Secondary Hemophagocytic Lymphohistiocytosis: A Series of Three Cases.

Hemophagocytic lymphohistiocytosis (HLH) is a disease of abnormal activation of the immune system, either due to a familial cause or a sporadic cause, in relation to various triggering agents. Secondary HLH is a complication of various diseases, such as infections, malignancies, and autoimmune disorders. In our case series, we present three cases of secondary HLH with varied etiologies. Case 1 involved an 18-year-old male with a history of pulmonary tuberculosis, presenting with fever, hepatosplenomegaly, and elevated inflammatory markers. HLH was treated with steroids alongside antitubercular therapy (ATT). In case 2, a 17-year-old male presented with dengue fever, fever, hepatosplenomegaly, and elevated inflammatory markers. HLH was managed with steroids and etoposide. In case 3, a 29-year-old female with systemic lupus erythematosus (SLE) presented with fever, hepatosplenomegaly, and a positive antinuclear antibody (ANA) test. Steroid therapy was initiated for HLH. The prognosis depends on various factors. The management of such cases necessitates expeditious treatment of the underlying disease in conjunction with amelioration of the cytokine storm with the immunosuppressive agents precipitated by the secondary conditions. Once the underlying cause of the cytokine storm is treated, the lethal progression of the disease may come to a halt.

Wernekink Commissure Syndrome With Bilateral Cerebellar Signs and Holmes Tremor in a Patient With a Preexisting Movement Disorder.

Wernekink commissure syndrome (WCS) is an extremely rare midbrain syndrome, in which there is the selective destruction of the decussation of the superior cerebellar peduncle, which commonly presents with bilateral cerebellar signs. We describe a case of WCS with Holmes tremor in a patient having an undiagnosed involuntary movement disorder since childhood following an undocumented case of meningitis. The patient presented with sudden onset gait instability with bilateral cerebellar signs (more prominent on the left side), Holmes tremor in bilateral limbs, slurred speech, and marked dysarthria. No ophthalmoplegia or palatal tremors were noted. The patient was conservatively managed along the lines of a stroke, and there was a marked improvement in cerebellar signs and Holmes tremor with time but no evolution (improvement or worsening) was observed in the involuntary movements of limbs and face that were present before the onset of WCS.

Association between ivermectin treatment and mortality in COVID-19: A hospital-based case-control study.

Purpose: This study was designed to test the hypothesis that exposure to ivermectin in early disease prevents mortality due to COVID-19. A secondary objective was to see if the drug has any impact on the length of hospital stay among the survivors. Methods: It was a hospital-based retrospective case-control study conducted at a tertiary teaching hospital in India. All patients with a diagnosis of COVID-19 who were admitted between 1st April and 15th May 2021 and received inpatient care were included. Important variables like demographic details, dates of admission and discharge or death, symptoms at the time of admission, comorbidities, severity of illness at the time of admission, whether ivermectin was administered or not during the course of the illness and other treatments received as part of the standard of care were retrieved from the medical records. Results: Of the 965 patients who received inpatient care, 307 died during their hospital stay while 658 were successfully discharged. The proportion of cases treated with ivermectin was 17.26% among the non-survivors (53/307) and 17.93% among the survivors (118/658). The effect was statistically insignificant (crude OR = 0.954; 95% CI: 0.668-1.364, P = 0.80). Among the survivors, the median length of stay was 11 days for patients who received ivermectin (IQR: 7-15) as well as for those who did not (IQR: 7-16). Conclusion: This study did not show any effect of ivermectin on in-patient mortality in patients with COVID-19 and there was no effect of the drug on the length of hospital stay among the survivors.

Kimura's Disease without Peripheral Eosinophilia: An Unusual and Challenging Case Simulating Venous Malformation on Imaging Studies-Case Report and Review of literature.

Kimura's Disease (KD) is a rare chronic inflammatory disorder presenting as multiple painless solitary subcutaneous nodules, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. Because of painless nature and indolent course, there is usually a delay in the patient's presentation. KD may radiologically mimic other chronic inflammatory conditions like tuberculosis, vascular malformations and neoplasms. Clinical correlation and histological evaluation along with elevated peripheral eosinophil and serum IgE level are considered important for confirmatory diagnosis. We report a case of painless swelling over right submandibular region extending to the right superficial parotid. The haematological reports were within normal limits. Ultrasound (USG), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) favoured a diagnosis of venous malformation. However, histopathological examination of excised lesion confirmed a diagnosis of KD. This case proves the possibility of the KD even in the absence of peripheral eosinophilia and/ or elevated serum IgE level, and may mimic venous malformation on imaging studies. Therefore, KD must find a place in the differentials of solitary painless neck swelling even in the absence of peripheral eosinophilia and/or elevated IgE level.

Autologous fat transfer for breast surgery.

Cosmetic and reconstructive surgeries always have a primary aim of the best outcome for the patient, with a big emphasis on the aesthetics. Lipomodelling is one such technique, originally described over a century ago but still used to this day, to provide a patient with the highest quality results. This is particularly true for lipomodelling of the breast, whether it be purely cosmetic, or for a post-mastectomy reconstruction for a breast cancer patient. Lipomodelling provides an effective way of restoring and even improving the look and aesthetics of the breast and of helping achieve the patient's expectations. With the added advantage of being autologous, the procedure is safe and effective. This review discusses the latest guidelines and literature on autologous lipomodelling.

Sudden Onset, Rapidly Expansile, Cervical Cystic Hygroma in an Adult: A Rare Case with Unusual Presentation and Extensive Review of the Literature.

Cystic hygroma (CH) is a benign infiltrative malformation of the lymphatic channels. We report a case of a 28-year-old Indian female who presented with rapidly enlarging right sided neck swelling over the posterior triangle since 5 days. Complete resection of CH is sometimes not amenable because of its infiltrative nature and involvement of surrounding vital structures. However, in our patient successful complete surgical resection was undertaken. The MRI findings of our patient were consistent with brachial cleft cyst; this posed a challenge in the diagnosis of CH. The histopathological analysis of the resected mass confirmed CH. CH is rare in adults and such an acute presentation is exceptionally atypical. History of prior trauma and infection are known etiological factors for adult CH; these were conspicuously absent in our patient. CH should be considered in the differentials of rapidly enlarging cystic swelling of posterior region of neck in adults. Optimal and timely management is necessary to achieve a favorable prognosis. Therefore, we report a case of rapidly enlarging cervical CH in an adult along with extensive literature review to have a better understanding regarding epidemiology, etiopathogenesis, clinical presentation, optimal management, and prognosis of such a rare entity in adults.

Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP), which makes the use of 11-13F sheaths as compared to 24-30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes. PATIENTS AND METHODS: A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely. RESULTS: Complete stone fragmentation was achieved in 114 out of 120 patients (95%) using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5%) patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120). There were no significant postoperative complications. CONCLUSION: This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.

Olopatadine Hydrochloride and Fluticasone Propionate in Topical Treatment of Allergic Rhinitis: A Single Blind Randomised Study.

INTRODUCTION: The use of corticosteroids or antihistaminics in treatment of allergic rhinitis is known and practiced since long. The efficacy of topical use of fluticasone propionate and Olopatadine Hydrochloride (HCL) for symptomatic relief of allergic rhinitis has been studied either individually or with other drugs. But very few studies show comparison between these two drugs. AIM: To compare the efficacy of topical use of fluticasone propionate and olopatadine hydrochloride for symptomatic relief of allergic rhinitis. DESIGN: In this single blind, randomized control study, the efficacy of topical use of olopatadine HCL was compared with fluticasone propionate for relieving symptoms of allergic rhinitis. MATERIALS AND METHODS: The symptomatic cases were randomized in two groups for treatment using either olopatadine HCL or fluticasone propionate respectively. In each group, the Total Symptom Scores (TSS) and individual symptom scores were recorded before and after treatment with the help of symptom evaluation scale. STATISTICAL ANALYSIS: Chi-square test, unpaired t-test, Mann Witney U-test, and Wilcoxon signed Rank test were used during analysis. The results of the comparison were noted and analysed. RESULTS: During four week study period both TSS and individual symptom score were reduced (p<0.05) in either groups. The TSS decreased by an average of 85.07% for those treated with olopatadine and by 95.55% for those treated with fluticasone. CONCLUSION: Overall fluticasone propionate was superior to olopatadine in relieving symptoms of allergic rhinitis (p<0.005).

Present and possible therapies for age-related macular degeneration.

Age-related macular degeneration (AMD) is the most common cause of blindness in the elderly population worldwide and is defined as a chronic, progressive disorder characterized by changes occurring within the macula reflective of the ageing process. At present, the prevalence of AMD is currently rising and is estimated to increase by a third by 2020. Although our understanding of the several components underpinning the pathogenesis of this condition has increased significantly, the treatment options for this condition remain substantially limited. In this review, we outline the existing arsenal of therapies available for AMD and discuss the additional role of further novel therapies currently under investigation for this debilitating disease.

Tubeless percutaneous nephrolithotomy using antegrade tether: a randomized study.

BACKGROUND AND PURPOSE: Tubeless percutaneous nephrolithotoomy (PCNL), although an accepted technique by now, continues to suffer from two major limitations: The need for postoperative cystoscopy for ureteral stent removal and inability to perform a "second-look" procedure for any residual fragments. We share our experience with a modification of the standard tubeless PCNL technique that allows us to overcome these shortcomings. PATIENTS AND METHODS: A total of 166 patients selected to have PCNL were randomized into two groups of 83 each. In group A (control group), the patients underwent standard PCNL with the insertion of a nephrostomy tube at completion; in group B (intervention group), modified tubeless PCNL was performed with a Double-J (DJ) stent inserted with a tether attached to its proximal end, taken out through the percutaneous tract. The nephrostomy tube in group A was removed postoperatively on the second or third day, whereas those in group B had the stent removed directly by pulling the attached tether within the office setting 10 to 14 days postoperatively. RESULTS: The need for postoperative analgesia was significantly higher in group A compared with group B (mean dose of tramadol needed, 128 mg vs 81.3 mg) (P<0.001). Four patients in group A had postoperative urinary leakage from the nephrostomy site, whereas there were no leaks in patients in group B. Group B patients spent significantly shorter average time in hospital (21.6 hours) compared with group A (54 hours) (P<0.001). Two of the patients in group B needed a second-look procedure, performed by the insertion of a guidewire down the stent, which was pulled out partially by its tether. Presence of the tether in the flank or the process of subsequent removal did not cause any discomfort to any patient. CONCLUSION: The present study demonstrates that tubeless PCNL with a tethered DJ stent overcomes its main drawback, namely, the need for cystoscopy for stent removal, and also allows access to the pelvicaliceal system for second-look nephroscopy.