Lineage switch of acute myeloid leukemia to T-Cell acute lymphoblastic leukemia – A unique case report

“Lineage switch” is term described when leukemic cells on relapse exhibit a new phenotype, where losses of one lineage defining markers with simultaneous gain of another lineage defining markers occur. Relapse of acute leukemia is although a very common event, lineage switch occurs and reported very rarely in such cases. The pathogenesis involved in this phenomenon remains unclear; however plasticity of hematopoietic progenitor affected by intrinsic and extrinsic environmental cues can be a possible explanation. In most of the cases at the time of relapse conversion of B-acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML) occurs. Here, we presented an unusual case of 10 year old boy with AML switched to T-ALL upon relapse, which is very rare and not well documented till date in literature. The diagnosis was further supported by morphologic, cytochemistry and flowcytometric immunophenotyping (FCM-IPT). Prognosis and survival of such cases remains poor even by the use of standard chemotherapy.

Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery

Purpose: To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods: In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results: The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion: ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3–4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.

Prevalence and risk factors of anemia and zinc deficiency among 4�year-old children of Allahabad District, Uttar Pradesh

Anemia and zinc deficiency are two of the most daunting nutritional problems afflicting the young children among developing countries like India. Thus, in view of this the following study was designed to investigate the status of undernutrition and micronutrient status (iron and zinc) of children aged between 4 and 6 years of Allahabad district. The anthropometric measurements (height and weight); biochemical parameters (hemoglobin and serum zinc), and general information of the children were recorded. Out of the total 365 children studied, 92.9% were anemic out of which 90.6% (n = 307) were moderately anemic having and 2.3% belonged to mild anemic group. Serum zinc deficiency was 65.3%. Anemia was more commonly observed among undernourished children. In case of zinc deficiency poor nutritional status, the age of 60� months and rural settlement projected out to be the potent risk factors.

Outcomes of rhegmatogenous retinal detachment surgery in eyes with pre-existing glaucoma drainage devices

Purpose: To evaluate the outcome of rhegmatogenous retinal detachment (RRD) surgery in eyes with preplaced glaucoma drainage device (GDD) with respect to intraocular pressure (IOP) control as well as success of retinal detachment (RD) surgery. Methods: It is a retrospective case series. The case records of patients who underwent RD surgery after GDD implantation from 2000 to 2014 were screened. The demographic data, ocular examination findings at all visits, details pertaining to retinal detachment and its repair, and the postoperative course was documented. Results: Twelve patients were included in study. The mean age of patients was 24.3 years (median 11 years; range 3-72 years). Male: Female ratio was 3:1. Mean duration between GDD and RD was 24 months (4 days-91 months). Of the ten eyes that underwent surgery, nine eyes underwent pars plana vitrectomy, and in one eye scleral buckling was done. GDD was removed only in one eye. At final follow-up, retina was attached with controlled IOP in 6 (60%) eyes, of which 5 (50%) had improvement in best corrected visual acuity. Conclusion: Pars plana vitrectomy was required in almost all cases for the management of RD in eyes with preplaced GDD. Retinal reattachment with good IOP control could be achieved in 60% of eyes. Removal of the drainage device was not essential for the effective management of the RRD in most cases. With multidisciplinary approach, close follow-up and timely intervention, vision can be preserved along with glaucoma control and successful retinal reattachment.

The Scope Of Ayurvedic Medicine And Therapy In The Managment Of Infertility

Infertility is described as an inability to conceive despite unprotective sex for duration of one year or more. Male, female or both can be a victim for this disorder. There may be many biological causes of infertility including some can be treated with medical or surgical intervention. Ayurveda consider this problem as a cause of deterioration of quality of four factors i.e., time of ovulation, female health in context of reproductive system, quality of sperm and ovum and female抯 proper nutrition. There are different treatment methods and medicines used according to the deficit in male, female or in both. Vajikaran drugs like Ashwagandha, Madhuyasthi, Vidarikanda, Gokshura etc., are used in male fertility problems and Satavari, Punarnava, Dasmoola, Aloevera etc., used in female infertility problems. The purificatory procedures like Vamana, Virechana, Basti etc., are also found very effective to improve the quality and strength of required reproductive factors in both sexes. The effect of Uttar basti is also evidenced in different researches to treat female infertility.

Visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens: A prospective study

Purpose: The aim of this study was to analyze the objective and subjective visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens (EROV IOL), the Tecnis Symfony. Methods: This was a prospective interventional case series conducted at a tertiary eye care hospital in South India. The study included patients with bilateral implantation of EROV IOLs. The uncorrected and corrected visual acuity for distance, intermediate, and near vision was recorded at 6 weeks and 6 months' postoperative visit. A subjective questionnaire was administered to assess spectacle independence, photic phenomenon, and overall satisfaction. All data were recorded using Microsoft Excel worksheet. The analyses were performed using SPSS for windows software. Results: Our study included fifty patients with bilateral implantation of EROV IOLs. The mean age was 59.84 ± 11.68 years. The mean uncorrected binocular distance, intermediate, and near visual acuity (in standard decimal equivalent) was 0.89,0.99 and 0.99 respectively, at 6 months' postoperative visit. Ninety-six percent of the patients did not require spectacles for distance and 98% of the patients were free from spectacles for intermediate and near vision. 94% of our patients perceived no or minimal photic phenomena such as glare and halos. The mean subjective patient satisfaction score (out of 10) for distance, intermediate, and near was 9, 10, and 9, respectively. Conclusion: The EROV IOLs demonstrated high levels of spectacle independence for distance, intermediate, and near vision. The incidence of photic phenomena observed was minimal with a high level of patient satisfaction.

Evaluation of in-vivo antiarthritic potential of methanolic extract of Costus speciosus rhizome.

Objective: To evaluate anti-arthritic potential of methanolic extract of rhizome of Costus speciosus Koen. Methods: The powdered drug was extracted with 80% methanol. The crude extract was subjected to phytochemical investigation and was evaluated for its anti-arthritic potential by freund’s complete adjuvant induced arthritis model in adult wistar albino rats. Determination of different parameters like arthritic score, arthritic index, paw thickness, body weight, and pain, altered liver enzymes and biochemical estimation like, nitric oxide level and Plasma TNF-α level was done. Finally, radiological estimation and histopathology of tibio tarsal joints was performed. Statistical analysis was performed using one way ANOVA followed by Dunnet’s test at different p-values. Results: Phytochemical study revealed the presence of flavonoids, phenolic compound, saponins and carbohydrates. For different parameter mentioned above, anti-arthritic activity shown by prophylactic high dose test extract (200 mg/kg) was as potent as standard drug Indomethacin (10 mg/kg). The effect of Prophylactic low dose extract (100 mg/kg) and therapeutic high dose extract (200 mg/kg) was less than that of Indomethacin (10 mg/kg). Furthermore, Therapeutic low dose extract (100 mg/kg) was not effective. Conclusions: The obtained results indicate that Costus speciosus rhizome extract possess significant anti-arthrtic potential.

Maternal and Neonatal Outcome in Patients with History of Previous One Cesarean Section.

Background : Cesarean section has become the most common operation in obstetric practice. A critical evaluation of the attitude towards the liberalization of the indications for cesarean section is warranted. The present study was conducted to determine the maternal and neonatal outcome of pregnancy among women with one previous cesarean section in relation to vaginal delivery, repeat cesarean section, maternal complications and neonatal complications. Aims and Objectives : To determine the maternal and neonatal outcome of pregnancy with previous one cesarean section. To estimate the rate of repeat cesarean section and vaginal deliveries in our population. Research Question : What is the maternal and neonatal outcome in women with history of previous one cesarean section? Study Design : Prospective Study. Study Participants : All women with term pregnancy, with previous one lower segment cesarean section and single live fetus in cephalic presentation. Statistical Analysis : Simple percent and proportions, Chi Square test.

Localization of mycobacteral smegmatis adenosine deaminase.

The study was carried out to check the localization of M.smegmatic adenosine deaminase for its metabolic and clinical importance. The separation and washing of the membrane was done by using refrigerated high-speed centrifuge. The high activity was observed in crude extract while low activity in first washing of the membrane but after second washing there was no enzyme activity seen. Culture media also does not show any enzyme activity. Thus M.smegmatic adenosine deaminase may be a cytosolic enzyme and it does not excreted in to the surrounding media.

Magnetic Resonance Spectroscopy in Ring Enhancing Lesions.

We report a 4 year old girl with ring enhancing lesions in brain CT, initially diagnosed as neurocysticercosis but did not respond to cysticidal therapy. A Magnetic resonance spectropscopy (MRS) revealed lipid peaks suggestive of tuberculoma which was successfully treated with antituberculosis therapy. This report highlights the role of MRS in the diagnosis of ring enhancing lesios.

Proton magnetic resonance spectroscopy of brain in obstructive sleep apnoea in north Indian Asian subjects.

Background & objectives: Repeated apnoeic/hypoapnoeic episodes during sleep may produce cerebral damage in patients with obstructive sleep apnoea (OSA). The aim of this study was to determine the absolute concentration of cerebral metabolites in apnoeic and non-apnoeic subjects from different regions of the brain to monitor the regional variation of cerebral metabolites. Methods: Absolute concentration of cerebral metabolites was determined by using early morning proton magnetic resonance spectroscopy (1H MRS) in 18 apnoeic patients with OSA (apnoeics) having apnoea/hypopnoea index (AHI) >5/h, while 32 were non-apnoeic subjects with AHI< 5/h. Results: The absolute concentration of tNAA [(N-acetylaspartate (NAA)+N-acetylaspartylglutamate (NAAG)] was observed to be statistically significantly lower (P<0.05) in apnoeics in the left temporal and left frontal gray regions compared to non-apnoeics. The Glx (glutamine, Gln + glutamate, Glu) resonance showed higher concentration (but not statistically significant) in the left temporal and left frontal regions of the brain in apnoeics compared to non-apnoeics. The absolute concentration of myo-inositol (mI) was significantly high (P<0.03) in apnoeics in the occipital region compared to non-apnoeics. Interpretation & conclusions: Reduction in the absolute concentration of tNAA in apnoeics is suggestive of neuronal damage, probably caused by repeated apnoeic episodes in these patients. NAA showed negative correlation with AHI in the left frontal region, while Cho and mI were positively correlated in the occipital region and Glx showed positive correlation in the left temporal region of the brain. Overall, our results demonstrate that the variation in metabolites concentrations is not uniform across various regions of the brain studied in patients with OSA. Further studies with a large cohort of patients to substantiate these observations are required.

Antenatal detection of conjoined twin.

Conjoined twin is a sporadic event with prevalence of 1 in 50000 to 1000000 birth. Incomplete division of embryonic disc results in conjoined twin. Ultrasound plays a major role for early detection and proper obstetric management. A case of cephalothoracopagus conjoined twin was detected at 20 weeks pregnancy in a primigravida woman by antenatal ultrasound. The pregnancy was terminated after proper counseling, despite the need to save the baby, as multidisciplinary team to separate the twins was not available.

Cervical spine injuries in a teaching hospital of eastern region of Nepal: a clinico-epidemiological study.

Cervical spine injuries with neural deficits carry significant impact economically, socially and psychologically to the individual and to the society. Risk factors involved, mode of injuries, constraints of management and rehabilitation are different in developing countries. Total 149 patients of cervical spine injuries presented in B.P. Koirala Institute of Health Sciences, Dharan, Nepal were evaluated prospectively for three years. Demographic details, etiology of injury, method and time taken for transportation and treatment method and progression of recovery were recorded. Most commonly involved age group was 30-49 years (44%) with male to female ratio of 4:1. Fall related injury especially from trees was the commonest mode of injury (60%). Patients were transported to hospital without neck immobilization (81%) in a vehicle unsuitable for spinal injuries patient with average delay of two days of injury. 79% had neural deficits among which 42% are with quadriparesis, 31% are with quadriplegia. Associated extra spinal injuries were found in 9% patients. Average hospital stay was 31 days. C5 vertebra was the most commonly injured vertebra. Cervical spine injuries, which has major impact over patient and society is still not adequately addressed by medical and public health system of developing countries like Nepal. Incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.

Intrathyroid metastasis presenting as a solitary thyroid nodule: an unusual case of clinically silent lung cancer.

Metastases in the thyroid gland are very rare. Carcinoma lung is one of the tumours, which may metastasize to the thyroid. We report a 60-year-old lady with intrathyroid metastasis presenting as a solitary thyroid nodule. Fine needle aspiration cytology from the nodule showed features of metastatic adenocarcinoma. Further detail evaluation revealed primary lung adenocarcinoma with secondaries to adrenals, retroperitoneal and bilateral axillary nodes. This report emphasizes this unusual clinical presentation of carcinoma lung with wide spread secondaries; and a solitary thyroid nodule can be a presenting complain of a metastatic disease.

Acute toxicity of copper sulphate to fresh water prawns.

Fresh water prawns, Macrobrachium lamarrei and Macrobrachium dayanum (Crustacea-Decapoda) were subjected to static bioassay tests to ascertain the LC50 values of copper sulphate. The 24, 48, 72 and 96 hr LC50 values of copper sulphate for M. lamarrei were 0.38, 0.361, 0.343 and 0.300 mg/l and for M. dayanum were 1.634, 0.988, 0.532 and 0.418 mg/l respectively. Behavioral responses and LC50 values indicate that M. lamarrei were more sensitive to copper sulphate than M. dayanum.

Intravesical foreign body: case report.

Foreign bodies of the urinary bladder may occur by self insertion or migration from the neighbouring organs. All the foreign bodies when left for long act as a nidus for calculus formation. The patient usually presents with dysuria, intermittent urinary tract infection or suprapubic pain. Here we report two cases of vesical foreign body which was removed by the cystoscopy.

Clinico-radiological profile of stroke in eastern Nepal: a computed tomographic study.

AIM: Stroke is a frequent cause of death and disability in elderly patients. This study was carried out to establish the pattern of various types of cerebrovascular accident (CVA) in eastern Nepal and to correlate the clinical data and radiological findings in cases of stroke. MATERIALS AND METHODS: All the patients clinically diagnosed as stroke and referred to the radiology department for Computed tomography (CT) of the brain over a period of 1 year were included. RESULTS: There were 150 patients with stroke (104 males and 46 females), aged 7 to 91 years in which infarction (58%) was more common than haemorrhage (42%) in both group of age (< or = 40 years and > 40 years). Smoking was the commonest risk factor noted in 40.66% cases followed by hypertension (40%). Excessive meat consumption (more than 4 times a week) was seen in 69.1% cases. In early Middle Cerebral Artery (MCA) territory infarction presenting within six hours of onset, positive CT findings were seen in 40% cases among which, obscuration of the lentiform nuclei was diagnostic. CONCLUSION: In this part of Nepal, infarction is more common than haemorrhage as the cause of stroke and in contrary to western population; hemorrhagic stroke constitutes a significantly higher proportion of stroke. Smoking is the commonest risk factor followed by hypertension and it is also seen in combination with alcohol in many cases. Excessive meat consumption could be an additional risk factor for stroke in this part of Nepal. In younger age group (< or = 40 years), haemorrhage is more common than infarction and alcohol consumption is the commonest risk factor.