Effect of Antiretroviral Therapy on Neutrophil Oxidative Burst in Children

Objective To ascertain the efect of human immunodefciency virus (HIV) infection, as well as, antiretroviral therapy (ART) on neutrophil oxidative burst in children. Methods Fifty-fve children living with HIV infection (30 receiving ART for?2 y, 25 treatment-naïve) and 30 healthy controls, aged 18 mo–18 y, were assessed for hemogram and neutrophil oxidative burst. The treatment-naïve children were followed up and the above tests were repeated after 6 mo of ART. Results Mean (SD) serum MPO activity at 6 mo after ART [32.1 (±19.9) U/L] was comparable to that at disease onset [17.2 (±23.0) U/L], although it was signifcantly higher compared to that in children on ART?2 y [13.3 (±15.8) U/L] and controls [12.1 (±11.9) U/L]. Median fuorescence intensity (MFI) of unstimulated DHR was highest at 6 mo after ART and in the treatment-naïve group, which was signifcantly higher than in the controls, as well as, children receiving ART?2 y. Stimulation index was highest in the control group [442.4 (341.9–562.9)], which was comparable to that in children on ART?2 y [304.2 (153.2–664.8)], but was signifcantly higher than the treatment-naïve cohort [266.1 (148.2–339.4)] and children on ART for 6 mo [318.8 (154.9–395.6)]. Conclusion A hyperinfammatory state caused by an increased serum myeloperoxidase enzyme activity and increased basal neutrophil oxidative burst was seen in untreated HIV infection and during initial 6 mo of ART. ART given for?2 y normalized the impaired neutrophilic phagocytic functions.

Practical Approach to the Interpretation of Complete Blood Count Reports and Histograms

Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.

Laparoscopic management of ruptured non communicating rudimentary horn in second trimester of pregnancy

Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in rudimentary horn is rare occurrence with incidence of less than 1 in 150,000. Prerupture diagnosis of rudimentary horn pregnancy with USG is technically difficult, with sensitivity of 30%. It is often not diagnosed unless it terminates by rupture in the second trimester leading to catastrophic haemorrhage and hence high incidence of maternal mortality. Management of such cases is a challenge till today due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management is life saving in such cases. Here we present a case of ruptured non-communicating rudimentary horn pregnancy at 15 weeks presenting in our emergency department as a case of pain abdomen. Laparoscopic resection of the rudimentary horn was performed for the patient.

Assessment of prophylactic effect of Senna auriculata (L.) Roxb. leaves on alcohol-induced pancreatitis in rat model.

Aqueous leaf extract of Senna auriculata (L.) Roxb. syn. Cassia auriculata (SLEx) is known to possess potential antidiabetic and antioxidant properties. Based on the known correlation between exocrine pancreatic function and endocrine secretary capacity, here, we studied the prophylactic effect of the SLEx on alcohol induced pancreatitis in rats. To induce chronic pancreatitis, the rats were fed with unsaturated fat i.e. corn oil (2.5 mL/kg) along with high dose of ethanol (10.2 g/kg) for 4 wk, and was increased 0.6 g/kg after every 2 days for 1 wk and then 0.6 g/kg after every 4 days for a period of 4 wk. SLEx was orally administered to rats at dose of 400 mg/kg/day for 4 wk. At the end of 4th wk, pancreatic enzymes i.e., α-amylase, lipase, serum and pancreatic MDA levels were estimated. Pancreatic histopathological studies were also performed. The SLEx significantly reduced the serum levels of α-amylase and lipase along with significant suppression in serum and pancreatic tissue lipid peroxidation. Histomorphological studies did not show any fatty vacoules in acinar cells of SLEx-treated rats. However, vacoulation was seen in acini of pathogenic control rats. With the results, we conclude that Senna auriculata aqueous leaf extract has potential to reduce the ethanol-induced pathogenecity, and it possesses prophylactic effect on alcohol-induced pancreatitis. However, a long term trial is needed to ascertain its therapeutic potential for pancreatitis.

Pierre Robin syndrome: a case report.

Pierre Robin syndrome is characterized by micrognathia, glossoptosis and palatal malformation. We report a case of a 6 day neonate who presented with complaints of feeding and respiratory difficulty and was later diagnosed as case of Pierre Robin syndrome.

Arteriovenous malformation of external ear and temporal region: a case report.

Arteriovenous malformations (AVMs) of the scalp are remarkably rare. We report a case of 20 years old female complaining of swelling over right pinna and scalp since 2 years with known history of trauma. This case report represents pathogenesis, clinical features and management of the disease.

Preauricular sinus: a clinicopathological study.

Background: Preauricular sinuses are common congenital malformations. In most instances the diagnosis and management of condition is straightforward. Methods: The present study was done on 26 patients of preauricular sinus who presented to the Department of ENT, S.S. Medical College & G.M. Hospital, Rewa from August 2012 to July 2013 prospectively. Results: Males and females were equally affected. Most patients i.e. 11 belong to 11-20 year age group with age ranging from 4 year to 60 years. Two cases had genetic history and one case was found to be associated with chronic suppurative otitis media (CSOM). Conclusions: The patients in whom a preauricular sinus is identified, the associated congenital anomalies and family history should be sought. Early identification and spreading of awareness should be done to avoid the complication of recurrent abscess in preauricular region.

A case report on two superimposed foreign body coins in esophagus.

Foreign body ingestion is a common occurence. We report a case of 8 year old male who presented with history of foreign body ingestion (coin). He had frequent episodes of vomiting along with foreign body sensation. Later on two superimposed foreign body coins were removed by rigid oesophagoscopy.

Unusual foreign body in oropharynx: a case report.

Foreign body in oropharynx is common occurrence. We report a case of a 7 month old male baby who presented with complaint of feeding difficulty and later diagnosed as case of foreign body oropharynx i.e. wheat stalk of 5 cm with overlying husk based on detailed history and meticulous examination.

Klippel-Feil syndrome: a case report.

Klippel-Feil Syndrome (KFS) is defined as congenital fusion of two or more cervical vertebrae. The most common signs are short neck, low hairline at the back of head and restricted mobility of neck. We report a case of a neonate who presented with complaint of respiratory difficulty and later diagnosed as case of Klippel-Feil syndrome.

A study on otitis media with special emphasis on acute suppurative otitis media.

Background: Otitis media is a common condition in developing countries and requires support and cooperation of both medical professionals and patients for the proper and timely management of this problem. Aim of current study was to present 148 OM (otitis media) cases observed at the S.S. medical college & G.M. hospital, Rewa. Methods: The present study was done on 148 patients of OM (otitis media) who presented to the S.S. Medical College & G.M. Hospital, Rewa prospectively from December 2012 to February 2013. Results: Most patients (56) belong to 11-20 year age group with age ranging from 4 years to 70 years. Male predominance (85) was observed. About 96 patients were from rural areas. Left laterality (60 cases) was commonest. Unsafe CSOM (62 cases) was the commonest type of otitis media seen. ASOM was seen in 20.27% cases. Conclusion: Otitis media is present in this region of country in abundance and need of hour is to spread awareness about the disease.

Prevalence of Rh, Duffy, Kell, Kidd & MNSs blood group antigens in the Indian blood donor population.

Background & objectives: Little data are available regarding the frequencies of the blood group antigens other than ABO and RhD in the Indian population. Knowledge of the antigen frequencies is important to assess risk of antibody formation and to guide the probability of finding antigen-negative donor blood, which is especially useful when blood is required for a patient who has multiple red cell alloantibodies. This study was carried out to determine the frequencies of the D, C, c, E, e, K, k, Fya, Fyb, Jka, Jkb, M, N, S and s antigens in over 3,000 blood donors. Methods: Samples from randomly selected blood donors from Delhi and nearby areas (both voluntary and replacement) were collected for extended antigen typing during the period January 2009 to January 2010. Antigens were typed via automated testing on the Galileo instrument using commercial antisera. Results: A total of 3073 blood samples from donors were phenotyped. The prevalence of these antigens was found to be as follows in %: D: 93.6, C: 87, c: 58, E: 20, e: 98, K: 3.5, k: 99.97, Fya: 87.4, Fyb: 57.6, Jka: 81.5, Jkb: 67.4, M: 88.7, N: 65.4, S: 54.8 and s: 88.7. Interpretation & conclusions: This study found the prevalence of the typed antigens among Indian blood donors to be statistically different to those in the Caucasian, Black and Chinese populations, but more similar to Caucasians than to the other racial groups.

Evaluation of lactose and milk intolerance, and bone mineral density in Indian patients with inflammatory bowel disease.

Background. A misconception that milk and lactose intolerance increases disease activity in inflammatory bowel disease leads to the exclusion of dietary dairy products, and patients are at an increased risk of low bone mineral density. Methods. Patients with inflammatory bowel disease (n=45, 19 men and 26 women) and healthy controls were included in this prospective open-label study. As part of exploratory dietary intervention, patients were advised to exclude milk and milk products from diet for the first 7 days and reintroduce at least 250 ml of milk for the next 21 days. Milk and lactose intolerance was assessed in patients and healthy subjects using clinical symptoms and lactose hydrogen breath test, respectively; bone mineral density was assessed in patients using a Hologic QDR 4500A DXA machine. Results. Milk and lactose intolerance was statistically comparable in patients with inflammatory bowel disease (31% and 44%, respectively) and healthy subjects (22% and 27%, respectively). Most of the patients (40%) had excluded dairy products from their diet, and 53% had dietary intake of calcium <200 mg/day. More than 60% of the patients had either osteopenia or osteoporosis. Conclusion. Milk and lactose intolerance in patients with inflammatory bowel disease was not different from that in healthy subjects. The proportion of patients with osteoporosis and osteopenia was high in this population. Hence, patients with inflammatory bowel disease in remission phase may be encouraged to add dairy products in their diet, unless otherwise indicated.

rare occurrence of shagreen patch on the face of a pediatric patient with tuberous sclerosis

Tuberous sclerosis is a neurocutaneous syndrome characterized by a clinical spectrum varying from severe mental retardation and incapacitating seizures to normal intelligence and lack of seizures, often within the same family [1]. The younger the patients present with symptoms and signs of TSC [tuberous sclerosis complex], the greater are the likelihood of mental retardation [2]. Skin features are very characteristic of the disease and help in the early diagnosis of the disease. Shagreen patch is one of the major diagnostic features of the disease. It is a less common skin lesion consisting of an excess amount of fibrous tissue similar to that found in scar tissues [3]. It is a section of thickened, elevated pebbly skin like an orange peel. The name is derived from the French phrase "peau chagrinee". It is usually found on the lower back, buttock, thigh and the nape of the neck commonly. In this case report we report a characteristic skin lesion, the shagreen patch in a six-year-old child with TSC at an unusual site [the cheek] never reported before with the best of our knowledge

Bronchial Thermoplasty.

Summary: Even with the use of maximum pharmacological treatment, asthma still remains uncontrolled in some cases. For such cases of uncontrolled asthma, a novel therapy – Bronchial Thermoplasty (BT) - has shown some promising results over the past few years. BT is application of controlled radiofrequency heat via catheter inserted through a flexible bronchoscope, to the bronchial walls. It reduces the smooth muscle mass in bronchial wall and thus results in decreased contractility. Three major trials of BT show that it does not cause any improvement in FEV1. However, BT causes improvement the quality of life and decreases the future exacerbations and emergency hospital visits due to asthma. But the benefit observed was too small to be clinically significant. Follow up (two to five years) results of these BT trials did not show any significant long term adverse event related to BT. However, further independent large randomized controlled trials and results of application of BT in real hospital settings are needed to define its role in asthma management.

Evaluation of the diagnostic yield and safety of closed pleural biopsy in the diagnosis of Pleural Effusion.

Aim: To assess the diagnostic yield and safety of closed pleural biopsy in patients with pleural effusion. Methods: In all, 48 consecutive cases of pleural effusion were evaluated with complete pleural fluid biochemical and microbiological analysis, cytology, routine bacterial and mycobacterial cultures. In all these 48 cases of pleural effusion closed pleural biopsy was done with tru-cut biopsy needle and biopsy samples were sent for histopathology and mycobacterial culture. Results: Out of 48 cases, main causes of pleural effusion were Tuberculosis in 21(43.8%) cases, Malignancy in 14(29.2%) cases, paramalignant effusion in six (12.5%) cases, Empyema in three (6.3%) cases, transudative effusion in three (6.3%) cases and parapneumonic effusion in one (1.9%) case. Diagnostic yield of closed pleural biopsy was 62.2% in cases of all exudative pleural effusion, 76.2% in cases of tubercular pleural effusion and 85.7% in cases of malignant pleural effusion. There was no incidence of post pleural biopsy pneumothorax or hemothorax, underlining the safety of pleural biopsy procedure. Conclusion: Closed pleural biopsy provides the highest diagnostic yield in cases of pleural tuberculosis and malignancy, the two most important causes of exudative pleural effusion. In view of low cost, easy availability and very low complication rates, it is a very important diagnostic tool in the hands of a trained pulmonary physician in India.