Role of histopathological and microbiological investigations for a definitive diagnosis of benign sinonasal masses: a tertiary care institute study

Background: This research aimed to study the clinical presentation of various sino nasal masses (SNM), to study the importance of Histopathological and microbiological investigations in making diagnosis of SNM and to study the correlation between clinical, radiological, histopathological, and microbiological findings of SNM. Methods: In the present study 50 patients attending the ENT outpatient department with clinical evidence of nasal mass were selected based on inclusion and exclusion criteria. Patients were examined clinically and radiologically followed by surgical intervention. Histopathological and microbiological examination was done to make a definitive diagnosis. Results: Majority of cases were from 21-40 years age group (66%) with male preponderance. Nasal obstruction was most common symptom 45 (90%) followed by nasal discharge 43(86%). On histopathology highest incidence was of inflammatory polyps 22 (44%) followed by allergic polyps 14(28%) and non-invasive fungal sinusitis (NIFS) 11 (22%) respectively. Microscopically in KOH, fungal elements, yeast and hyphae were seen in total 11 (22%) cases and with SDA, Aspergillus niger was seen in 7 (14%) cases, Candida albicans in 3 (6%) and both in 1 (2%) case. Correlation of provisional diagnosis with HPE was found to be highly significant. Conclusions: It was observed that histopathological and microbiological examination is irreplaceable as both are the 揋OLD STANDARD� for making a definitive diagnosis.

Fertility preservation in women undergoing treatment for malignancies: a narrative review

Incidence of cancer is increasing in young patients with simultaneous improvement in survival secondary to advances in cancer treatment. Fertility preservation in this young population is often overlooked in view of priority of cancer treatment, however it is important to avoid distress and provide a good quality of life in these young patients of child bearing age. Fertility might be affected due to systemic therapy like chemotherapy, radiotherapy and surgery involving reproductive organs. Timely referral to reproductive specialist during the narrow window after diagnosis and before starting cytotoxic treatment is required. Embryo and oocyte cryopreservation remains the gold standard with ovarian tissue cryopreservation and re-transplantation undertaken for special situations. Patients undergoing pelvic or abdominal radiotherapy benefit from ovarian transposition and ovarian shielding. Medical gonado-protection with Gonadotropin releasing hormone agonist during cytotoxic chemotherapy remains an area of controversy with conflicting results with recent consensus for use in premenopausal breast cancer patients. Patients requiring surgery for endometrial cancer, ovarian cancer or cervical cancer may be considered for conservative management including conservative surgery for early stage cancers with specific indications with the intent to allow patients to complete family. Adequate patient counselling for oncology outcomes and fertility preservation are required to enable the patients to take informed decisions to choose the unconventional path of cancer management and uncertainty involving pregnancy and live births.

The impact of hospitalization on mortality in patients with connective tissue disease-associated interstitial lung disease: a medical records review study

Abstract Background Interstitial lung disease (ILD) remains one of the most important causes of morbidity and mortality in patients with Connective Tissue Diseases (CTD). This study evaluated the impact of hospitalization on mortality in an ethnically and racially diverse cohort of CTD-ILD patients. Methods We conducted a medical records review study at Montefiore Medical Center, Bronx, NY. We included 96 patients and collected data on demographic characteristics, reasons for hospitalization, length of stay, immunosuppressant therapy use, and mortality. We stratified our patients into two cohorts: hospitalized and nonhospitalized. The hospitalized cohort was further subdivided into cardiopulmonary and non-cardiopulmonary admissions. Two-sample tests or Wilcoxon's rank sum tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables were used for analyses as deemed appropriate. Results We identified 213 patients with CTD-ILD. Out of them, 96 patients met the study's inclusion criteria. The majority of patients were females (79%), and self-identified as Hispanic (54%) and Black (40%). The most common CTDs were rheumatoid arthritis (RA) (29%), inflammatory myositis (22%), and systemic sclerosis (15%). The majority (76%) of patients required at least one hospitalization. In the non-hospitalized group, no deaths were observed, however we noted significant increase of mortality risk in hospitalized group (p = 0.02). We also observed that prolonged hospital stay (> 7 days) as well as older age and male sex were associated with increased mortality. Conclusion Prolonged (> 7 days) hospital stay and hospitalization for cardiopulmonary causes, as well as older age and male sex were associated with an increased mortality risk in our cohort of CTD-ILD patients.

Schizencephaly: a rare case with early diagnosis, management and review of literature

Schizencephaly or split brain is an uncommon congenital disorder of cerebral cortical development, belonging to the group of cell migration defects. It is characterized by the presence of a cleft in the brain extending from the surface of the piamater to the cerebral ventricles. A 21-year-old primigravida at 19+2 weeks of gestation was referred to our Outpatient department with a level-2 ultrasound done at 18+2 weeks suggestive of schizencephaly. First trimester genetic screening was not done. Quadruple testing was normal. After genetic consultation and poor prognostication by neonatologist, decision for medical termination of pregnancy was taken. Patient underwent medical termination with mifepristone -misoprostol regimen. A female abortus weighing 200 gm was delivered. Gross examination showed only facial malformation in the form of cleft lip and hypoplastic nose. Infantogram did not reveal any skeletal deformity. On fetal autopsy, findings were consistent with the diagnosis of schizencephaly (type 1). Schizencephaly is a rare disorder in prenatal medicine with grave prognosis. Majority of cases are either diagnosed at late gestation or present in the first decade of life. Hence with periodic surveillance during antenatal care and help of ultrasonography, such rare and serious congenital malformations can be diagnosed and managed at an early stage.

A rare case of broad ligament fibroid in Mayer-Rokitansky-Küster-Hauser syndrome

Mayer-Rokitansky Kuster Hauser (MRKH) syndrome with lieomyoma is a rare disorder. Women with this syndrome have normal 46 XX karyotype, normal secondary sex characteristics and primary amenorrhea. There is a scarcity of cases in the literature where fibroid develops in women suffering from MRKH syndrome. Here, we present a case of an ectopic broad ligament fibroid found in a 41-year-old woman with MRKH syndrome type II. A 41-year-old married nulliparous female diagnosed with MRKH syndrome 20 years back, presented with an abdominal mass. Trans-abdominal ultrasound suggested a large mass on right side arising from paracolic area with heterogeneous echo texture. However, the ovarian vs leiomyoma origin of mass was of diagnostic dilemma. CEMRI confirmed the same findings and ruled out ovarian origin of the mass along with the presence of rudimentary uterus. Following this, the patient was taken for laparotomy followed by total abdominal hysterectomy with bilateral salpingoopherectomy, the fibroid was found to be arising from broad ligament and was removed along with the hypoplastic uterus and bilateral Fallopian tubes and ovaries. The case we presented exhibits the development of leiomyomas in patients with MRKH syndrome, although rare, is always a possibility and should be kept in mind as a differential diagnosis while evaluating an abdominopelvic mass. MRI is an accurate modality both for delineating the mass, confirming its origin as well as diagnosing MRKH syndrome.

Heart Smart Diabetes Care

The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.

Hormonal profile of survivors of breast cancer with fatigue: A pilot study

Background & objectives: One of the most common problems experienced by breast cancer survivors (BCSs) is fatigue. There has been little research about the status of hormones in breast cancer patients as an aetiology of cancer-related fatigue (CRF). Hence, a pilot study was conducted to assess the levels of hormones such as thyroid, cortisol, dehydroepiandrosterone sulphate (DHEAS), oestrogen and progesterone in BCSs with fatigue. Methods: BCSs with complaints of fatigue were assessed using the Brief Fatigue Inventory (BFI) tool and evaluation of the hormone profiles was done in moderate-to-severe fatigued survivors. Data collected were analyzed to look for any association between fatigue and altered hormonal levels. Results: In this study, 56 per cent (n=62) of survivors experienced moderate-to-severe fatigue out of 110 patients reporting fatigue. Thyroid functions were deranged in 22 patients (35.48%). The thyroid stimulating hormone (TSH) levels were found to have a significant negative association with the severity of fatigue, (P<0.05). Twelve patients (19.35%) had reduced DHEAS levels suggestive of impaired hormone synthesis in the adrenal gland. Twenty two postmenopausal survivors (35.48%) had raised oestradiol levels. Interpretation & conclusions: The findings of this study suggest that the hormonal milieu, especially thyroid hormone and DHEAS may have a role in CRF experienced by BCSs and needs further exploration.

Concomitant Transcatheter Transfemoral Double Native Valve Replacement for Severe Aortic Stenosis and Severe Mitral Stenosis with Mitral Annular Calcification

Concomitant mitral and aortic valve stenosis in a patient with mitral annular calcification and porcelain aorta poses a unique problem to the surgical team. Transcatheter aortic and mitral valve replacements in native valves offer a viable option for such selected group of patients. We present the case of a 54-year-old male who presented with severe aortic stenosis (AS) and severe mitral stenosis (MS) but was deemed high risk for surgery owing to intense calcification of the aorta and mitral annular calcification, and successfully underwent transcatheter double native valve replacement.

Missed tubal ectopic pregnancy in hysterectomised patient: a rare case report

Tubal ectopic pregnancy (EP) in hysterectomised patient is uncommon. It has propensity to be overlooked. We report a rare case of missed tubal ectopic in 46 years old hysterectomised patient. She presented with abdominal pain and adnexal mass on imaging. Diagnosis was only possible intraoperatively owing to overlapping symptoms and imaging features with that of ovarian tumor.

Heart Smart Diabetes Care

The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.

Glucometric Guardianship

This communication conceptualizes, defines and describes glucometric guardianship, as a means of ensuring optimal glycemic management. We define glucometric guardianship as the process of ensuring appropriate measurement, monitoring and analysis of glucose levels, so as to ensure alertness in glycemic management, and agility in anticipating and detecting suboptimal glycemic parameters, and responding to them. This paper hopes to draw attention to the need for glucometric science, encourage debate and discussion and facilitate research on the topic.

Comparison of Intraoperative Low-Dose Ketodex and Fentanyl Infusion for Postoperative Analgesia In Spine Surgery: A Prospective Randomized Double-Blind Study

Methods@#The study included 60 patients graded American Society of Anesthesiologists I and II and scheduled for thoracolumbar spine surgery involving >3 vertebral levels. The patients were divided into two groups: group KD (ketodex) and group F (fentanyl). The primary objective was to compare the postoperative analgesic requirements among the groups. The secondary objectives included a comparison of the intraoperative anesthetic requirements, postoperative pain scores, hemodynamic parameters, side effects of the study drugs, and the duration of post-anesthesia care unit stay of both the groups. @*Results@#Ketodex use prolonged the mean time to first rescue analgesia (22.00±2.30 hours vs. 11.69±3.02 hours, p 0.05). The postoperative pain scores were significantly lower in the group KD than in group F at most timepoints (p 3 vertebral levels to achieve prolonged analgesia without any opioidrelated side effects.

Evaluation of antifungal susceptibility and clinical characteristics in fungal keratitis in a tertiary care center in North India

Purpose: To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North Indian population. Methods: Prospective study of the antifungal sensitivity testing (natamycin, amphotericin B, voriconazole, itraconazole, fluconazole, posaconazole, caspofungin, micafungin) of fungal isolates from 50 cases of culture positive fungal keratitis by using E test method. Details noted included demographic data, visual acuity, clinical details, grade of keratitis, healing time, and success in medical management. Results: Of 50 patients with fungal keratitis (mean age: 40.28 ± 16.77 years), 12 eyes healed within 3 weeks, 14 had a delayed healing response, and 24 had chronic keratitis. Among the 15 cases of Fusarium isolates, 93.3% were sensitive to natamycin, while 40% to amphotericin B; 66.6% to voriconazole, 13.4% to itraconazole and fluconazole each. 80% of Fusarium cases (n = 12) showed susceptibility to posaconazole. Among Aspergillus flavus isolates, 53.4% (n = 8) were sensitive to natamycin, with only 40% (n = 7) showing sensitivity to amphotericin B and good susceptibility to azoles. MIC against susceptible Fusarium spp. for natamycin was 3–16 ?g/mL, amphotericin B: 1–8 ?g/mL, voriconazole: 0.5–1.5 ?g/ mL, itraconazole: 0.5–12 ?g/mL, posaconazole: 0.094–1.5 ?g/mL. MIC against Aspergillus flavus was natamycin: 8–32 ?g/mL, amphotericin B: 0.5–16 ?g/mL, voriconazole: 0.025–4 ?g/mL, itraconazole: 0.125–8 ?g/mL, posaconazole: 0.047–0.25 ?g/mL; against Aspergillus niger isolates, to natamycin was 6 ?g/mL (n=1), amphotericin B 8–12 ?g/mL (n = 3), voriconazole: 0.125–0.19 ?g/mL (n = 3), itraconazole: 0.38–0.75 ?g/mL, posaconazole: 0.064–0.19 ?g/mL and against Aspergillus fumigatus (n = 1), was natamycin4 ?g/ mL, amphotericin B ? 8 ?g/mL, voriconazole 0.25 ?g/mL, itraconazole 1 ?g/mL, and posaconazole 0.19 ?g/mL. MIC against susceptible Acremonium spp. for natamycin was 1.5–16 ?g/mL, amphotericin B: 0.5–8 ?g/mL, voriconazole: 0.19–3 ?g/mL, itraconazole: 0.125 ?g/mL, posaconazole: 0.125–0.5 ?g/mL and against susceptible Curvularia was natamycin 0.75–4 ?g/mL, amphotericin B 0.5–1 ?g/mL, voriconazole 0.125–0.19 ?g/mL, itraconazole 0.047–0.094 ?g/mL, posaconazole 0.047–0.094 ?g/mL. MIC against Mucor spp.+ Rhizopus spp. (n = 1) was natamycin: 8 ?g/mL, amphotericin B: 0.75 ?g/mL, posaconazole: 1.5 ?g/ mL. MIC against of Alternaria (n = 1) was voriconazole: 0.19 ?g/mL, posaconazole: 0.094 ?g/mL. MIC against Penicillium (n=1) was natamycin: 8 ?g/mL, voriconazole: 0.25 ?g/mL, itraconazole: 0.5 ?g/mL, and Posaconazole: 0.125 ?g/mL. Conclusion: Our observations highlight the variations in susceptibility to antifungal agents. Posaconazole seems to be effective with low MIC against common corneal pathogenic fungal isolates

Choosing Glucose-lowering Therapy: A Collaborative Choice Model

Diabetes care is challenging, and the increasing number of available therapeutic options has made it even more complex. Moreover, with an increasing prevalence across the world, it needs to be managed right from the primary care level to a quaternary care hospital. This calls for an easy-to-use algorithm that can be used by a general practitioner, who is often the first contact of a patient to manage diabetes in many countries. There are multiple models to assist in choice of pharmacotherapy, and these have evolved over time. We propose a user-friendly collaborative choice, as an aid to clinical decision-making. This alliterative framework supplements and strengthens existing guidance, by creating a comprehensive, yet simple, thought process for the diabetes care professional.

Motivating Persons Living with Diabetes for Insulin/Injectable Therapy

Motivating patients to initiate or intensify insulin is a challenging aspect of diabetes practice. This paper reviews certain motivational strategies and methods used for insulin initiation/intensification. It places various domains of motivational interviewing in perspective, under a single umbrella, making it easier for practitioners to understand the art and science of insulin motivation.

Feasibility and impact of screening for venous thromboembolism in treatment?naive lung cancer patients–Results of a prospective cohort study

Background: Venous thromboembolism (VTE) in cancer remains underdiagnosed. This prospective study aimed to evaluate the feasibility of screening for VTE in lung cancer (LC) patients. We assess the incidence of VTE, its risk factors, and effects on overall survival (OS). Methods: Consecutive treatment?naive LC patients were screened for deep venous thrombosis (DVT) with compression ultrasonography and pulmonary thromboembolism (PTE) with computed tomography pulmonary angiography (CTPA) at diagnosis and after 3 months of treatment. The incidence rate of VTE (DVT and/or PTE) was calculated. Risk factors associated with VTE were assessed using logistic regression analysis. All participants were followed?up to 1 year after enrollment. OS was compared in LC subjects with and without VTE, using the Cox proportional hazard analysis. Results: Around 301 subjects with LC (stages IIIB?IV accounted for 83.1%) were enrolled, of which 16 had VTE (5.3%). The incidence rate of VTE was 90 per 1000 person?years (PY). PTE was asymptomatic in 27.3% of cases while all DVT episodes were symptomatic. The incidence rate of asymptomatic PTE identified during the screening was 17 per 1000 PY. The median duration from LC diagnosis to the VTE event was 96.5 days. Median OS was significantly less in VTE patients [161 versus 311 days; P = 0.007] and death was attributable to VTE in 50%. After adjusting for covariates, VTE (hazard ratio [HR] = 2.1), smoking (HR = 1.7), and Eastern cooperative oncology group performance status ?2 (HR = 1.6) were independently associated with poor OS in LC. Conclusions: VTE occurs in approximately 1 in 20 newly?diagnosed patients with LC and is associated with decreased OS. Screening for PTE may be considered even in resource?limited settings

Acute Kidney Injury in Dengue Fever: A One-year Hospital-based Prospective Cross-sectional Study

Background and objectives: Dengue fever is amongst the most cardinal arthropod-borne infection among humans. Around the world, an estimated 2.5 billion individuals are at peril of infection, of which approximately 975 million reside in urban areas of tropical and subtropical nations like Southeast Asia, the Pacific, and surprisingly Americas. Acute kidney injury (AKI) is so far not a well-studied dengue complication. The renal abnormalities, though not common, are AKI, proteinuria, glomerulonephritis, and hemolytic uraemic syndrome, which are considered complications of the disease. This study was designed to evaluate the prevalence of AKI in DF and find out the predictors of the development of AKI in patients with DI. Methodology: This one-year hospital-based cross-sectional study was performed in the Department of General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala from March 2020 to April 2021. A total of 120 eligible patients with DI were enrolled. These patients were evaluated for AKI based on acute kidney injury network (AKIN) criteria. Results: The majority of the patients were males 57.5% and the male to female ratio was 1.35:1. Most of the patients were aged between 31 and 50 years (40.8%) and the mean age was 42.23 ± 16.28 years. The majority of the patients (72.5%) had DF, 13.3% of the patients had dengue fever with warning signs and 14.2% of the patients had severe dengue. The prevalence of AKI was 27.5% in patients with dengue fever. Other than AKI, Acute respiratory distress syndrome (ARDS) (11.7%), Multiple Organ Dysfunction Syndrome (MODS) (3.3%), and sepsis (0.8%) were the complications noted. The majority of the patients (83.3%) improved and were discharged and mortality was noted in 16.7% of the patients. Also, significant differences were noted in patients with and without AKI.

Purification, characterization and potential detergent industry application of a thermostable ?-amylase from Bacillus licheniformis RA31

?-Amylase is an endoamylase catalysing the degradation of starch into maltose, maltotriose and glucose. The enzyme isolated from microbial sources possess unique properties of thermostability thus making it a useful tool in the detergent industry. Here, we explored a strain of thermophilic bacteria Bacillus licheniformis for its potential application in detergent industry. The B. licheniformis RA31 was isolated from soil samples of hot spring in Rampur district of Himachal Pradesh, India and grown on optimized media to produce thermostable ?-amylase. The enzyme was ethanol precipitated, purified (12.93 fold, 55.52% yield and 621.93 U/mg specific activity) to homogeneity with a single band on SDS-PAGE (66 kDa) and native-PAGE (68 kDa). Purified enzyme displayed best activity in pH 8 buffer and ?80% activity was retained in pH 7 and 10. It showed temperature optima at 70°C. Its activity was decreased at 70°C (70% after 4 h), 80°C (65% after 4 h) and 90°C (50% after 1 h). The enzyme was stimulated (126%; 5 mM) by barium chloride. It was relatively stable in the presence of commercial detergents (109-125%), SDS (84%), Tween 20 (88%), EDTA (72%) and ?-ME (70% at 10 mM). Km and Vmax for the enzymatic hydrolysis of starch were 0.339 mg/mL and 1.450 mg/min, respectively. The enzyme revealed the highest specificity towards wheat starch granule (140% after 1 h) and SEM analysis displayed its biodegradation (2-10 h). Improved cleaning efficiency of potato curry stained fine cotton clothes were observed with enzyme assisted detergent advance treatment (0.02% w/v). The enzyme showed potential applications in detergent industry.

Langerhans cell sarcoma with BRAF?V600E mutation and hemophagocytosis: An autopsy report

Langerhans cell sarcoma (LCS) is a rare high-grade neoplasm of langerhans cell phenotype having unambiguous malignant cytological features. We report such a rare case in a 20-year-old man who presented with dyspnea and high-grade fever. On evaluation, he had generalized lymphadenopathy, hepatosplenomegaly, and a large anterior mediastinal mass. Fine needle aspiration from the mediastinal mass and bone marrow aspirate showed numerous atypical cells, many of which showed grooved nuclei. In addition, the bone marrow showed prominent hemophagocytosis. The patient had a stormy hospital stay and succumbed to the illness. The autopsy revealed a rare multisystem involvement by LCS involving the lymph nodes, liver, spleen, lungs, and intestine, which harbored a BRAFV600E mutation and was associated with hemophagocytosis