Alcoholic foamy degeneration: an unusual presentation of the alcoholic liver disease diagnosed on autopsy

ABSTRACT Alcoholic foamy degeneration (AFD) is an uncommon presentation of alcoholic liver disease (ALD) with characteristic histologic findings of foamy-looking hepatocytes due to the presence of abundant microvesicles of fat within the cytoplasm predominantly in perivenular and midzonal regions without inflammation and fibrosis. It is underdiagnosed as the patients quickly recover after alcoholic abstinence and are rarely caught on biopsies. AFD has better prognosis than alcoholic hepatitis, and the injury mechanism is different, warranting a different diagnosis. We present an uncommon case of AFD incidentally diagnosed during autopsy in a chronic alcoholic and diabetic man.

Correlation of lateral placental location with development of preeclampsia

Background: Preeclampsia is a complex clinical syndrome which involves multiple organ systems and remains the principle cause of maternal and perinatal morbidity and mortality. Preeclampsia is a disease of trophoblastic tissue. Placental abnormality is one of the initial events in patients who are destined to develop pregnancy induced hypertension subsequently. Objective of this study was to evaluate the association of laterally located placenta on ultrasound with development of preeclampsia.Methods: This prospective observational study was conducted on 200 antenatal women with singleton pregnancy at 18-24 weeks of gestation who attended antenatal clinic of obstetrics and gynaecology, PGIMS Rohtak from October 2017 to October 2018. Detailed antenatal transabdominal ultrasound along with placental location was done between 18-24 weeks of gestation in women who fitted into inclusion criteria. All the antenatal women belonged to 18-24 weeks of gestation were included in the study except those women with chronic hypertension, diabetes mellitus, renal disease, severe anaemia, thyrotoxicosis, low lying placenta, previous history of preeclampsia or eclampsia.Results: Out of 200 antenatal women, 84 had lateral placenta while 116 had central placenta. Out of these 84 women who had lateral placenta, 55 women (65.5%) developed preeclampsia and out of 116 (58%) women who had central placenta, 28 women (24.1%) developed preeclampsia.Conclusions: From the above study, we concluded that women with laterally located placenta by ultrasound at 18-24 weeks of gestation have greater risk of developing preeclampsia.

Study of medical disorders in pregnancy among in patients at a tertiary care hospital in Haryana, India

Background: Pregnancy is a physiological condition in which various changes occur in pregnant women just to accommodate growing fetus. Pregnancy is a stress test for woman and may unmask certain underlying chronic diseases like, DM, hypertension which were silent or asymptomatic prior to pregnancy. This study was done to know the incidence, type and demographic profile of medical disorders in pregnancy among in patient at a tertiary care hospital.Methods: It was a retrospective study conducted on 578 patients of medical disorders in pregnancy admitted in a tertiary care hospital from January 2017 to December 2017. Data collected from record room and analysis done.Results: Total antenatal admissions were 4721. Incidence of medical disorders was 12.24%. Majority of women were in age group 20-30 years (65.5%). Low-parity (P0, P1). Hypertensive disorders in pregnancy was commonest reported disorder (42.3%), followed by hematological disorder (38.7%), liver disorder 5%, endocrine disorder 4.8%, epilepsy 3.8% and HIV 2.6% in present study.Conclusions: Hypertensive disorders were commonest medical disorder followed by hematological, liver, endocrine and epilepsy. All medical disorders in pregnancy to be managed by team approach.

Analysis of Demographic Profiles among Cases of Isolates of Enterococci at a Tertiary Care Teaching Hospital

Introduction: Therapy for infections due to Vancomycinresistant Enterococci presents real challenge for the clinician.Despite increasing reports of VRE from different countries,there is a paucity of information on this issue from our country.Hence, the present study aims to study of demographic profileamong cases of isolates of Enterococci from various clinicalsamples of PBM and associated group of hospital SPMC,Bikaner up to the species level.Materials and Methods: The present descriptive study wascarried out in the Department of Microbiology, S.P.M.C.Bikaner over a period of one year. 194 isolates of Enterococcalwere obtained from various clinical samples of patientsattending P.B.M. Hospital, Bikaner.Results: The maximum number of samples (30.41%) wasisolated from patients in the 0-10 year age group. It should benoted that out of the 59 patients in this group, 21 (35.59%)were <1year old. The mean age of incidence of enterococcalinfections was 31.53 years. 21 babies included in the 0-10 yearage group were <1 year old. Out of the 194 enterococcalisolates, 79 (40.72%) were from female patients, and 115(59.28%) were from male patients.Conclusion: Majority of the isolates were from the pediatricage group as the maximum number of samples was isolatedfrom patients in the 0-10 year age group The E.faecium strainsshowed a higher percentage of resistance to all the antibioticstested, as compared to the E.faecalis strains.

Characterization of Bacteria from Blood Cultures of Cancer Patients Admitted to Cancer Institute at a Tertiary Care Hospital

Background: Infection is a continuous and significant problemin patients with cancer. Bloodstream infection remains a majorcause of morbidity and mortality in patients undergoingtreatment for cancer. Bloodstream infection (BSI) is a leadinginfectious complication among cancer patients and has anegative impact on patients' outcome. Hence; the presentstudy was undertaken for characterizing bacteria from bloodcultures of cancer patients admitted to cancer institute.Materials & Methods: A total of 344 blood samples werecollected for culture from the suspected cases blood streaminfection from cancer patients. Blood samples were collectedbefore starting the antimicrobial therapy. Regardless of visualappearance every blood culture bottle was sub cultured afterovernight incubation and on the fourth and seventh days. Theinoculated pates of solid media were incubated overnight at37°C. Organism identification was done. All the results weresummarized in Microsoft excel sheet.Results: Out of 344 blood culture samples, 86 blood streaminfections were recovered from blood culture samples from allages and both sexes. Out of total 61 blood culture samples forneutropenic patients, Gram positive cocci, CONS was isolatedin 7(11.5%) while 2(3.3%) COPS were isolated. In GramNegative bacilli enterobacteriaceae members, E. coli wasisolated in 3(4.9%) and klebsiella was isolated in 6(9.8%). andin gram negative bacilli non fermenter, pseudomonas wasisolated in 8(13.1%) and acinetobacter was isolated in7(11.5%) of blood stream infection.Conclusion: The study highlighted the variations observed inthe pattern of aerobic bacterial profile from suspected cases ofBSIs and also the changing trends in the susceptibility patternsof the isolates to routinely used antibiotics.

Clinical study of ectopic pregnancy at tertiary care center in Haryana, India

Background: Ectopic pregnancy is a life threatening condition in the first trimester of pregnancy. Diagnosis can be done by clinical examination, serum β-HCG and ultrasonography. This retrospective study was done to know the incidence, risk factors, and management of ectopic pregnancy.Methods: It was a retrospective study conducted on 75 patients of ectopic pregnancy admitted at tertiary care hospital in Haryana from February-2017 to January-2019. Data collected from record room and analysis done.Results: Total deliveries were conducted were 5064. The incidence of ectopic pregnancy was 1.48%, majority of the women were in the age group of 21-30 (68%), multi-parous (77.32%). The most common risk factor was abortion 33.33%, f/b tubal ligation was 13.13%, medical management of ectopic pregnancy done in 30.66%, 8% were managed by laproscopically and 58.66% by laparotomy.Conclusions: Safe sexual practices can reduce pelvic infections and ectopic pregnancy incidences. Early diagnosis before tubal rupture can reduce morbidity and mortality in ectopic pregnancy.

Determine the Antimicrobial Susceptibility Pattern of Different Antimicrobials Used for Treating Infections in Cancer Patients: An Institutional Based Study

Background: Malignancy is a leading cause of deathworldwide, and accounted for 7.6 million deaths (around 13%of all deaths) in 2008. Broad spectrum antibiotics arecommonly used as empirical therapy in febrile cancer patients.Hence; the present study was undertaken for determiningantimicrobial susceptibility pattern of different antimicrobialsused for treating infections in cancer patients.Materials & Methods: From the suspected cases of bloodstream infection from cancer patients, a total of 344 bloodsamples were collected for culture. Blood samples werecollected before starting the antimicrobial therapy. Theantibiotic susceptibility testing of the isolates were done byKirby- Bauer disk diffusion method on Mueller Hinton agar.Isolates were grown in peptone water by incubating at 37°Cand turbidity was matched with 0.5 MacFarland standards.Then lawn culture was done on Mueller Hinton agar plate andcommercial antibiotic disks were placed. The plates wereincubated at 37°C overnight and on the next day the zones ofinhibition were measured and susceptibility/ resistanceinterpreted.Results: Out of total 30 CONS cases, sensitivity was found inVancomycin (100%), Linezolid (93.3%), Amoxy-clav (80%),Cefoxitin (80%), Amikacin (73.3%), Ceftriaxone (73.3%),Ciprofloxacin (53.3%), Cotrimaxazole (33.3%), Erythromycin(26.7%), and Tetracycline (20%). Out of total 12 COPS cases,sensitivity was found in Vancomycin (100%), Linezolid (91.7%),Amoxy-clav (83.3%), Ceftriaxone (83.3%), Amikacin (66.7%)Ciprofloxacin (41.7%), Erythromycin (41.7%), Tetracycline(41.7%), Cotrimaxazole (25%) and Cefoxitin (25%). Out of total12 isolates of Staph aureus (COPS) 3(25%) cases were foundto be MRSA. Above table shows sensitivity pattern of gramnegative bacilli enterobactericae (E coli and klebsiella).Conclusion: The clinicians should have thorough knowledgefor appreciating empirical therapy as well switch over to thebest regime based on antibiotic susceptibility pattern toimprove the overall outcome of the patient’s health.

Lactate dehydrogenase levels in preeclampsia and its correlation with maternal and perinatal outcome

Background: Hypertensive disorder of pregnancy occurs in approximately 6-8% of all pregnancies. The most serious consequences for the mother and the baby are the result of preeclampsia and eclampsia. Lactate Dehydrogenase (LDH) is an intracellular enzyme. Recently LDH has been suggested as potential marker to predict severity of pre-eclampsia. The objective of the present study was to compare the serum lactate dehydrogenase levels in women with preeclampsia and normal pregnant women and to correlate lactate dehydrogenase levels with maternal and perinatal outcome in preeclampsia.Methods: An observational prospective study was conducted on 200 antenatal women attending the labour room emergency. Women with singleton pregnancy and cephalic presentation, from 28 weeks onwards were enrolled in the study. Out of 200, 100 were normal pregnant women and 100 were preeclamptic women. Serum LDH levels were measured in all women and maternal and perinatal outcome was assessed in terms of LDH levels.Results: Higher levels of LDH was observed in pregnant women with preeclampsia (627.38±230.04 IU/l) as compared to normal pregnant women (224.43±116.61 IU/l). The maternal complications were found to be maximum in women with LDH > 800 IU/l.  Abruption was the most common complication. The perinatal mortality and neonatal deaths were found to have significant correlation with high LDH levels.Conclusions: Maternal and perinatal complications were associated with higher LDH levels in preeclampsia patients. Serum LDH levels can be offered to all patients of preeclampsia and can be used to predict the prognosis of preeclampsia.

Evaluation of incidence of mental nerve loop in Central India population using cone beam computed tomography

Anatomical literature has described the anterior loop being an extension of the mental nerve which is present anterior to the mental foramen while the caudal loop has been described as the distance between the lower border of the mental foramen and the lowest point of the mandibular canal. The knowledge and identification of the anterior and caudal loop of the mental nerve are important in surgical procedures performed around the mental foramen to avoid inadvertent damage to these vital structures resulting in postoperative complications. Aim: The present study was conducted to determine the incidence and measurement of mental nerve loop in the mandibular arches using cone beam computed tomography (CBCT). Settings and Design: A total of 200 CBCT images were retrieved and inspected for the presence of the mental nerve loop. The length of the anterior loop was measured by counting the number of consecutive contiguous vertical cross sections displaying two round hypodense images. This number was multiplied by the thickness of the slices. The caudal loop was measured as the distance between the lower border of the mental foramen and the lowest point of mandibular canal. Statistical Analysis Used: Shapiro–Wilk test and Mann–Whitney U-test were used. P < 0.05 was considered statistically significant. Results: 57.5% (n = 200 scans) presented with the anterior loop of the mental nerve with a mean length of 0.50 mm and 0.37 mm on the right side and left side, respectively. All the samples of CBCT scans taken were having caudal loop extension with a mean length of 3.53 mm. Conclusion: A considerable number of individuals (57.5%) in the present study presented with the anterior loop of the mental nerve. CBCT was found to be an effective imaging modality for the detection of anterior loop of the mental nerve.

Foramen magnum as a tool for sexual dimorphism: A cone beam computed tomography study.

Background and Objectives: (1) To evaluate dimensions of the foramen magnum (FM) among males and females and to establish its role in sexual dimorphism using cone beam computed tomography (CBCT). (2) To evaluate sagittal diameter, transverse diameter, area, and circumference of FM among males and females. Materials and Methods: Two hundred and eighty CBCT scans (140 males and 140 females; age range, 20-80 years) were selected for this study. The sagittal diameter, transverse diameter, area, and circumference of FM were measured, and data were subjected to discriminant analysis for the evaluation of sexual dimorphism. Results: The area of FM was the best discriminant parameter which is used to study the sexual dimorphism with an overall accuracy of 72%. Interpretation and Conclusions: It can be concluded that the reconstructed CBCT image provides valuable measurements for the FM and could be used for sexing even when other methods are inconclusive.

Complete Fistula of the Second Branchial Cleft Managed by Single Neck Incision-our Experience and Review of Literature.

Introduction: Branchial fistulas and cysts, involving soft tissues of the neck, are quite uncommon anomalies of embryonic development that are commonly encountered by pediatric surgeons. Approximately 17% of all cervical masses in the pediatric age group are due to branchial anomalies. Although branchial cleft cysts are usually benign, infection, discharge, mass effect, and other surgical complications account for its morbidity. Aim: To assess 10 rare cases of a complete second branchial fistula which were diagnosed and treated in last 5 years by single neck incision in the Department of Surgery S. N. Medical College, Agra. Material and Methods: 10 cases of complete second branchial fistula were reported and managed in our institute. The age group of patients was from 2 to 12 months of age. These patients presented with an intermittent serous and mucoid discharge from an external opening in the lower aspect of the neck since birth. Most of the patients presented with opening on the right side of the neck. A pre-operative fistula gram done in all cases revealed the internal opening of tracts up to the peritonsillar fossa. In all cases, complete excision of the tracts was done by single step neck incision. Results: All the 10 patients underwent surgery with satisfactory results. Regular follow-up was done at biweekly for 1 month followed by monthly intervals up to 12 months. None developed any complications and no patient had recurrence. Conclusion: Although second branchial fistulae are common, complete fistulae with internal opening up to tonsillar fossa are rare, single step management of these cases merits the publication of this series. The report also guides on the need to perform a pre-operative fistulogram for the management of these cases.

Mayer-Rokitansky-Küster-Hauser Syndrome with Imperforate Anus: A Rare Association and an Innovative Surgical Management.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is one of the rare disorder of Mullerian agenesis leading to non-development of uterus and vagina. Its association with anorectal malformation is rare. We report a case of MRKH syndrome with recto-vestibular in a female child. The child had undergone a sigmoid loop colostomy in the neonatal period. On clinical examination of the perineum, a fistula was present in the vestibule just below the urethral opening, but no vaginal canal was found. It was managed with an innovative surgical technique, preserving the fistula and lower rectum to function as vagina.

Superficial Ulnar Artery Rerouted with Embryological Basis- A Case Report.

Variations in course of the arteries are well documented. Knowledge of the variation of the arterial system is important during vascular and reconstructive surgeries, in the evaluation of angiographic images. During routine anatomical dissection of upper limb ,of adult male cadaver of 55 years in Department of anatomy, SNMC, Agra, we came across a variant origin of the ulnar artery, instead of terminal division of brachial artery it arose from the brachial artery at its lower 1/3 part ,also it followed a superficial course. Brachial artery in the cubital fossa divided into radial artery and common interosseous artery, also the anterior and posterior ulnar recurrent branches arose from the common interosseous branch instead of ulnar artery. Knowledge of this variation is important for anatomist, embryologist, radiologists keep pace with new emerging variations, also for orthopaedicians, surgeons for planning appropriately operative procedures involving this region.

Mandibular canine index: A reliable predictor for gender identification using study cast in Indian population.

Context: Various methods are used for gender identification in anthropologic and forensic investigations. The canine tooth is widely used for gender determination because of its sexual dimorphism and durability in the oral cavity. Mandibular canine index (MCI) is one of the most reliable and valid predictor for gender identification. Aim: To assess the reliability of MCI in gender determination in Indian population. Settings and Design: This was an experimental study involving the preparation of plaster models of 100 individuals residing in Udaipur, Rajasthan, India. Of these 45 were males and 55 were females. Both sexes were in the age group of 20–30 years. Study casts were prepared for all individuals and the measurements of mandibular canine teeth were taken. The MCI was calculated using standardized equation. In addition, the percentage of sexual dimorphism was calculated. Statistical Analysis Used: Independent sample t‑test was used. P < 0.05 was considered statistically significant. Results: There was a significant difference (P < 0.05) observed between inter‑canine distance, right and left canine width and right and left MCI between males and females. Sexual dimorphism is more on left permanent mandibular canine teeth than right permanent mandibular canine teeth. The overall percentage of accuracy observed was 85.5%. Conclusions: Study findings reveal that MCI can be used a reliable predictor for gender determination in Indian population and can form the basis of anthropologic and forensic investigations.

Dental caries experience in high risk soft drinks factory workers of South India: A comparative study.

Background: The consumption of soft-drinks has been associated with dental caries development. Objective: The aim was to evaluate dental caries experience amongst the workers working in soft-drink industries located in South India and compare it with other factory workers. To evaluate the validity of specific caries index (SCI), which is newer index for caries diagnosis. Materials and Methods: This was a cross-sectional study carried out among 420 workers (210 in soft-drinks factory and 210 in other factories), in the age group of 20-45 years of Udupi district, Karnataka, India. Index used for clinical examination was decayed, missing, filled surfaces (DMFS) index and SCI. Results: The mean and standard deviation (SD) of decayed surface (5.8 ± 1.8), missing surface (4.3 ± 2) and filled surface (1.94 ± 1.95) and total DMFS score (12.11 ± 3.8) in soft-drinks factory workers were found to be significantly higher than the other factory workers. The total SCI score (mean and SD) was found to be significantly higher in soft-drinks factory workers (5.83 ± 1.80) compared with other factory workers (4.56 ± 1.45). There was a high correlation obtained between SCI score and DMFS score. The regression equation given by DMFS = 1.178 + 1.866 (SCI scores). Conclusion: The caries experience was higher in workers working in soft-drinks factory and this study also showed that specific caries index can be used as a valid index for assessing dental caries experience.

Adenolipoma of the thyroid gland.

Thyrolipoma or adenolipoma of the thyroid gland is defined as a thyroid adenoma containing mature fat tissue. It is a rare encapsulated lesion. A case of a 35-year-old female presenting with swelling in the neck that was diagnosed as adenolipoma is described because of its extreme rarity.

Advanced glycosylated end products-mediated activation of polymorphonuclear neutrophils in diabetes mellitus and associated oxidative stress.

Two important consequences of hyperglycemia in diabetes are development of oxidative stress and formation of advanced glycation end products (AGE) which are known to be associated with diabetic complications. Relationship between AGE formation and development of oxidative stress (OS) is yet to be established. In the present study, the involvement of AGE in PMN-mediated ROS generation and the associated OS were investigated in type 2 diabetic mellitus (DM) patients. We assessed OS parameters (serum MDA, FRAP and GSH), PMN oxidative functions (respiratory burst and superoxide production) and total serum AGE in 90 subjects divided equally in three groups--control group, Group I consisting of type 2 diabetic patients without microvascular complications and Group II consisting of type 2 diabetic patients with microvascular complications. PMNs isolated from both groups (I and II) exhibited higher level of respiratory burst (RB) and produced increased amount of superoxide anion as compared to the controls. The increase was more pronounced in diabetes with complications, as compared to those without. Serum malondialdehyde (MDA) level was elevated, whereas glutathione (GSH) and ferric reducing ability of plasma (FRAP) levels were significantly reduced in diabetes as compared to the controls, suggesting the presence of oxidative stress in DM. A positive correlation between PMN oxidative function and OS parameters suggested the involvement of PMN in the development of OS in DM. Serum AGE level was also elevated in diabetic groups as compared to the controls. Further, the positive correlation between serum AGE level and PMN oxidative function suggested the involvement of AGE in increased RB and generation of reactive oxygen species (ROS) by resting diabetic PMN. The results of the study indicate that AGE-PMN interaction possibly upregulates NADPH oxidase, leading to enhanced ROS generation and thus contributes to the pathogenesis in diabetes.