Efficacy and Safety of Oral Tolvaptan Therapy in Hospitalized Cirrhotic Patients with Hyponatremia.

BACKGROUND: Tolvaptan is an orally administered, nonpeptide, selective arginine vasopressin V(2) receptor antagonist that increases free water clearance, thereby correcting and increasing the low serum sodium levels in patients of cirrhosis, where hyponatremai is am major encountered problem. AIMS: Evaluate the efficacy and tolerabilty of tolvaptan in cirrhotics with symptomatic hyponatremia that resist correction with fluid restriction. Intellectual improvement assessed using Short Portable Mental Status Questionnaire (SPMSQ) pre and post therapy(on conclusion). Adverse drug reactions monitored to assess safety. METHDOLOGY: Study design: Prospective, pre and post drug efficacy and safety evaluating study with permission from ethical committe. Study Population: one hundred cirrhotic patients, irrespective of etiology, with hyponatremia, who fulfill the inclusion criteria. Protocol: All enrolled patients, treated with oral Tolvaptan at doses of 15 mg once daily in addition to the concurrent treatment regimen. Tolvaptan therapy was concluded as soon as the patient reached the normal sodium levels, which were monitored daily. RESULTS: Our study population had a majority of Hepatitis C patients (49%). Mean sodium levels at baseline were 125.79 + 3.49 which had a significant (130.25+3.28), and highly significant (133+ 3.19) change post 48 and 72 hours. In clinical parameters, urine output was altered significantly (pre drug mean 1530.76+619.02 to post drug mean of 1783+563.01. Body weight and Abdominal girth changes were not significant.

Non Secretory Multiple Myeloma With HCV Infection: A Rare Case Entity.

Multiple Myeloma is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells. It is characterized by a clinical pentad of 1) anemia, 2) a monoclonal protein in the serum or the urine or both, 3) bone leisons and or bone pain, 4) hypercalcemia>11.5g/dl and 5) renal insufficiency. Non secretory multiple myeloma is a rare variant of the classic form of multiple myeloma and accounts for 1% to 5 % of all cases of multiple myeloma. The clinical presentation and radiographic findings of non-secretory multiple myeloma and multiple myeloma are the same. The diagnosis of multiple myeloma requires the demonstration of monoclonal gammopathy in the serum or urine. In non-secretory multiple myeloma, however no such gammopathy can be demonstrated, making the diagnosis more difficult. We describe a 60 year old woman who initially presented with back pain which when further investigated by complete blood count revealed hemoglobin of 13g/dl, Total Leukocyte Count of 10,890 and platelet count of 1.5 lac/cmm. Viral markers revealed HCV positive. Hypercalcemia with a serum calcium level of 12.5g/dl was also demonstrated. MRI revealed multiple lytic bony lesions. No monoclonal gammopathy was found in the serum or urine and bone marrow biopsy showed marked plasmacytosis of > 45%. We present a case of Non Secretory multiple myeloma because of its illusive nature and rare entity.

Cytological spectrum of salivary gland lesions and their correlation with epidemiological parameters.

BACKGROUND: The role fine-needle aspiration (FNA) in the diagnosis of salivary gland lesions has evolved over the years. Although clinical and radiological parameters help to narrow the differential diagnosis the tissue diagnosis still remains the gold standard. MATERIALS AND METHODS: This study is from January 2013 to December 2015 in our Department of Pathology where 170 salivary gland lesions were aspirated. The aim of the present study was to analyze adequacy rate in relation to the size of lesion and to evaluate varied cytological spectrum of salivary gland lesions with emphasis on differential diagnosis and to correlate cytological diagnosis with age, gender and anatomical site. RESULTS: The 170 cytological smears were categorized into two groups: Group 1 adequate aspirations (88.2%), Group 2 inadequate aspirations (11.7%). The adequate aspirations were subdivided as neoplastic (53.33%) and nonneoplastic (46.66%). The distribution of the various neoplastic lesions (80; 53.33%) were 66 (82.5%) benign, 12 (15%) were malignant and 2 (2.5%) were suspicious of malignancy. Among benign neoplasms, the pleomorphic adenoma (62; 93.3%) was the most frequent followed by Warthins tumor (4; 6%). The most common malignant neoplasms were adenoid cystic carcinoma (6; 50%), followed by mucoepidermoid carcinoma (4; 33.3%), malignant lymphoma (1; 8.3%) and metastatic carcinomatous deposits (1; 8.3%). In two cases, cytological picture indicated suspicion for malignancy however specific tumor typing could not be done. The neoplasms occurred more frequently in the parotid gland (65%), followed by submandibular gland (21.3%) and minor salivary glands (13.8%). The nonneoplastic lesions (70) included 68.6% cases of chronic sialadenitis, 17.1% cases were reported as mucocele, 11.4% cases of acute sialadenitis 2.9% cases as tubercular granulomas. CONCLUSION: FNA cytology provides useful information on the management of salivary gland lesions and prevents unnecessary surgery in cases of nonneoplastic lesions and identification of malignancy helps the surgeon in deciding type and extent of surgery.

Fine-needle aspiration cytology of cysticercosis in submandibular gland.

Fine-needle aspiration cytology (FNAC) has emerged as simple, minimally invasive, low-cost, outpatient diagnostic modality for the evaluation of nodules caused by parasites. Cysticercosis is caused by larval stage of Taenia solium, pork tapeworm. It is endemic in Southeast Asia, Latin America and South Africa. We report a case of cysticercosis in a 25-year-old male who presented with painless swelling of submandibular gland which was diagnosed on FNAC. The patient was recommended antihelminthic therapy which resulted in complete resolution of the swelling.

Clear Cell Adenocarcinofibroma Ovary - A Rare Histopathological Variant with Unusual Presentation.

The clear cell adenocarcinoma of ovary is a distinctive tumour. Stroma rich variants (adenocarcinofibroma) of these types of tumours are uncommon. We report a rare case of clear cell adenocarcinofibroma of ovary in 37 years of female presenting with bilateral ovarian masses. The tumour contained fibrous component and was radiologically indistinguishable from soft tissue malignancy. The serum level of CA-125 was raised. Histopathology and immunohistochemistry revealed the rare microscopic type of ovarian tumour. Because of differences in the clinical course as well as management, possibility of this unusual type of carcinoma must be ruled out.

A study of Basal cell carcinoma in South asians for risk factor and clinicopathological characterization: a hospital based study.

Objectives. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So, this study was done focusing on its epidemiology, risk factors, and clinicopathological aspects. Methods. A hospital based cross-sectional study was conducted in Punjab, North India, from 2011 to 2013. History, examination and histopathological confirmation were done in all the patients visiting skin department with suspected lesions. Results. Out of 36 confirmed cases, 63.9% were females with mean ± SD age being 60.9 ± 14.2 years. Mean duration of disease was 4.7 years. Though there was statistically significant higher sun exposure in males compared to females (P value being 0.000), BCC was commoner in females, explainable by intermittent sun exposure (during household work in the open kitchens) in women. Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% of cases, with nose being the commonest site (50%) with nodular/noduloulcerative morphology in 77.8% of cases. Pigmentation was evident in 22.2% of cases clinically. Nodular variety was the commonest histopathological variant (77.8%). Conclusions. This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose, and higher percentage of pigmentation in Indians.

Hypermobility syndrome.

Three cases of Hypermobility Syndrome (HS) are discussed. The first case was a young female, aged 24, with musculoskeletal symptoms since 5 years. Second was an 18 year old male with similar symptoms since 3 years. The third was an elderly female who presented with knee joint osteoarthritis (OA) and apparent but reducible deformities of hands mimicking rheumatoid arthritis (RA). All three patients had hypermobility of joints in absence of demonstrable systemic rheumatic disease. The prevalence, clinical features and management of the entity is discussed. An increased awareness of this condition among physicians is warranted as some patients may be erroneously diagnosed as RA/SLE and may be put on DMARDs and steroids.

Silent myocardial infarction during hypoglycemic coma.

Hypoglycemia is a common complication of treatment of diabetes mellitus. The potential neurological complications of hypoglycemia as seizures and coma are well-recognized entities. A hypoglycemic episode is a risk factor for a patient with diabetes to have cardiovascular complications. Myocardial ischemia and infarction are known to occur in the setting of hypoglycemia. In view of the potential association of the two, the diabetic patients should undergo a routine ECG in such circumstances.

Rapidly locating and characterizing pollutant releases in buildings.

Releases of airborne contaminants in or near a building can lead to significant human exposures unless prompt response measures are taken. However, possible responses can include conflicting strategies, such as shutting the ventilation system off versus running it in a purge mode or having occupants evacuate versus sheltering in place. The proper choice depends in part on knowing the source locations, the amounts released, and the likely future dispersion routes of the pollutants. We present an approach that estimates this information in real time. It applies Bayesian statistics to interpret measurements of airborne pollutant concentrations from multiple sensors placed in the building and computes best estimates and uncertainties of the release conditions. The algorithm is fast, capable of continuously updating the estimates as measurements stream in from sensors. We demonstrate the approach using a hypothetical pollutant release in a five-room building. Unknowns to the interpretation algorithm include location, duration, and strength of the source, and some building and weather conditions. Two sensor sampling plans and three levels of data quality are examined. Data interpretation in all examples is rapid; however, locating and characterizing the source with high probability depends on the amount and quality of data and the sampling plan.