Breast mass - An uncommon clinical manifestation of ovarian carcinoma: A case report and brief literature review

Metastasis from non-mammary malignant neoplasms to the breast is rare and represents 0.2%-1.3% of all breast malignancies. Fine needle aspiration cytology (FNAC) is the first line of investigation for any breast lump and cyto-morphological appearance of primary breast malignancies is well documented. Occasionally metastasis to the breast may be the initial presentation and can masquerade clinically as primary breast malignancy. The present case describes the clinical and cytological challenges in an unusual case of ovarian carcinoma with initial presentation as breast mass, mimicking as inflammatory carcinoma. In cytology the breast lesion was initially misdiagnosed as primary breast carcinoma and subsequently diagnosed as metastatic ovarian carcinoma based on core needle biopsy findings, aberrant immuno-profile and clinical findings; thus making the complex case worthy of discussion.

Effectiveness of implementation of formative assessments as a part of competency-based medical education on summative assessment: A pilot study

Background: Assessment is an essential part of each and every education, which represents the learning of a student. If the assessments are performed regularly, it inspires active study habits and inevitably enhance learning. Aim and Objectives: Formative assessments, which are performed regularly, increase the effectiveness of the learning. Hence, we aimed to observe the effectiveness of spaced formative assessments on the performance of students in summative assessments. Materials and Methods: We selected 250 first-year medical students from the 21 to 22 batch. The students were categorized into three groups on the basis of formative assessment performance. Group I did not appear in the formative assessment, Group II scored <50% in the formative assessment, and Group III scored more than 50% in the formative assessment. Multiple comparisons of scores of summative assessments between different groups were done using ANOVA. Scores of formative assessments and summative assessment were correlated using Pearson correlation. Results: We got a statistically significant difference (P < 0.05) in mean summative assessment scores in different groups. Again, the analysis showed formative assessments had a significant (P < 0.05) relationship with summative assessment performance. Conclusion: The performance of formative assessments is predictive of summative examination scores. Academically poor medical students will be benefited from formative assessments.

Impact of yoga on lipid parameters in different age groups

Background: Cardiovascular diseases (CVDs) rise first among the causes of death occurring due to non-communicable diseases in the world. The majority of cardiovascular deaths are due to ischemic heart disease and cerebrovascular disease. Among the major risk factors, dyslipidemia is an important risk factor. Hence, the prevention of dyslipidemia results in the prevention of ischemic heart disease. Dyslipidemia can be corrected by drugs but more importantly, it can be prevented by lifestyle modification. Aim and Objectives: Our aim is to observe the impact of yoga on lipid parameters in different age groups. Materials and Methods: We included 54 subjects between the age group of 30 and 60 years for this study. They were categorized into two groups: Group I having ages between 30 and 45 years (n = 23) and Group II having ages between more than 45 years and <60 years (n = 31). The lipid parameters were measured afore of yoga training, at the end of 2 months and after 6 months of yogic practices. Statistical analysis was done using the SPSS version of 20.0. A P value of less than 0.05 is considered as statistically significant. Results: Our study revealed that yoga induces a decrease in total cholesterol, triglycerides, low-density lipoprotein cholesterol, and very LDL cholesterol and an increase in high-density lipoprotein cholesterol in both Group I and Group II subjects which were statistically significant. Conclusion: Yoga tends to improve dyslipidemia, a major risk factor for CVDs. A yoga lifestyle can be considered a preventive measure for CVDs.

Brunner's gland hamartoma with dysplasia, presenting as multiple duodenal polyps: An unexplored entity with literature review

Brunner's gland hamartomas (BGHs) are uncommon lesions of duodenum which show hyperplasia of these glands along with smooth muscle bundles, adipose tissue and lymphoid aggregates. These are usually benign, solitary, pedunculated, polypoidal lesions. Dysplastic changes in BGH are extremely rare and even rarer is the multiplicity of this lesion. We hereby report an index case of BGH showing features of high-grade dysplasia, presenting as multiple duodenal polyps.

Mullerian adenosarcoma (heterologous) of uterine cervix with sarcomatous overgrowth: A case report with review of the literature

Mullerian adenosarcoma is a rare biphasic malignant neoplasm of cervix characterized by an admixture of benign epithelial elements and a malignant sarcomatous stromal component, which may be either homologous or heterologous. Mullerian adenosarcoma with stromal overgrowth (MASO) in an aggressive variant of adenosarcoma, which is extremely rare with only two such cases reported till date. In this report, we present a case of MASO of cervix with heterologous elements in a 55/F presenting with postmenopausal bleeding. As it commonly simulates clinically and radiologically as benign cervical polyp, the gynecologists and pathologists should be aware of this extremely rare entity presenting with aggressive clinical course.

Bacteriological profile of ventilator-associated pneumonia in a tertiary care hospital

Background: Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection. The etiology of VAP and their antimicrobial susceptibility pattern varies with different patient populations and types of ICUs. Materials and Methods: An observational cross-sectional study was performed over a period of 2 years in a tertiary care hospital to determine the various etiological agents causing VAP and to detect the presence of multidrug-resistant (MDR) pathogens in these VAP patients. Combination disk method, Modified Hodge test, ethylenediaminetetraacetic acid disk synergy test, and AmpC disk test were performed for the detection of extended-spectrum beta-lactamase (ESBL), carbapenemases, metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: The prevalence of VAP was 35%. Enterobacteriaceae (66.66%) and Staphylococcus aureus (20%) were common in early-onset VAP, while nonfermenters (50%) and Enterobacteriaceae (40.61%) were predominant from late-onset VAP. Nearly 60.87% of the bacterial pathogens were MDR. ESBL was produced by 21.74% of Enterobacteriaceae. AmpC ?-lactamase was positive in 35.29% nonfermenters and 26.08% Enterobacteriaceae. MBL was positive in 17.64% nonfermenters and 17.39% Enterobacteriaceae. Among the S. aureus isolates, 75% were cefoxitin resistant. Prior antibiotic therapy (P = 0.001) and hospitalization of 5 days or more (P = 0.001) were independent risk factors for VAP by MDR pathogens. polymyxin B, tigecycline, and vancomycin were the most sensitive drugs for Gram-negative and positive isolates respectively from VAP. Statistical Analysis: SPSS for Windows Version SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and Chi-square with Yates correction. Conclusion: Late-onset VAP is increasingly associated with MDR pathogens. Treatment with polymyxin B, tigecycline, and vancomycin should be kept as last-line reserve drugs against most of the MDR pathogens.

Biofilm as a virulence marker in Candida species in Nosocomial blood stream infection and its correlation with antifungal resistance.

Nosocomial blood stream infections (BSI) due to fungi especially Candida is increasing steadily. A two year prospective study was conducted in the S.C.B. Medical College with an aim to evaluate the species distribution, antifungal susceptibility and biofi lm formation of Candida spp. isolated from nosocomial BSIs. 34 Candida spp. were isolated from 359 blood cultures. Antifungal susceptibility was performed by microbroth dilution technique and both visual and spectrophotometric method were used for biofi lm detection. C. tropicalis was the common spp. isolated followed by C. parapsilosis and others. Most (92%) of the isolates were susceptible to Amphoterecin-B and highest resistance was observed against Flucytosine (37%) and Fluconazole(35%). Biofi lm production and antifungal resistance was observed more in nonalbicans Candida spp.

Tuberculous Synovitis of Knee Joint.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tuberculous synovitis of the knee joint in a 69 years old male. The diagnosis was done by Ziehl – Neelsen stain and culture on Lowenstein – Jensen medium of the synovial fluid along with X-ray finding of the knee joint. Though the sputum sample was negative for AFB, X-ray of the chest showed finding suggestive of old pulmonary tuberculosis. The patient was treated with the anti tubercular regimen and responded well .

Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma.

Chondroid hamartomas of the lung are uncommon lesions which are generally small sized and asymptomatic. Herein we describe a case of a large-sized pulmonary chondroid hamartoma which clinically mimicked bronchogenic carcinoma. A large hilar growth was detected in the left lung on radiological studies. Left upper lobectomy was done. The growth was well defined with a lobulated bluish cut surface. Histopathology disclosed lobules of mature cartilage rimmed by long slit-like epithelial channels admixed with mature adipose tissue.

Successful replacement of fetal calf serum with human urine for in vitro culture of Leishmania donovani.

Leishmania donovani causes visceral leishmaniasis claiming several thousand lives every year in Indian sub-continent. The etiological agent is grown in cell free media supplemented with fetal calf serum (FCS). Urine from human beings and other mammalian species has also been reported to stimulate growth of Leishmania species No study has been carried out Leishmania donovani. Therefore, we studied the feasibility of culturing Leishmania donovani promastigotes in M199 medium supplemented with 10% human urine and compared the phenotypic and genotypic characters under supplementation with urine vis-a-vis FCS. The growth curve showed no significant difference in the promastigote counts in urine vs. FCS supplementation. The best growth was observed in cultures supplemented with the post-menopausal urine. No difference in antigenic bands and RFLP pattern was seen indicating that no alteration occurred in strain specific characters of the parasites cultured with human urine.