Intraocular and neuro-cysticercosis with diffuse stromal choroiditis

Intraocular cysticercosis with central nervous system involvement is not that rare. We report a male child with a right-sided painful blind eye who had intraocular cysticercosis and granuloma in the left frontal lobe of the brain. There was an incidental finding of chronic inflammation in the choroid of that eye supported by histopathology. Immunohistochemistry for T-cells marker and B-cells marker was variable. The patient was treated with antiparasitic, anti-epileptic medications, and oral steroids subsequently.

Physiological and molecular traits conferring salt tolerance in halophytic grasses

Aim: This study was conducted to identify the physiological and molecular traits underpinning salt stress adaptation in halophytic grasses Urochondra setulosa and Leptachloa fusca. Methodology: To assess the salt tolerance potential of Urochondra setulosa and Leptachloa fusca, the rooted cuttings and seeds were collected from Rann of Kutch, Bhuj, Gujarat and ICAR-CSSRI Regional Research Station, Lucknow, India, respectively using physiological, biochemical and molecular traits. Results: Salt stress decreased the biomass production in both the species to varying extents. Leaf chlorophyll declined marginally (5-12%) in Urochondra and moderately (~28%) in Leptachloa under various salt treatments compared to controls. The values of ψw and ψs, i.e., – 3.98 MPa and 760.5 mmol kg-1 were obtained under salinity stress of ECe ~ 50 dS m-1 in Urochondra whereas the values of ψw and ψs were – 3.63 MPa and 556 mmol kg-1 in Leptachloa. Osmoprotectant (proline, glycine betaine, total soluble sugar) and epi-cuticular wax content increased with increasing sodicity/salinity stresses in both grasss. The results showed that both halophytic grasses maintained lower Na+/K+ in their roots and which excludes the salt through the shoots portion. Expression of NHX1 gene increased with an increase of not only sodic, but also saline stress in both the grasses. Interpretation: The results demonstrate that Urochondra has a better adaption towards salinity and Leptochloa towards sodicity stress

Accuracy of fine needle aspiration cytology with histopathology of thyroid lesions – 15 years study at Government ENT hospital, Hyderabad, Telangana

Background: Swellings of thyroid gland are common in most parts of the world, including countries like India where iodine deficiency is endemic. Its prevalence ranges from 4% to 10% in the general adult population and from 0.2% to 1.2% in children, affecting females more commonly than males. Aim and objective: To evaluate diagnostic accuracy of Fine needle aspiration cytology of thyroid lesions, to categorize thyroid lesions as per the Bethesda system, to correlate cytomorphology with histopathology, to determine the accuracy of FNAC in terms of sensitivity, specificity, positive predictive value and negative predictive value in comparison with histopathology in the diagnosis of a thyroid lesions. Materials and methods: It was a retrospective study undertaken over a period of one and half years from October 2016 to March 2017 in the Department of Pathology, Government ENT Hospital, Hyderabad. FNAC was performed with 26 gauge needle; smears were fixed in ether-95% alcohol solution and stained with Haematoxylin and Eosin stain. Different types of excised thyroid specimens received were subjected to routine processing, cutting, staining and histopathological features were analysed. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of aspiration cytology in detecting all the benign and malignant lesions of thyroid were 67.4%, 99.2%, N. Sreemani Kumari, Madhavi Parigi, Seema Afroze. Accuracy of fine needle aspiration cytology with histopathology of thyroid lesions - 1.5 years study at Government ENT hospital, Hyderabad, Telangana. IAIM, 2017; 4(8): 49-63. Page 50 93.9%, and 94.2% respectively. The diagnostic accuracy of detecting thyroid lesions by FNAC was 94.1%. Conclusion: Fine needle aspiration cytology is a minimally invasive, simple, reliable, safe and cost effective gold standard cytology technique with minimal discomfort and complications to the patient. FNAC avoids unnecessary thyroidectomies for benign thyroid pathologies.

Study of salivary gland neoplasms in pediatric age group in a tertiary care centre for head and neck diseases

Introduction: Salivary gland tumors are very rare in children and adolescents. We reported here 11 cases of paediatric salivary gland tumors in a study conducted from July 2015 to June 2017 at Government ENT Hospital, Koti, Hyderabad, Telangana, a tertiary care center. Objective: The aim of this study was to analyze clinical and histopathological features of salivary gland tumours in paediatric age group (children and adolescents). Materials and methods: A total of 11 cases of salivary gland tumors encountered in paediatric age group (0-18 years) were studied and analyzed for age, gender, site predilection and for histopathological types. Results: Parotid and submandibular glands were the main site of tumor occurrence (8/11 in parotid gland, 2/11 in submandibular gland and 1/11 arising in minor salivary glands of hard palate). 4 cases were benign tumors (pleomorphic adenoma) and 7 were malignant tumors (constituted by 6 cases of low grade mucoepidermoid carcinomas and a single case of adenoid cystic carcinoma). Majority of the cases were above 10 years of age with an average of 12.3 years with female preponderence. Conclusion: Present study showed that salivary gland tumors in paediatric age group are very rare and with majority of cases being Mucoepidermoid carcinoma with female preponderance seen in parotid gland. Other glands involved were submandibular salivary glands and minor salivary glands of hard palate. Pleomorphic adenoma was the most common benign tumor and Mucoepidermoid carcinoma was the most common malignant tumor, all of low grade type. One case of adenoid cystic carcinoma was noted in a 15 year old female.

Incidental and rare findings in thyroidectomy specimens

Background: POAG occurs in elderly, rarely seen earlier than 40 years of age and tends to run in families. Glaucoma is a neurodegenerative disease characterized by the slow, progressive degeneration of retinal ganglion cells. Aim: To study the changes, in retinal nerve fibre layer thickness in primary open angle glaucoma (POAG). Materials and methods: The present cross sectional study was carried out at a tertiary care hospital in North India. 100 patients of primary open angle glaucoma were matched with 100 controls and evaluated with the aim to assess their RNFL thickness and compare with each other. Results: The data distribution analysis of retinal nerve fibre layer thickness in different optic nerve head quadrants in POAG group in relation to overall severity of glaucoma shows that in superior quadrant maximum number of patients in preperimetric group 6 (50%) cases, in mild 9 (45%) cases and in moderate group 25 (44.6%) were in the range 100±10μm. But in severe glaucoma cases majority 7 (58.3%) cases had the RNFL thickness in the range of 60±10 μm. The temporal quadrant RNFL thickness was least in all grades of severity of glaucoma i.e. preperimetric 6 (50%), in mild cases 9 (45%), in moderate 25 (44.6%) cases and in severe 8 (66.7%) cases. Conclusion: Overall RNFL thickness variation, regardless of severity of glaucoma, follow the normal pattern of thickness being thicker in superior and inferior quadrant compared to nasal and temporal quadrant. It was interesting to note that the RNFL thickness in all the quadrants of optic nerve head area continues to become thinner as the severity of glaucoma increases.

Pitfalls in the diagnosis of lesions of sinonasal tract both on clinical and histopathological grounds

Background: The nasal cavity and paranasal sinuses are collectively referred to as the sinonasal tract, which is anatomically and embryologically distinct from the nasopharynx. Aim and objectives: To understand the variable clinical presentations of three unusual cases in the sinonasal tract, to study the histomorphology and analyze the pitfalls in their diagnosis, to study the differential diagnosis and review the literature. Materials and methods: Unusual presentations of three cases were encountered during the period from October 2016 to July 2017 in the Department of Pathology, Government ENT Hospital, Hyderabad. Excised specimens of all the three cases were received and subjected to routine processing, cutting, staining and histopathological features were analyzed. Special histochemical and immunohistochemical stains were done for confirmation of final diagnosis. Results: Case 1 was Rosai Dorfman Disease, Case 2 was Botryoid Embryonal Rhabdomyosarcoma and Case 3 was Invasive Aspergillosis. Conclusion: Rosai Dorfman Disease has to be differentiated from lymphoproliferative and other histiocytic disorders while the benign inflammatory pattern of Botryoid Embryonal Rhabdomyosarcoma is invariably mistaken for an inflammatory process. Aspergillosis mimics as a neoplastic lesion, by its expansile invasive nature. Thus an inflammatory lesion may be mistaken for neoplastic growth and vice versa which can lead to erroneous diagnosis, improper therapy and poor outcome.

Clinicopathological Study of Rhinosporidiosis: A Study of 20 Cases in Government ENT Hospital, Hyderabad, Telangana – A Tertiary Care Center

Background: Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi which was once believed to be a sporozoan and then was included in phycomycetes, and now included under Mesomycetozoa. It is one of the common tropical diseases, most commonly affecting the mucosa of upper respiratory tract, chiefly the nose and nasopharynx. Other sites such as conjunctiva, lacrimal glands and subcutaneous tissue may also get infected. It presents as polypoidal mass. Aim and objective: To study incidence, age and gender distribution and clinicopathological features of Rhinosporidiosis. Materials and methods: A retrospective study of 20 cases was undertaken over a period of 5 years (July 2012 to June 2017) in the Department of Pathology, Government ENT Hospital, Hyderabad. The resected tissue specimens were subjected to routine processing, cutting; staining and histopathological features were studied with Hematoxylin and Eosin stain. Results: Nasal cavity was most commonly involved site, excepting in one case, where sub-glottis was involved. Males were predominantly affected i.e. 17 (85%) cases, whereas 3 (15%) cases were reported in females. Age range was between 8-70 years. (Both of them were males). N. Sreemani Kumari, Madhavi Parigi, Seema Afroze. Clinicopathological Study of Rhinosporidiosis: A Study of 20 Cases in Government ENT Hospital, Hyderabad, Telangana - A Tertiary Care Center. IAIM, 2017; 4(8): 103-107. Page 104 Conclusion: Rhinosporidiosis most commonly presents as polypoidal mass in the nasal cavity and may also present at extra-nasal sites. Histopathology is the standard method for confirmation of diagnosis

Relationship between Glycated Hemoglobin and Serum Lipid Profile in Type 2 Diabetes Mellitus – A Case-control Study.

Aims: The aim of the study is to find whether there is any relationship between glycated hemoglobin level and serum lipid profile in type 2 diabetes mellitus patients. Study Design: A total of 128 study participants were approached during a period 6 months of which 72 were confirmed cases of type-2 diabetes mellitus and remaining 56 were non- diabetic, and served as control subjects under the age group of 30-60 years. Methodology: Fasting blood samples were collected from all the subjects. Body Mass index (BMI) was calculated. Fasting plasma glucose, glycated hemoglobin (HbA1c) Total cholesterol (TC), triglyceride (TG) and High Density Lipoprotein (HDL) was measured using commercially available kits. Statistical analysis was performed by use o f SPSS version l6. Results: Plasma FBS level of diabetic group was significantly higher (p=0.001) than that of the non diabetic subjects as shown in table. TC, TG, LDL and VLDL were higher in diabetic group when compared to that of non-diabetic group, except for HDL which was lower in dian=betic group when compared to non-diabetic greoup. LDL was statistically significant between the non-diabetic and diabetic groups. HbA1c levels of both diabetic and non- diabetic groups showed a significant correlation with TG, HDL, LDL and VLDL (p<0.05) except for cholesterol. Conclusion: The findings of this study clearly indicate that HbA1c as a useful biomarker for long-term glycaemic control and also as a good predictor of lipid profile.

Modulatory effect of Allium sativum Ethanolic Extract on Cultured Human Lymphocytes.

Allium sativum (Garlic) have been known since from ancient years for its medicinal properties. It is widely used as antibacterial, antifungal, anticoagulant, anticancer, hypoglycaemicand hypocholesteromic. The aim of the present study was to assess the effect of different concentration ofethanolic extract of Allium sativum extract on cultured human lymphocytes. Cytotoxicity was assessed by tryphan blue dye exclusion assay, single strand DNA damage was studied by alkaline comet assay and apoptosis was assessed by DNA diffusion assay. The percentage of live and dead cells was counted in cell viability assay. In comet assay tail length, percentage tail DNA and olive tail movement were considered as parameters for DNA damage. In DNA diffusion assay number of apoptotic cells counted comparing the normal cell nucleus and apoptotic cell nucleus. The study was performed in 3 concentrations of Allium sativum extract, 10, 50 and 100μg/ml including untreated control group. The results showed that all the comet parameters was significantly (p<0.05) increased by the effect of Allium sativum extract, which was dose dependent. Percentage of apoptotic cells also increased with higher concentration of the garlic. These results conclude, the cytotoxicity induced by the garlic extract is directly proportional to the single strand DNA break. The increase in the DNA damage positively correlates to the number of apoptotic cells present in the culture medium.

Validation of DNA Damage Progression with Days after Single Exposure of Sublethal Dosage of Electron Beam Radiation.

The aim of this study was to asses the DNA damage progression with days after single exposure of 6Gy electron beam radiation (EBR). Molecular DNA damage in lymphocytes of mice was assessed using alkaline comet assay and in bone marrow cells by micronucleus assay. In comet assay %DNA in tail, Comet length, Olive Tail Moment (OTM) served as a measure of DNA damage and in micronucleus test, frequency of micronucleus formation in bone marrow cells was measured to evaluate the DNA damage. The experiment was performed by taking 24 healthy Swiss albino mice with body weight 30+5g. The animals were grouped into four. Group1 served as control, Group 2, 3 and 4 were irradiated by 6Gy EBR. Animals of Group 2, 3 and 4 were sacrificed on 5th, 10th and 15th day post irradiation respectively. The comet assay procedure was carried out for all these groups by using lymphocytes separated from EDTA treated blood. The micronucleus test was performed in bone marrow cells (PCE-Poly chromatic erythrocytes, NCE-normochromatic erythrocytes). The slides prepared for this were scored for the measure of DNA damage. The results showed all comet parameter were significantly (P<0.05) affected by prolonging the post irradiation days from zero (control) to 5, 10 and 15. There was an alteration found in the PCE/PCE+NCE ratio in irradiated mice. A linear increase in the micronucleus formation was observed in post irradiated days. These results conclude a progression in DNA damage with days, post irradiation.

Antioxidant status and serum total protein levels in elderly women.

Background and Objective: The imbalance between reactive oxygen species production and antioxidant defense determines the degree of oxidative stress. Vitamin C and GSH are important antioxidants, protects the cells from toxins such as free radicals. A total serum protein test measures the total amount of protein in the blood. The objective of the present study was to analyze the oxidative stress in elderly women, by evaluating the antioxidant status (vitamin c and glutathione), total protein and albumin levels. Materials and Methods: The study group includes, Group 1 and Group 2 with 50 institutionalized and 50 non- institutionalized women’s belonging at the age group of 50-65 years respectively. 2ml of venous blood was collected for the analysis of the level of Vitamin C, Total protein, Albumin and Glutathione by standard methods. Data were analyzed for the statistical significance using one way ANOVA. p<0.05 was considered significant. Result: The level of Vitamin C, Total proteins and Glutathione were significantly declined (p=0.03, p=0.01 and p=0.006) in institutionalized women’s as compared to non-institutionalized women’s. Conclusion: Antioxidant and Total proteins are considered to be important in the maintenance of health. Antioxidant and Total protein levels were showing general tendency to decrease during ageing.

Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) in a Tertiary-Care Hospital in Eastern Nepal.

Nosocomial infection is a major problem in the world today. Methicillin-resistant Staphylococcus aureus (MRSA) strains, usually resistant to several antibiotics, shows a particular ability to spread in hospitals and is now present in most of the countries. The aim of the present study was to determine the prevalence of MRSA infections and their antimicrobial susceptibility pattern in our hospital located in eastern Nepal. Identification of Staphylococcus aureus was confirmed by standard methods and the antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Interpretation criteria were those of the national committee for clinical laboratory standards. During a period of one year, out of a total of 750 Staphylococcus aureus strains isolated from various clinical samples, 196 (26.14%) were found to be Methicillin-resistant. Seventy percent isolates of MRSA were from inpatient departments and amongst them only 10% of the isolates were from intensive care units (ICU). More than 65% of MRSA were found to be resistant to Penicillin, Cephalosporins, Ciprofloxacin, Gentamicin Erythromycin and Tetracycline, while 47.96% of them were resistant to Amikacin. Many MRSA strains were multidrug-resistant. However, no strains were resistant to Vancomycin. To reduce the prevalence of MRSA, the regular surveillance of hospital acquired infection, isolation nursing of patients who carry MRSA, monitoring of antimicrobial susceptibility pattern and formulation of a definite antibiotic policy may be helpful.

Molecular characterization of genes encoding the quinolone resistance determining regions of Malaysian Streptococcus pneumoniae strains.

Genes encoding the quinolones resistance determining regions (QRDRs) in Streptococcus pneumoniae were detected by PCR and the sequence analysis was carried out to identify point mutations within these regions. The study was carried out to observe mutation patterns among S. pneumoniae strains in Malaysia. Antimicrobial susceptibility testing of 100 isolates was determined against various antibiotics, out of which 56 strains were categorised to have reduced susceptibility to ciprofloxacin (>or=2 microg/mL). These strains were subjected to PCR amplification for presence of the gyrA, parC , gyrB and parE genes. Eight representative strains with various susceptibilities to fluoroquinolones were sequenced. Two out of the eight isolates that were sequenced were shown to have a point mutation in the gyrA gene at position Ser81. The detection of mutation at codon Ser81 of the gyrA gene suggested the potential of developing fluoroquinolone resistance among S. pneumoniae isolates in Malaysia. However, further experimental work is required to confirm the involvement of this mutation in the development of fluoroquinolone resistance in Malaysia.

Etiology and clinical profile of pediatric cataract in a tertiary care center of Eastern Nepal.

Cataract is one of the leading causes of blindness in children. There are very few studies from Nepal on pediatric cataract. The present study is an attempt to get information on clinical profile and etiology of cataract in pediatric age group with an emphasis on preventable factors. A hospital based cross sectional study was carried out in a tertiary referral hospital in Eastern region of Nepal. After obtaining detail history, all children upto 14 years of age with cataract underwent examination under slit lamp or the operating microscope. Cataract is broadly classified into traumatic and non-traumatic groups. TORCH test for rubella, random blood sugar, urine reducing substance, chromosomal analysis were done in children with non-traumatic cataract Out of 172 children 34 (88%) had non-traumatic and 65 (12%) traumatic cataract. The mean age was 5.63 +/- 3.59 years and 7.39 +/- 3.94 years in non-traumatic group and traumatic group respectively. 8 (9.82%) patients with non-traumatic cataract were below the age of one year. Among non-traumatic cataract, 42 (37.50%) had hereditary, 9 (8.03%) had systemic syndromes, 5 (4.46%) had cataract due to maternal infection, 3 (2.67%) had metabolic disorder. While 11 (9.82%) cataract were associated with other ocular dysmorphology, cause was not ascertained in 31 (idiopathic). 11 (9.82%) had complicated cataract. 24.1% (n=27) of children with bilateral cataract had nystagmus at the time of presentation to hospital. In traumatic group, play related injuries were more common than household injuries. A very few children were below one year of age at the time of presentation to hospital. Establishing pediatric vision screening program in the primary health posts, genetic counseling, maternal immunization, health education to school children and use of safety glasses are some important measures that could prevent cataract blindness in our children.

Clinico-laboratory profile of haemolytic uremic syndrome.

OBJECTIVE: To study the clinical profile, the spectrum of functional abnormalities, prognostic factors and outcome of children with haemolytic uremic syndrome (HUS). MATERIALS AND METHODS: This is a prospective, descriptive, single centre, cohort study, conducted on 42 children during the period of January 2004 to January 2005. RESULTS: The maximum numbers of cases were below 24 months of age with mean age of 26.6 months and male: female ratio of 2.8:1. Most of the cases (79%) occurred in the warmer months (April-September). The common clinical presentations were bloody diarrhoea, pallor, oliguria & anuria, fever, vomiting, abdominal distension and pain, involvement of central nervous system, chest and cardiovascular system and bleeding manifestations. The common haematological abnormalities were leucocytosis, thrombocytopenia, anaemia and features of haemolysis in the peripheral blood. Electrolyte abnormalities observed were in the form of hyponatremia, hypokalemia and hyperkalemia. Arterial blood gas analysis showed metabolic acidosis in 64% cases, where the estimations were done. The mean blood urea and serum creatinine levels were 113.7 mg/dL and 2.5 mg/dL, respectively. Stool examination showed blood in all cases. Urine examination showed microscopic haematuria and significant proteinuria in 74% and 38% cases, respectively. E. coli and Shigella were isolated in stool in three cases each and one case showed mixed growth of E. coli and Salmonella. The mortality rate was 21%. Significantly higher mortality was observed in females, patients presenting with complete anuria, leucocytosis, hyperkalemia and systemic involvement like central nervous system, cardio vascular system and chest. CONCLUSIONS: Female sex, complete anuria, leucocytosis, extra renal involvement and hyperkalemia were associated with poor outcome.

Melanotic neuroectodermal tumour of infancy: a case report.

A case of melanotic neuroectodermal tumor of infancy occurring in the maxilla in a 13 day old neonate is described. Computed tomography and histopathology confirmed the diagnosis and a submucosal excision was carried out when the infant was 30 days old. But three weeks later the patient reported back with a recurrence and a wide surgical excision was performed. The recurrence may have been caused by incomplete removal of the tumor cells and the initial surgical procedure may have stimulated tumour cell proliferation. Fortunately, 6 month follow up of the patient showed no recurrence.

Knowledge and attitude on infant oral health among graduating medical students in Kerala.

Providing dental and oral health care to all children in Kerala remains a thorny challenge. Lack of community water fluoridation, dental workforce shortages and geographical barriers all aggravate oral health and access problems. Children from low-income and minority families and children with special needs are at particular risk. Family centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. Present study was conducted to evaluate knowledge and attitude of graduating medical students towards infant oral health qualitative methods were used to evaluate the program.

Intestinal trematode infection in North Bihar.

Reports of intestinal trematode infections are not common from Bihar, India. However, we herewith report one case of fasciolopsiasis from North Bihar, India. A 14 years old girl presented with diarrhea, vomiting, generalized pain abdomen and loss of weight. Routine stool examination and upper gastrointestinal endoscopy revealed fasciolopsis buski in large numbers. Her rural life style and food habit (ingestion of raw vegetables- caltrops and water chest nuts) supported the cause of infestation. Despite treatment with praziquantel, the patient died after two days. Mild infestations of Fasciolopsis buski may pass on unnoticed. However, heavy infestations may cause considerable prostration, illness and even death in younger age groups. Awareness regarding this parasitic infestation (endemic in some regions), especially in the rural set up is still a much needed entity.

Brain abscess due to Scedosporium apiospermum in a non immunocompromised child.

Scedosporium apiospermum is a filamentous fungi that commonly causes cutaneous infection. In certain circumstances, S. apiospermum can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited and the prognosis is poor. Early identification and treatment can decrease the mortality rate. Here we present a case of brain abscess with chronic suppurative otitis media, caused by S. apiospermum. This is the first such case report from Nepal. We could identify the organism only post mortem. We could not save the patient, probably due to delay in diagnosis.