A Diagnostic Journey

We describe the case of a patient who came with features suggestive of diabetic ketoacidosis. On further evaluation of DKA, we found that it was caused by acute pancreatitis. This acute pancreatitis was found to be caused by hypercalcemia, which was in turn due to primary hyperparathyroidism. Imaging studies done for hyperparathyroidism revealed a thyroid nodule which later turned out to be malignant. This patient was also incidentally found to have hypertrophic obstructive cardiomyopathy.

Clinico-etiological Characteristics of Cystic Lung Disease: A Retrospective Study

Introduction: Diffuse cystic lung diseases (CLDs) are a heterogeneous group of uncommon disorders with characteristic imaging appearance. Cystic lung disease is a significant cause of mortality and morbidity with a wide spectrum of radiological presentations and etiological differentials. Though the literature is widely available on radiological approaches to CLD, a knowledge gap exists on the etiological spectrum, especially in the Indian scenario, as it is an orphan group of lung disorders. The interest and experience among pulmonologists regarding CLD are growing with the widespread use of CT scans. Clinical, radiographic, and histological findings are often essential for proper diagnosis, and multidisciplinary approach is required for optimal management of such cases. In our study, through real-world cases, we have highlighted the clinical manifestations and diverse etiological spectrum of CLD. Since these disorders are rare, incurable, and have variable disease progression, the authors have tried to address the holistic approach of this relatively less-understood group of disorders. Aims and objectives: The aim of the study was to identify clinical characteristics and etiological spectrum of patients manifesting with diffuse cystic lung disease radiologically. Materials and methods: In this retrospective analysis, the hospital electronic database was screened with Boolean operations and keywords for cysts OR pneumothorax. Among a total of 4,479 patients admitted to the respiratory ward /ICU during the period of January 2020–September 2022 at a tertiary care center in northern India, 14 patients with radiological diagnosis of CLD matched the relevant search. All relevant data of these patients were retrieved from the records. Results: Our patients presented predominantly with symptoms of cough and breathlessness. About 4 patients had pneumothorax as the first presentation. The mean age of presentation was 42.14 (standard deviation 12.6, age range 16–62 years). About 64% (n = 9/15) patients were females. The various etiologies identified were lymphangioleiomyomatosis (LAM), lymphocytic interstitial pneumonia, Birt–Hogg–Dube syndrome, hypersensitivity pneumonitis, Pneumocystis jirovecii pneumonia, and cystic metastasis, and in one patient, no definite cause was found despite detailed evaluation. Conclusion: Cystic lung disorders are a less commonly diagnosed entity with rare etiologies. In our study, we found a female preponderance and LAM as the commonest CLD. Pneumothorax is a sentinel event and commonly the presenting complaint in CLD. Identification of the etiology can help in institution of definite therapy when available. In view of unpredictable disease progression and outcome, these diseases warrant follow-up and imaging surveillance.

Detection of diarrheagenic Escherichia coli by multiplex PCR.

Background: Diarrheagenic E.coli (DEC) are an important cause of childhood diarrhea.Identification of DEC strains needs to detect factors that determine the virulence of these organisms. There is not much data regarding the importance of DEC as a cause of diarrhea in children in India.The prevalence of DEC in children belowfive years with and without diarrhea was studied using two multiplex PCR assays. Materials and Methods: Two multiplex polymerase chain reaction assays were used to detect genes of five types of DEC.The targets selected for each category were eae and bfpA (bundle-forming pilus) forEnteropathogenic E.coli (EPEC), hlyA for Enterohemorrhagic E.coli (EHEC), elt and stla for Enterotoxigenic E.coli (ETEC), CVD432 for Enteroaggregative E.coli (EAEC) and ial for Enteroinvasive E.coli (EIEC). Results: In 200 children with diarrhea 52 (26%) DEC infections were found. Among 100 controls 8 (8%) DEC infections were found. EAEC was the most common DEC by multiplex PCR both in cases (26, 13%)and controls (5,5%), followed byEPEC seen in 16% cases and 3% controls. ETEC and EIEC were found in 7 (3.5%) and 3 (1.5%) of the diarrheal cases. EIEC and ETEC were not detected in the control cases. EHEC was not isolated from either the diarrheal or control cases. Conclusion: DEC strains are a significant cause of diarrhea in children. The two Multiplex PCR assays can be used for the detection of DEC in routine diagnostic laboratories. These assays are specific and sensitive for the rapid detection of DEC. EAEC was the most frequent pathotype in the population under study.

Inflammatory myofibroblastic tumor parieto-occipital bone.

Inflammatory myofibroblastic tumor is a diverse group of lesions first described in lung and later on reported in various sites like stomach, bowel, spleen, bone. We report a case of inflammatory myofibroblastic tumor in a 30-year-old male who presented with a slowly progressive scalp swelling of two-year duration. Magnetic resonance imaging showed an intradiploic well enhancing lesion in parietal and occipital bone, isointense on T1 weighted images and hypo intense on T2 weighted images with dural enhancement. On histopathological examination, the lesion was composed of variable admixture of spindle cells with eosinophilic cytoplasm and inflammatory cells comprising of plasma cells and lymphocytes. The lesion was infiltrating the underlying dura. The spindle cells showed strong positivity for smooth muscle actin on immunohistochemistry. A final histopathologic diagnosis of inflammatory myofibroblastic tumor was rendered.

Effect of stress on production of heat labile enterotoxin by Escherichia coli.

Enterotoxigenic Escherichia coli (ETEC) is an important pathogen responsible for secretory diarrhoea. The production of heat labile enterotoxin (LT), by ETEC, is largely responsible for the pathogenesis of diarrhoea. In the present study we investigated the effect of stress factors such as temperature, pH, osmotic stress and nutritional limitation on the production of LT by ETEC using in-house GMI-ELISA. Four strains of E. coli consisting, one standard strain MTCC 723 and three clinical isolates were used in the study. Maximum amount of LT (OD 3.285) was produced at 37 0 C followed by 40 0 C (OD 3.305). Growth of E. coli in medium with pH 8.6 resulted in maximum amount of LT production (OD 3.489). LT was not detectable when bacteria were grown in medium with pH ≤7.2 and ≥ 9.2. Sodium chloride concentration of 0.2 M stimulated maximum amount of LT production. Maximum amount of LT was produced when the bacteria were grown in medium containing 2.5g/l of glucose. All the stress factors had a significant effect on the LT production by E. coli , though quantitative differences in the various strains were observed.

Persistent primitive hypoglossal artery associated with lower basilar artery aneurysm: diagnosis and clinical implications.

An elderly male was evaluated for subarachnoid hemorrhage and found to have a persistent primitive hypoglossal artery with its associated abnormal posterior fossa circulation and a lower basilar artery aneurysm. Angiography findings are described and are corroborated with computed tomography and magnetic resonance imaging. Its surgical and clinical relevance are discussed.

Effect of Phyllanthus niruri Linn. treatment on liver, kidney and testes in CCl4 induced hepatotoxic rats.

Phyllanthus niruri extract is extensively used in treating liver ailments. Effects of aqueous extract of P. niruri on liver, kidney and testes of CCl4 induced hepatotoxic rats were studied. High levels of malondialdehyde (MDA) were observed in the CCl4 test group with significant reduction of MDA levels in all groups on P. niruri extract administration. Highest levels of glutathione (GSH) were found in P. niruri group. Activities of alanine transaminase, aspartate transaminase and alkaline phosphatase enzymes were significantly reduced in the curative group (P. niruri treatment after CCl4 injection). Histopathology of liver showed lesser degree of inflammation in all P. niruri treated groups while the renal and seminiferous tubules showed eosinophilic protein casts with signs of tubular damage and degeneration. Testes also showed decreased amount of mature spermatozoa. The results suggest that P. niruri has anti-oxidant and hepato-protective activity with associated deleterious effects on kidney and testes.

Child friendly school initiative at Karkala Taluk, Karnataka.

We conducted a cross-sectional study in 40 schools in Karkala Taluk, Karnataka to evaluate whether they met the 10 criteria of Child Friendly School Initiative as recommended by Indian Academy of Pediatrics. Data were collected using a predesigned proforma by talking to the headmaster and school teachers and inspection of the premises for various facilities. We found that none of the schools met all the criteria; 90% of the schools did not have adequate toilet facilities, 90% did not have safe transportation for the students, children in 82% schools had excess baggage, 72% did not have access to safe drinking water, 57% did not have properly ventilated and illuminated classrooms, and physical punishment was being administered in 45% of schools. 72% of schools did have periodic health checkup, 60% of schools had clean kitchen/ dining room, 60% had adequate facilities for games, and 57% had facilities for first aid facility at school.

Effect of exposure to hydrogen peroxide on the virulence of Escherichia coli.

PURPOSE: To eliminate pathogenic bacteria, the host presents conditions that are stressful for bacteria. Oxidative stress arises when the concentration of pro-oxidants like hydrogen peroxide (H2O2 ) and superoxide anion increases to a level over the basal defence capacity of the cell. In the present study, we studied the effect of oxidative stress on the production of certain virulence factors by Escherichia coli . METHODS: E. coli was exposed to oxidative stress by growing in the presence of different concentrations of H2O2 . The effect of oxidative stress on the expression of surface hydrophobicity, adherence, haemolysin production, serum resistance and phagocytosis was studied. RESULTS: Oxidative stress caused a significant decrease in the expression of all the virulence factors of E. coli . CONCLUSIONS: Synthesis of virulence factors can be significantly altered by oxidative stress and such changes may affect the pathogenicity of E. coli.

Isolated intracranial Rosai Dorfman disease masquerading as meningioma: a case report.

Isolated intracranial Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is rare. We present a 26-year-old male who presented with left focal motor seizures becoming secondarily generalized of one-year duration. Clinically and radiologically patient was diagnosed to have a right parietal convexity meningioma. However on histopathological examination a final diagnosis of intracranial Rosai Dorfman disease was rendered.

Dermatoglyphic peculiarities in children with oral clefts.

In humans, the development of the primary palate and the lip is completed by the 7th week of intra uterine life and that of secondary palate by 12th week. The dermal ridges develop in relation to the volar pads, which are formed by the 6th week of gestation and reach maximum size between 12th and 13th weeks. This means that the genetic message contained in the genome - normal or abnormal is deciphered during this period and is also reflected by dermatoglyphics. Hence this study was done in order to observe the differences in dermatoglyphic patterns between the children with oral clefts and normal children and to determine the usefulness of dermatoglyphics in studying the genetic etiology of oral clefts. Dermatoglyphic data from 50 oral cleft children and 50 normal children were collected using the ink method and comparison was done between them. In the present study, we found an increase in the ulnar loop patterns on the distal phalanges of the ten fingers, an increase in the atd angle and an increase in the fluctuating asymmetry of the atd angle in the oral cleft children which indicates the degree of developmental instability of the oral cleft individual.

Alterations in tumour suppressor gene p53 in human gliomas from Indian patients.

Alterations in tumour suppressor p53 gene are the most common defects seen in a variety of human cancers. In order to study the significance of the p53 gene in the genesis and development of human glioma from Indian patients, we checked 44 untreated primary gliomas for mutations in exons 5-9 of the p53 gene by PCR-SSCP and DNA sequencing. Sequencing analysis revealed six missense mutations. The incidence of p53 mutations was 13.6% (6 of 44). All the six mutations were found to be located in the central core domain of p53, which carries the sequence-specific DNA-binding domain. These results suggest a rather low incidence but a definite involvement of p53 mutations in the gliomas of Indian patients.

Caries prevalence amongst handicapped children of South Canara district, Karnataka.

This epidemiological investigation was carried out among 524 handicapped children in the age group of 3-30 years, attending 8 different non-residential special schools in South Canara district, Karnataka. The examination procedure and criteria were those recommended by W.H.O. in 1997. The total caries prevalence was found to be 71.56%. The mean deft in the primary dentition was found to be 3.06 +/- 3.14. The mean deft and DMFT in the mixed dentition were 3.32 +/- 2.82 and 1.14 +/- 1.08 respectively. The mean DMFT in the permanent dentition was 4.51 +/- 3.17. The prevalence of dental caries was higher in the mentally subnormal and handicapped children. The decayed component constituted the majority of the dental caries index. Lack of conservative approach to the treatment had been confirmed in the study.

An Unexpected Fatal Complication Following a Re-do Mitral Valve Replacement.

Cardiac surgery involving cardiopulmonary bypass (CPB) is known to be associated with many major complications. A rare complication following a re-do mitral valve replacement (MVR) which turned out to be fatal is discussed.

An unusual systemic presentation of gout.

An elderly female presented with a systemic febrile illness and acute polyarthritis as the first manifestation of gout. She improved dramatically with anti-inflammatory therapy.

Relationship between the existing caries status, plaque S. mutans and Cariostat caries activity test in children.

An attempt was made in this study to find out the sensitivity and specificity of a caries activity test, CARIOSTAT and its relationship to the existing caries status and the plaque S. mutans level. The test proved to be highly sensitive and specific with significant relationship to the S.mutans count in the dental plaque. There also was a significant relationship between both the cultured microorganisms on MSB agar and the plaque in the Cariostat medium.

Trigeminal evoked potentials in patients with symptomatic trigeminal neuralgia due to intracranial mass lesions.

Trigeminal evoked potentials (TEP) were recorded by electrical stimulation of the lips in 7 patients with symptomatic trigeminal neuralgia due to CT proved mass lesions involving the trigeminal nerve. All the patients showed TEP abnormalities on the affected side. Chronic compression and irritation of the trigeminal nerve may be responsible for these changes. The results obtained were compared with other similar studies and TEP abnormalities observed in idiopathic trigeminal neuralgia. As all the patients had unequivocal compression of the trigeminal nerve and all of them had TEP changes, it can be concluded that TEP abnormality is an accurate predictor of trigeminal nerve compression. TEPs may be a valuable aid in demonstrating a compressive element in patients with trigeminal neuralgia.