (21.3%). Prednisolone alone was successful in achieving remission in 50.8% of total cases and less commonly involving use of other immunosuppressants with prednisolone such as levamisole (23%), cyclophosphamide (9.8%), and tacrolimus in (3.3%). However, prednisolone in combination with cyclophosphamide and then MMF was used in 14 (23%) in an aim to achieve full remission, but full remission was achieved in 48 (78.7%). Conclusion: In the present study, clinical profile of children with nephrotic syndrome was concordant with typical nephrotic syndrome in children. Pattern of nephrotic syndrome differs in our population in terms of increased number with SDNS and response to treatment did not differ significantly from other studies.

Inguinal Hernia Repair using Prolene Hernia System – a Simplified Technique for Beginners

Introduction: Surgical repair of the inguinal hernia is themost common general surgery procedure performed today.Even today inguinal hernias pose a great burden on thehealthcare system. Hence even modest improvements inclinical outcomes are warmly welcomed. This study describesthe technique of Prolene Hernia System (PHS) in its simplifiedform for the beginners to learn it quickly.Material and methods: A prospective study was conductedin 50 patients in a tertiary centre from April 2010 to Oct 2011for period of 18 months. Patients’ demographic data wascollected and patient selected as per the selection criteria. ThePHS mesh repair was performed as described by Gilbert etal3 with some simplification and modification as described.Absorbable sutures were used to fix the mesh in the describedfour stitch technique. All data collected from study wereentered in the database for statistical analysis.Results: All participants were males and most of them werefrom manual labour background (38 patients (76%). Most ofthe patients belonged to 26-35 year age group (18 patients(36%). 40 participants were found to have indirect hernias(80%). Right sided hernia was found more common (33patients (66%). The mean duration of surgery was 31.96 min(SD – 2.303). Intraoperative complication included 2 cases ofnerve damage (4%). The mean pain score in first 24 hours was6.82/10 (SD – 1.848). None of the patients reported recurrenceof hernia (0% recurrence).Conclusion: The PHS mesh, consisting of an underlay patch,an overlay patch, and a joining connector, has potentialbenefits over the traditional Lichtenstein, Mesh Plug Repair(MPR) and Laparoscopic repairs. The PHS mesh providescomplete coverage of the entire myopectineal orificethrough the underlay placed in the preperitoneal space, theoverlay placed in the inguinal canal and the connector whichmaintains the mesh in position. In our study we also found thatuse of absorbable sutures helped in relieving neuralgia andlessened chronic groin pain by causing less permanent nerveentrapment without affecting the recurrence rate.

To Study the Prevalence of Cognitive Impairment in Alcohol Dependence

Introduction: Present study aimed to evaluates the cognitive status among dependent patients and effect of abstinence from alcohol for one month. Materials and methods: Study included 50 alcohol dependent male inpatients and a similar number of age and education matched controls. Specially designed semi-structured proforma was used to collect demographical data. Cognitive functions were evaluated by Post Graduate Institute of Medical Education and Research, Chandigarh Battery of Brain dysfunction (PGI-BBD). Assessment by similar method was done in both cases (at baseline and 1 month after abstinence/treatment) and controls. Data was analyzed by SPSS ver. 21.0. Results: Significant cognitive dysfunction was seen in all domains among alcoholics as compared to controls (p<0.05). Post-treatment/ abstinence improvement was seen in all domains except recent memory, mental balance, immediate and delayed recall, retention for similar and dissimilar pairs. Performance quotient impairment was seen in 40 (80%), 18 (36%) and 12 (24%) in pre-treatment, post-treatment and control group respectively. Further PQ evaluation revealed that mean scores of 69.54, 82.82 and 91.08 (p<0.05; all groups). Increase in years of consuming alcohol of study group is associated with more cognitive impairment in memory and intelligence. Conclusion: Present study had validated the assumption that there is significant cognitive impairment among alcohol dependent cases. These deficits can be detected with formal neuropsychological assessment Awareness of alcohol’s effects on cognition can help health-care providers in addressing the problem and instituting appropriate treatment.

Pulmonary Mycetoma Due To Candida Albicans Masquerading Bronchogenic Carcinoma In A Patient With Type -2 Diabetes Mellitus

Fungal lesions of lung presenting as a mass are called mycetomas. Mycetoma is a conglomeration of cellular debris and mucous with finely woven fungal hyphae present in a cavity in pulmonary parenchyma or a bronchus.The most common infections causing pulmonary mycetoma are aspergillus.Candida species causing pulmonary mycetoma is rare. A70 year old patient of Diabetes and chronic obstructive pulmonary diseases (COPD), presented with acute on chronic respiratory symptoms. On contrast enhanced CT scan of thorax he was diagnosed as having a heterogeneously enhancing mass lesion in left lower lobe and minimal pleural effusion with a provisional diagnosis of neoplasm. Thorough examination of oral cavity revealed thrush. CT guided biopsy confirmed pulmonary candidiasis. Patient responded well to medical treatment. Only a few such cases have been reported in literature.

Multidrug Resistant Tuberculosis: Trends and Control.

Multidrug resistant tuberculosis (MDR-TB) has been an area of growing concern and is posing a threat to the control of tuberculosis (TB). The exact magnitude of problem of resistance to anti-tuberculosis drugs worldwide was not known till the 1994-97 global project on anti-tuberculosis drug resistance surveillance initiated by the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Diseases (IUATLD). The Global Tuberculosis Report 2014 estimated that an 3.5% of newly diagnosed and 20.5% of previously treated TB cases had MDR-TB. It has been estimated that 480,000 cases emerged and 210,000 deaths occurred due to MDR-TB globally in 2013. In India, estimates showed that the prevalence of MDR-TB among new and previously treated patients was 2.2% and 15%, respectively. It is estimated that 99,000 cases of MDR-TB emerge every year of which 62,000 were among notified cases of TB in 2013. The MDR-TB is a human-made problem and results largely from poorly managed cases of TB. Adequate, timely diagnosis and optimal treatment of MDR-TB will help curb the epidemic. Efforts must be focused on the effective use of anti-tuberculosis drugs in every new patient, so as to prevent the emergence of MDR-TB.

State of globe: mitigating measles menace in era of MMR/V

In non vaccination ancient era, multiple epidemics of measles/german measles/variola used to occur in the cyclical trend of two to three years during spring months. Outbreaks in Faroe Islands in 1846 and in Fizi Island in 1875 are examples of this type of transmission where virgin epidemics took the highest mortality toll. According to WHO report, in the absence of immunization, 90% of the persons can be expected to develop clinical measles sometimes in their life time as noted in Greenland in 1951 epidemic and german measles in 2012 in Kangra. But the epidemiology of communicable diseases underwent tremendous change not only in the developed countries, viz America and European countries but also in the developing countries like India, Pakistan and African countries with the introduction of vaccination and thereby mortality and morbidity on account of vaccine preventable diseases in all the age groups around the world nose dived. This provided a big relief to the suffering humanity across the world. Different countries have various sets of immunization programme running in the countries; be it single dose of measles at the age of 270 days or second shot of measles or other vaccinations. Round the globe, MMR or MMRV or pentavalent vaccination with their pluses or minuses, still is the right choice to mitigate the menace of measles