Tumoral cutaneous rhinosporidiosis: Case report and review of literature

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi commonly affecting nasal mucosa, conjunctiva, and urethra. Subcutaneous tumor nodule presentation is rare and often mimics as sarcoma. Such tumoral rhinosporidiosis has been reported rarely. This report describes a 60-year male who presented with a solitary, firm, nontender swelling in posterior aspect of right leg with an ulcer and mimicking clinically as soft tissue sarcoma. Histopathology was diagnostic. Surgical excision was found to be useful.

The rhabdoid variant of adrenocortical carcinoma-Report of three cases and literature review

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Extensive rhabdoid morphology in ACC has been described recently in very few cases. The proportion of rhabdoid morphology and the role of SMARCB1/ INI1 expression in these tumor cells to diagnose the specific variant is not described in the literature. We reviewed the clinicopathological features of nine cases of adrenocortical neoplasm. Out of which, three cases of ACC showed predominant rhabdoid morphology. Large discohesive cells with abundant cytoplasm containing eosinophilic inclusions, eccentric vesicular nucleus, and prominent nucleoli. INI1 immunostain was retained in all cases. We reported the rhabdoid variant of ACC, a novel entity, and its diagnostic approach from their histological mimickers. Identifying more cases of this entity will help to clearly understand the pathogenesis, biologic behaviour, and any specific molecular alterations in the future.

A rare case of primary giant myxoid liposarcoma of the pericardium

Primary pericardial neoplasms account for 6.7–12.8% of all primary tumors arising in the cardiac region. Pericardial tumors are most likely to be metastatic and are an extension of the primary tumors from the surrounding structures. Sarcomas of the pericardium are rare. Myxoid liposarcoma (ML) represents about 5% of all the soft-tissue sarcomas in adults. They are usually located in the deep soft tissues of the extremities. There have been less than 20 cases of pericardial liposarcomas reported on PubMed since 1973. Here, we present a rare case of primary giant pericardial myxoid liposarcoma (ML) in a 46-year-old female diagnosed on frozen section and later was confirmed histopathologically.

Utilization of Reproductive and Child Health Services and Client Satisfaction from Urban Primary Health Centers by Recently Delivered Women Living in Urban Slums of Lucknow, India

Background: Due to rapid urbanization, there is an increase in population in slums often lacking access to basic health services. Objective: The purpose of this study was to assess the utilization of reproductive and child health services by recently delivered women and their children residing in catchment areas of urban PHCs, to evaluate their level of satisfaction and to determine the factors associated with utilization of these services by recently delivered women. Settings and Design: The study was conducted in the catchment areas of urban primary health centre of Lucknow. Methods and Material: A cross-sectional study was conducted among 320 women having children less than 24 months in the slums covered under selected U-PHCs, sampled through a multi-stage random sampling technique using a semi-structured questionnaire. Statistical analysis used: SPSS-26 and MedCalc software were used for data analysis. Results: Utilization of RCH services by recently delivered women from UPHC was 39%. About 24% of recently delivered women availed ANC services from UPHC and 56.7% utilized family planning services and 95.8% immunization services for children. Child care services for diarrhea and ARI were availed by 9.9 and 3.1% of women, respectively. Satisfaction regarding maternal care and immunization services was seen in 84 and 95.8% of women. Poor satisfaction regarding child care was seen in 56.5% of women. Conclusions: The utilization of RCH services was found to be poor in the study population. Most recently delivered women were satisfied with all services except child care.

Pediatric primary extra-ovarian Sertoli Leydig cell tumor of the retroperitoneum

Ovarian Sertoli Leydig cell tumors (SLCT) accounts for less than 0.5% of all ovarian malignancies. The incidence of primary extra-ovarian SLCT is extremely rare with reported cases occurring in young adult women till now. We report case of primary retroperitoneal extra-ovarian SLCT in a seven-year girl child without any hormonal manifestation. She presented with complaint of left side abdominal swelling associated with intermittent pain for a duration of six months. CT scan revealed a huge retroperitoneal space-occupying lesion abutting the dorsal vertebrae and present posterior to pancreas, spleen and left kidney. The tumor was diagnosed as extraovarian Sertoli Leydig cell tumor with intermediate differentiation on histopathology and immunohistochemistry.

A simulation study to compare physiological responses to hypoxia and exercise between anaemic subjects and healthy controls

Objectives: Military flying is a complex task and requires high level of physical fitness of aviators. Various aviation stressors such as acceleratory force, hypoxia, cold weather conditions and decompression sickness place enormous stress on human physiological systems of the aviators. Individuals with Hb <13 g/dL (males) are being placed in the lower medical category which makes them unfit to fly. The present study was undertaken to assess the implication of low haemoglobin (Hb) on exercise capacity and hypoxia tolerance. Materials and Methods: Twenty-five individuals with anaemia and 15 healthy controls participated in the study. The participants were subjected to normobaric hypoxia (NH) equivalent to an altitude of 15,000 feet. Different physiological parameters such as heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), respiratory rate (fR) and arterial oxygen saturation (SpO2) were measured during NH. Participants also performed maximal aerobic capacity (V?O2 max) and maximal anaerobic capacity test in bicycle ergometer. Results: HR, SBP, DBP and fR in anaemic subjects were higher than healthy controls during NH, whereas SpO2 in anaemic subjects was lower as compared to healthy controls. Anaemic individuals had a lower VO2 max than their healthy counterparts. Critical power and anaerobic work capacity were lower in anaemic subjects than healthy controls. Conclusion: There is a deterioration in exercise capacity and hypoxia tolerance in individuals with low Hb levels. Adequate precaution should be exercised for permitting military aviators to fly with low Hb level.

Morbidity pattern and health-seeking behavior among elderly population in rural area of district Barabanki: A cross-sectional study

Background: Aging is a universal and inevitable process of life. Elderly people are the most vulnerable group in terms of their health. In India geriatric-aged population is increasing day by day. Understanding the morbidities and health-seeking behavior of the elderly is essential for strengthening geriatric health-care services delivery. Objectives: The objectives of the study were (1) to assess the morbidity pattern in elderly people and (2) to know the health-seeking behavior of the aged population. Materials and Methods: This community-based, cross-sectional, and descriptive study was conducted among 160 elderly individuals over a period of 3 months from February 2019 to April 2019. Participants were interviewed and clinically examined for the assessment of sociodemographic detail, morbidity profile, and health-seeking behavior. Results: Of 160 study subjects, 71 were males and 89 were females. The majority (61.3%) of the elderly were in the age group of 60–69 years. Overall the prevalence of morbidity was high, i.e., 76.9%. The most common illness was a nonspecific generalized weakness (48.1%) and gastrointestinal problems (44.4%). Majority of them (65.4%) have faith in allopathic medicines and used government facilities. Of the total morbid elderly, 15.5% of them could not get medical advice. Conclusions: High prevalence of morbidity among elderly population stresses the need to provide suitable health facilities and affordable health care to the elderly. Non-specific generalized weakness was one of the most important problems in this age group. Further research is to be done to know the cause of this weakness. Policymakers must focus on rural elderly and their beliefs which prevent them from seeking healthcare.

Comparison of Serum Biochemical and Mineral Profiles of Cattle Reared Under Island and Coastal Ecosystem

The present study was conducted in the Department of Animal Reproduction Gynaecology and Obstetrics, College of Veterinary Science and Animal Husbandry, OUAT, BBSR in collaboration with ICAR-Central Island Agricultural Research Institute, Portblair (Andaman and Nicobar Island). Crossbred cattle with the history of anoestrus and repeat breeding were considered for the present investigation. The basic difference in serum biochemical and mineral profiles of cattle reared under two quite different ecosystems namely Island and coastal ecosystem was estimated which might be due to the variability in rainfall, ambient temperature, day light length and humidity. The incidence of different infertility conditions in both the ecosystems also might vary as per the environment. Serum samples were collected for estimations of biochemical parameters like total protein, glucose, cholesterol, Ca, P and Ca:P ratio. The overall incidence of infertility was recorded to be 47.62 % in island and 45.90 % in coastal ecosystem. No significant difference in serum levels of total protein, glucose, cholesterol, zinc, copper and manganese could be observed in between cattle reared in both ecosystems. It was concluded that the variations in humidity, ambient temperature, rain fall and day light length between Portblair, Andaman and coastal climate of Odisha, did not have much effect on reproduction of cattle

Time Series Investigation of Milk Production in Major States of India Using ARIMA Modeling

In India, white revolution was started during 1970’s with Operation flood programme. After this revolution, production of milk in India had tremendously increased. Contribution of diary sector has continuously increased in Indian Gross Domestic Product (GDP). Livestock sector has emerged as an essential growth driver of the Indian wealth. This study is associated with time series data of five major milk producing states in 2017-18 in India. The milk production projection has been made using Auto Regressive Integrated Moving average model (ARIMA) for year 2024-25. From the forecasted figures, Uttar Pradesh would be leading states of India in milk production with 37.68 MMT in year 2024-25. Whole India milk production would reach 252.948 MMT in year 2024-25. This projection helps in formulating national agricultural policy as well as proper planning for products into dairy sector

A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI

@#Introduction: An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendontrochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. Materials and Methods:This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. Results: The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. Conclusions:The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.

Perception regarding Bio-medical Waste Management among medical students in a Tertiary Care Hospital

Background: Bio-medical waste is perilous and can be a health hazard. There is considerable role of medical undergraduates, interns and post-graduates in preventing hazardous consequences from mishandling of bio-medical waste. Aims & Objectives: To assess the knowledge, attitude and practice about Bio-medical waste management among medical undergraduates, interns and post-graduate students. Methodology: A cross-sectional study was carried out among 75 participants including MBBS students, interns and post-graduate students (25 from each group) at King George’s Medical University, Lucknow through purposive sampling technique over a period of one month. A structured self-administered questionnaire was used for data collection. Data were analyzed using Chi-square, Fischer-exact, one-way ANOVA and Post Hoc (Tukey) Tests. Results: MBBS students had more knowledge and the better attitude towards BMW management guidelines as compared to interns and post-graduates(p<0.001), while post-graduate students were more aware of the needle-stick injury and were correctly practicing BMW management as compared to MBBS students and interns(p<0.001). Conclusions: Knowledge, attitude and practice regarding BMW management is still inadequate among MBBS students, interns and post-graduates, so repeated training-retraining and supportive supervision regarding the same should be foster. Strict regulations and surprise perusals might be a strong impetus for medical students and other health personnel.

Attitude toward eye donation - A population-based study from Western Uttar Pradesh

Background: Corneal blindness is one of the major causes of blindness and vision can be successfully restored by corneal transplantation. Eye donation can improve the availability of cornea, but it depends on awareness and willingness in general population. Objectives: The objectives of this study were to assess the awareness and willingness of urban population of western UP about eye donation and to correlate factors with willingness. Materials and Methods: A cross-sectional study was conducted among randomly selected 400 residents >30 years of age of urban field practice area of the Department of Community Medicine, TMMC and RC, Moradabad. Pre-tested structured questionnaire was used to obtain information about the awareness and perception regarding eye donation. Results: Of 400 participants, 75% were aware about eye donation and 25% were ignorant; print and electronic media were the most common source of information. 51.6 % knew about the time limit of eye donation. 63.5% were willing for eye donation; willingness for eye donation was significantly higher in younger age group, males, and well-educated participants. Conclusion: Our study establishes the need to improve the awareness of eye donation in the study population. The most idealist public health approach would be, to reduce the occurrence of vision loss due to corneal diseases, with effective preventive policies, but as a short-term goal, the key way to deal with corneal blindness is to obtain the required number of corneas for transplantation.

Expect the unexpected – Loss of surface CD3 on flow cytometry in hepatosplenic T-cell lymphoma: An eye opener

Hepatosplenic T-cell lymphoma (HSTCL) is a rare extranodal T-cell lymphoma that shows preferential sinusoidal infiltration of spleen and liver. It usually shows bright expression of surface CD3 (sCD3) with restriction for γδ-T cell receptors (TCR). We present a case of a 34-year-old male who presented with hepatosplenomegaly and B symptoms. His peripheral blood and bone marrow (BM) was involved by atypical lymphoid cells that were CD2+, CD7+, CD56+, cytoplasmic CD3+, and sCD3− on immunophenotyping by flow cytometry. As sCD3 is a lineage marker for T-cell lymphomas, the loss of sCD3 posed a diagnostic dilemma. However, typical pattern of sinusoidal BM and liver involvement by CD3+ cells and TCR gene rearrangement positivity led to final diagnosis of HSTCL. The differential diagnosis, workup, and clinical course of the case are discussed. To the best of our knowledge, only one case of de novo HSTCL with negative sCD3 has been reported before in the literature.

Papilledema revisiting after sinus angioplasty of chronic cerebral venous sinus thrombosis

This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting). After the resolution of CVST, patients developed the recurrence of symptoms which on digital subtraction angiography revealed dural arteriovenous malformation (DAVM). DAVM and papilledema resolved with endovascular embolization. This case series highlights a need of constant monitoring of CVST cases after the endovascular intervention.

Encephalocele presenting as lower lid swelling: A rare case report

Encephalocele is a rare congenital abnormality characterized by abnormal protrusion of brain and meninges through an opening in the skull. We report an 8-year-old girl who presented with a swelling in the right lower lid for the last 6 years. In her infancy, she had undergone surgery for a very small swelling located in the right nasolacrimal area. On further clinicoradiological evaluation, anterior encephalocele was diagnosed. This case highlights the uncommon site of anterior encephalocele; misdiagnosis and mismanagement of which could result in dreaded complications such as meningitis and cerebrospinal fluid leaking fistula formation.

Drug susceptibility of rapid and slow growing non‑tuberculous mycobacteria isolated from symptomatics for pulmonary tuberculosis, Central India.

Background: Non‑tuberculous mycobacteria (NTM) are emerging as important pathogens. Their treatment also differs from that of Mycobacterium tuberculosis. In India, any datum on them is scarce as species identification and drug susceptibility are not performed in most laboratories. Susceptibility also differs from one geographic area to another, and in our country, there are no data even to guide the clinicians to start treatment empirically. Methodology: The present study endeavours to generate drug susceptibility data on NTM isolated from sputum samples collected and stored from 6445 symptomatics for pulmonary tuberculosis during a prevalence survey and from specimens received from the hospital. Isolates were not necessarily associated with the disease. Species were identified and antibiotic susceptibility was performed using micro‑broth dilution technique as per the standard Clinical and Laboratory Standards Institute guidelines. Results: A total of 65 NTM with 11 species were identified, of which 27 belonged to Mycobacterium fortuitum complex, 14 Mycobacterium gordonae, 9 Mycobacterium avium, 7 Mycobacterium flavescens, 4 Mycobacterium scrofulaceum and one each of others. Sensitivity to amikacin for M. fortuitum was 95.22% (20 out of 21), followed by ciprofloxacin (76.19%) and clarithromycin (71.42%). All the 9 M. avium isolates, 11 of M. gordonae (78.57%), 5 of M. flavescens and 2 of M. scrofulaceum were sensitive to clarithromycin. All NTM were resistant to first‑line antitubercular drugs except 8, which were sensitive to streptomycin. Conclusions: Drug sensitivity of NTM varies from species to species. While amikacin was the best for rapidly growing mycobacteria, clarithromycin was the most active drug against M. avium and other slow growers.

Waist-to-Height Ratio as an Indicator of High Blood Pressure in Urban Indian School Children.

Objectives: To examine the utility of waist-to-height ratio to identify risk of high blood pressure when compared to body mass index and waist circumference in South Indian urban school children. Design: Secondary data analysis from a cross-sectional study. Settings: Urban schools around Bangalore, India. Participants: 1913 children (58.1% males) aged 6-16 years with no prior history of chronic illness (PEACH study). Methods: Height, weight, waist circumference and of blood pressure were measured. Children with blood pressure ≥90th percentile of age-, sex-, and height-adjusted standards were labelled as having high blood pressure. Results: 13.9% had a high waist-to-height ratio, 15.1% were overweight /obese and 21.7% had high waist circumference. High obesity indicators were associated with an increased risk of high blood pressure. The adjusted risk ratios (95% CI) of high systolic blood pressure with waist-to-height ratio, body mass index and waist circumference were 2.48 (1.76, 3.47), 2.59 (1.66, 4.04) and 2.38 (1.74, 3.26), respectively. Similar results were seen with high diastolic blood pressure. Conclusion: Obesity indicators, especially waist-to-height ratio due to its ease of measurement, can be useful initial screening tools for risk of high blood pressure in urban Indian school children.

Clinico‑hematological profile and outcome of acute promyelocytic leukemia patients at a tertiary care center in North India.

OBJECTIVES: Acute promyelocytic leukemia (APL) is the only acute leukemia amenable to targeted therapy. However, there is limited Indian data on APL. We aimed to analyze data of APL patients treated with all trans retinoic acid (ATRA) and anthracycline based chemotherapy. MATERIALS AND METHODS: A total of 34 cases of APL were treated at our center over 4 years. Induction chemotherapy consisted of a combination of ATRA and daunorubicin. RESULTS: Most of our patients were intermediate risk (50%) followed by high risk (41.17%). Induction mortality was 14.7%. We observed a high incidence of febrile neutropenia (91%) and 50% of our patients developed ATRA syndrome. Four patients (11.76%) relapsed during follow‑up (median ‑ 15 months, range: 13‑33 months). There was no correlation between risk status and death or relapse or ATRA syndrome. Median event free survival (EFS) duration was not reached however mean duration was 38.45 ± 3.84 months. Median overall survival (OS) duration was also not reached at 53 months of follow‑up. The 4 year OS and EFS were 75.45% and 64.5% respectively. On multivariate analysis, only disseminated intravascular coagulation (DIC) significantly correlated with a poor OS and EFS. DISCUSSION: Our data reflects that APL remains a highly curable malignancy with good response to ATRA plus anthracycline based chemotherapy even with a greater number of high and intermediate risk patients. Only DIC during induction chemotherapy bore an impact on survival in our patients.

Young onset colorectal cancer: How does it differ from its older counterpart.

BACKGROUND: Colorectal cancer in the young has been a debated topic in literature with conflicting reports as to its pattern of occurrence and survival as compared to the older age group. MATERIALS AND METHODS: Retrospective study to analyze the clinicopathological characteristics, treatment modalities and survival of sporadic young‑onset colorectal cancer (YOCR) patients (<40 years) and compare them with the older group (>40 years). RESULTS: Of 172 patients managed, 72 (42%) were in the YOCR group. Among 72 patients, six were excluded because of hereditary syndromes. Incontinence (P = 0.02) and obstruction at time of presentation (P = 0.03) was significantly more common in the YOCR group. Left sided disease was more common in YOCR group (47/66) compared to the older group (65/100), but the difference was not statistically significant (P = 0.45). The proportion of rectal cancers was significantly more in the YOCR group (39/47) compared to the older group (39/65) (P = 0.01). Significant difference in resectability was noted in the left sided (YOCR 26/47 vs. older 49/65 P = 0.04) and the rectal cancers (YOCR 18/39 vs. Older 29/39 P = 0.02). The survival was similar among the two groups. CONCLUSIONS: Sporadic colorectal cancers in the young are more advanced and less resectable when compared to older population. Genetic studies are needed to elaborate the reasons for left sided predominance and aggressiveness of sporadic colorectal cancers in the younger subgroups.