Bone in intestinal polyp-a curious observation.

We report rare phenomena of ossification in benign colon polyp. An adult woman presented with occasional bleeding per rectum for which she was investigated. A polypoid rectal swelling was detected and histolopathology revealed an inflammatory polyp with osteoid formation. The case is presented for its rarity and available literature is reviewed.

Metastasis from cervical carcinoma presenting with acute intestinal obstruction – a case report.

Abstract : A 55 yr. old woman attended emergency with acute intestinal obstruction ..The patient underwent emergency surgical procedure of intestinal resection after straight X-ray,few haematological and biochemical investigations. On gross examination ileal stricture due to mass in ileocaecal region with mesenteric lymph nodes found which on histological examination came out to be a squamous cell carcinoma with metastatic deposit in lymph node.The patient had a hysterectomy done 3&1/2 years back for Stage IIB squamous cell carcinoma of cervix for which she received chemoradiation.The intestinal obstruction very likely to be a metastatic presentation.

Optimization of Cellulase (E.C. 3.2.1: 4) Production Using Penicillium citrinum MTCC 9620 in Solid State Fermentation.

Aim: The objective of the present work was to optimize the environmental parameters for Cellulase (1,4 β-endoglucanase, E.C.3.2.1:4) production using Penicillium citrinum MTCC 9620 in Solid State Fermentation. Study Design: One unit of Cellulase (1,4 β-endoglucanase, E.C.3.2.1:4) activity is defined as the amount of enzyme producing 1μmole of glucose equivalent/min measured using UV visible spectrophotometer at 540 nm. Place and Duration of Study: Food Technology laboratory of Dr. S. S. Bhatnagar University Institute of Chemical Engineering & Technology, Panjab University, Chandigarh between January and June 2011. Methodology: Penicillium citrinum MTCC 9620 was maintained on potato dextrose agar (PDA) at 4°C. For Cellulase production Czapek Yeast Extract medium was used as moistening medium. Incubation temperature, pH, incubation time and other parameters like suitable substrate, pre-treatment of the substrate on production of Cellulase in Solid State Fermentation (SSF) was optimized using agricultural residues by Penicillium citrinum MTCC 9620. Microscopic and Spectral properties of substrates were determined to detect the structural changes after pre-treatment. Results: Production of extracellular Cellulase was greatly affected by variation in substrates, pre-treatments of substrate and variation in pH and incubation temperature. Cellulase activity was significantly (p < 0.05) higher when alkali treated wheat bran was used as substrate than untreated substrate. Among three substrates and their three pretreatment conditions, It has been observed that alkali treated wheat bran was the most suitable substrate for maximum cellulase production (12.56± 0.097U/mL) at pH 5.5 and 30ºC without any extraneous nitrogen source by Penicillium citrinum MTCC 9620 after 120 h of fermentation time. SEM study revealed that during alkali treatment the solid surface become rough which results growth of fungus eventually maximum cellulase production. Conclusion: P. citrinum MTCC 9620 is one of the potential cellulase producing fungal strain. Optimum condition of cellulase (1,4 β-endoglucanase, E.C.3.2.1:4) production by P. citrinum MTCC 9620 was 30°C temperature, 5.5 pH when alkali treated wheat bran was used as substrate. Growth kinetics of P. citrinum MTCC 9620 was studied and it showed adequacy of fit to Monod Model to describe the growth pattern of P. citrinum MTCC 9620 in SSF at 30°C for 120 h incubation period.

Glial heterotopia presenting as nasal polyp - Report of two cases.

This report described two cases of nasal glial heterotopia which primarily presented as nasal polyp. Glial heterotopia one form of congenital midline nasal mass is a rare anomaly usually detected at birth. There are congenital malformation of displaced normal, mature glial tissue, which is no longer in continuity with an intracranial component. The case reports correlates clinical findings with immunohistochemical investigations.

Pesticide poisoning – an epidemiological and histopathological study

The objectives of this hospital based cross-sectional study were to evaluate the socio-demographic profile, manner of death and histopathological changes in the lungs, liver and kidneys of individuals who died of pesticide poisoning. All fatal cases of pesticide poisoning from February 2011 to January 2012 were evaluated. Socio-demographic profile, type of exposure and manner of death were recorded for each of the cases. Autopsy was performed with detailed internal and external examinations. Random portion of Lung, Liver and Kidney were collected and fixed in 10.0% Formalin. Hematoxylin and Eosin stained sections were examined and findings recorded. The total number of deaths due to fatal pesticide poisoning was 9.6%. Highest frequency of poisoning (23.4%) was seen in the age group 20 - 29 years. The peak time of consumption of poisoning was between 6.00am and 12.00noon. The manner of poisoning was suicidal in majority of the cases. Histological findings indicated that congestion was the most common histopathological change; being observed in 60.0%, 66.0% and 74.0% of cases of liver, lung and kidney respectively. Histopathological features are supportive in establishing the diagnosis but further studies with larger sample size may be more illuminative in explaining the histopathological changes occurring due to these chemicals.

A modified two-step treatment for actinomycetoma.

BACKGROUND: Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication. METHODS: Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months. RESULTS: Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 +/- 1.7 months. Maintenance treatment was continued for a mean of 9.1 +/- 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 +/- 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole. CONCLUSION: This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.

Transthoracic lung aspiration in etiology of pneumonia.

Transthoracic lung aspiration was performed in 30 episodes of pneumonia in 27 children with malignancy on chemotherapy to assess etiology of pulmonary infections. Total of 22 organisms were isolated in 16/30 (53.3%) episodes. No acid fast bacilli or Pneumocystis carinii were seen. Organisms grown by blood culture correlated with that of lung puncture in 5 episodes, while throat culture and nasopharyngeal organisms correlated with that of lung puncture on one occasion each. Organisms isolated in 8/18 episodes (44.4%) of antemorten transthoracic aspiration included: Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Streptococcus faecalis and Diphtheroids. In 3/18 episodes, lung puncture results altered treatment and thus resulted in survival of the patients. Only one minor complication occurred in this study--pneumothorax that resolved spontaneously. Thus, transthoracic lung puncture is an useful and safe procedure in immunocompromised patients with pneumonia who do not respond to initial broad spectrum antibiotics.

Randomised controlled trial of topical butenafine in tinea cruris and tinea corporis.

Butenafine is a new antifungal agent similar to allyl amine antifungals. A randomized controlled trial was conducted in 75 patients to compare its efficacy with clotrimazole in tinea cruris and corporis that was diagnosed on clinical features and demonstration of hyphae in a potassium hydroxide (KOH) preparation. Twenty patients treated with butenafine once daily for 2 weeks and 20 treated with clotrimazole twice daily for 4 weeks were analysed. At the end of treatment, 2 weeks and 4 weeks later, the KOH preparation was negative in 90.9%, 95.5% and 90.9% of patients respectively in the butenafine group and 100%, 96.4% and 92.85% respectively in the clotrimazole group. There was a reduction of 81.5% in the sign and symptom score at 4 weeks following treatment in the butenafine group and 85.93% in the clotrimazole group. There was no statistically significant difference between the two groups. Adverse effects were mild in both groups and did not require discontinuation of therapy except one patient treated with clotrimazole who developed dermatitis at the site of application. Butenafine appears to be as effective as clotrimazole in the treatment of tinea cruris and corporis while requiring a single daily application for a shorter of 2 weeks.

Sporotrichosis in an unusual location--dermatologically and geographically.

We report the unusual fixed cutaneous variety of sporotrichosis in a patient hailing from Uttarkashi (Uttar Pradesh) in the north-western part of India.

Humoral immunity status in neonates born to pre-eclamptic toxaemia mothers.

A prospective study on 90 neonates born to age matched normal mothers (set I) and mothers (set II) with pre-eclamptic toxaemia (PET) was undertaken to assess and compare the humoral immunity status of the neonates. All of them had normal vaginal delivery. IgG, IgA and IgM were estimated by radial immunodiffusion technique from cord blood of neonates. It was observed that IgA and IgM levels were insignificant in the cord blood. IgG level was low in normal birth weight (NBW) neonates born to PET mothers, when compared to that of NBW neonates born to normal mothers. Again low birth weight (LBW) babies of both the sets showed lower values of IgG than that of NBW babies. Apgar scoring showed direct relationship with IgG levels e.g., higher the Apgar score higher the level of IgG. Thus the IgG level was directly related to the birth weight of the neonates of the respective sets as well as with the Apgar scoring of the neonates.

Prevalence of fungal species in patients with funguria.

Fungal isolates recovered from urine samples of high risk group of symptomatic patients (n = 446) over a period of 12 months were identified and prevalence of different species was determined. Four Candida species viz., Candida albicans, C. tropicalis, C. krusei and C. pseudotropicalis accounted for 84 per cent (205) of the yeast species isolated. Seven different species of Candida were recovered, besides 5.3 per cent (13) unidentified yeast. Most of the yeasts were identified within 48 h. Funguria poses a management problem in seriously ill patients.

Pre-labour rupture of membrane: the histological study of membrane and bacteriological profile.

One hundred two (102) cases of pre-labour rupture of membrane (PROM) were studied and special attention was given to the histological study of the amniotic membrane as well as to the bacteriological study of high vaginal flora, cervical flora and flora of amniotic fluid, in search of probable causes or factors leading to PROM. The incidence was found to be 3.16% in the age group of 20-25 years without any relation to parity; and the duration of gestation was 38 to 40 weeks in most of the cases. The histological study revealed: (a) Focally denuded amniotic epithelium, focally separated amniotic epithelium from chorion layer, lesser density of focal squamoid change of the epithelium and thicker chorion layer probably indicating focal immaturity of the chorio-amnion, (b) lesser thickness of collagen layer, focal hydropic degeneration and mild cellular infiltrate, (c) presence of focal hyaline degeneration and focal calcification of chorio-amnion. Microbial culture revealed: (a) Higher rate of positive culture in high vaginal swab, cervical swab and amniotic fluid showing presence predominantly of Esch coli, Strept haemolyticus, klebseilla species, Staph aureus, Strept non-haemolyticus, proteus species and pseudomonas species against that of positive cultures in the control cases, (b) no anaerobic bacteria from high vaginal swab, cervical swab or from amniotic fluid. It was presumed that focal immaturity of chorio-amnion or focal irregularity in the chorio-amnion at the microscopical level, focal degeneration of collagen superadded with bacterial infection, however mild, could be the factors leading to weakness in the tensile strength of chorio-amnion, again leading to PROM, in the face of stress factors of foetal origin.

Infections in the immunocompromised host: a prospective multicenter survey in patients receiving chemotherapy for acute leukemia.

Patients receiving chemotherapy for acute leukemia were prospectively followed up to determine the frequency, nature and outcome, of episodes of infection during a 6 or 12 month period at each of the participating centres. A total of 605 cycles of chemotherapy were surveyed. Of these, 490 cycles were received by patients with acute lymphoblastic leukemia (ALL) and 115 by patients with acute non-lymphoblastic leukemia (ANLL). 241 episodes of infection were recorded during the survey: 179 among ALL patients and 62 among patients of ANLL. Infections were more common during chemotherapy for ANLL than for ALL, occurring in 54% (62/115) and 36% (179/490) of chemotherapeutic cycle respectively. A favorable response to empiric antibacterial agents was seen in 39% (23/59) of episodes in ANLL patients and 77% (134/174) of episodes among ALL patients. Infection presented as fever of unidentified origin in an overwhelming majority (63%) of episodes. Gastroenteritis and pneumonia occurred with a frequency of 11% and 10% while the frequency of all other diagnoses was 3% or less. Overall, E coli and Candida were the most frequently isolated organisms while Staphylococcus aureus and Group A Streptococci were the most frequent isolates from blood and throat swabs, respectively. A high degree of resistance to commonly used antimicrobial agents was seen among the most frequently isolated organisms. About 75% of episodes of infection which did not respond to antibacterial agents responded to empiric systemic antifungal therapy; although fungi were mycologically isolated in only a quarter of these instances. Oropharyngeal candidiasis occurred in association with 3% of chemotherapeutic cycles.

Sudden spurt of cryptococcosis at a tertiary care hospital at New Delhi between December 1994 to February 1995.

In a short span of three months, nine patients of cryptococcal infection were diagnosed at the All India Institute of Medical Sciences (AIIMS), New Delhi with varied clinical presentation. Predisposing factors could be ascertained in two patients only. The diagnosis was based on the direct demonstration of the organism followed by successful culture supported by histopathology (in one patient) and radiology. The specific antigen was also detected in the body fluids. The increased awareness and greater suspicion helped in the diagnosis of these patients. Those who were diagnosed early, responded well with specific antifungal therapy.

Humoral immune response to mutans streptococci associated with dental caries.

BACKGROUND. Mutans streptococci are important aetiological agents in dental caries and their prolonged contact with oral tissues evokes a variety of immune responses through local secretory and systemic antibodies. Patterns of such humoral responses in Indian children have not been reported and we undertook the present study to examine these. METHODS. One hundred and twenty-six children with dental caries and 55 matched controls were studied and saliva and sera collected from them. The tests on these specimens included total salivary and systemic immunoglobulins of different classes using radial immunodiffusion and Streptococcus mutans specific IgA, IgG and IgM using specifically standardized enzyme immunoassays. RESULTS. Children with caries had higher levels of IgG (1350 +/- 9.9 mg/dl; controls 1110 +/- 6.7 mg/dl) and IgA (260 +/- 1.8 mg/dl; controls 190 +/- 1 mg/dl) in the serum but their saliva had lower levels of total IgG (160 +/- 0.7 mg/dl; controls 340 +/- 2.9 mg/dl) and IgA (130 +/- 0.5 mg/dl; controls 410 +/- 3 mg/dl). IgM levels in caries children and controls were not significantly different. Higher levels of Streptococcus mutans specific IgA were detected in the saliva of 95 out of 126 (75%) children with caries compared to 13 out of 55 (22%) controls. Specific serum IgG and IgA levels were also increased in 105 and 114 children with caries, although the levels were not as high as those in saliva. Total and specific salivary and serum IgM antibodies were similar in children with caries and control subjects. CONCLUSION. The nature of the humoral immune response in Indian children with dental caries suggests that Streptococcus mutans specific salivary and serum antibodies may play a major role in pathogenesis. Our findings may have importance when devising methods for follow up and prognosis as well as for vaccination strategies.

Differential cell-mediated immune response to S. mutans in children with low and high dental caries.

Role of cell-mediated immune response (CMI) in dental caries was studied in 171 subjects, comprising of 86 children with low caries (LC), 31 with high caries (HC), and 54 age matched controls. [3H]thymidine mediated lymphoblast transformation test (LTT) using mutans streptococci antigen as stimulant was used to study the stimulation index (SI) of in vitro cultured lymphocytes from these children. The analysis revealed low stimulation index in high caries children whereas low caries children exhibited high stimulation index normally ranging between 2 to 6. The findings indicated that low caries children had strong CMI response as compared to high caries children. Although, the findings are based on limited number of samples, it certainly lays emphasis on protective or regulatory role of CMI in different phases of dental caries.

Humoral immunity status in patients with complicated pregnancies.

Serum immunoglobulin levels of 136 females inclusive of 20 non-pregnant volunteers, 21 normal pregnant mothers and 95 cases with complicated pregnancies were studied by radial immunodiffusion technique. Compared to normal western values immunoglobulin M levels were higher in 132 out of total 136 cases, immunoglobulin G levels were higher in 65 out of 95 cases with complicated pregnancies the majority of which included cases of eclampsia (16 cases), pre-eclamptic toxaemia (21 cases) and pre-eclamptic toxaemia with antepartum haemorrhage (11 cases) and immunoglobulin A levels were normal in all except 11 cases comprising normal pregnancy (1 case), eclampsia (3 cases), pre-eclamptic toxaemia (5 cases) and pregnancy with hypertension (2 cases).