A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in Children < 2 Years in Rajasthan, India.

OBJECTIVE: To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan. METHOD: This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed. RESULTS: During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases. CONCLUSION: Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.

A clinicopathological study of upper aerodigestive tract cancers.

BACKGROUND: The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. MATERIALS AND METHODS: This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. RESULTS: Most patients of UAT cancers were in the age group of 40-70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. CONCLUSION: Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.

Evaluation of enzyme-linked immunoelectrotransfer blot for diagnosis of cysticercosis in swine from North India.

Taenia solium cysticercosis is a major public health problem in developing countries. Swine cysticercosis results in economic losses for pig farmers in disease endemic areas. Consumption of cysticercotic pork leads to taeniasis in humans. Eggs excreted in the faeces of T. solium carriers disseminate to humans and pigs through the faecal-oral route, thus maintaining the life cycle in endemic areas. An enzyme-linked immunoelectrotransfer blot (EITB) assay was developed using whole crude T. solium cysticercus antigens (WCA) for the diagnosis of swine cysticercosis. Sera from 30 swine with cysticercosis confirmed by magnetic resonance imaging were subjected to EITB assay. Sera from 50 swine that were raised in a government farm and not allowed to roam freely were included as negative controls. Two or more bands of 8, 11, 14, 24, 26 and 29 kDa were immunoreactive on blot with sera from all infected swine except two, and none from swine raised on the government farm. The overall sensitivity and specificity of EITB assay for diagnosis of swine cysticercosis were 93.3% and 100%, respectively. Hence, EITB assay based on WCA may be a suitable diagnostic tool for swine cysticercosis in endemic areas.

Characterization of breast lesion using T1-perfusion magnetic resonance imaging: Qualitative vs. quantitative analysis.

OBJECTIVES: The objective of this study was to quantify the hemodynamic parameters using first pass analysis of T1-perfusion magnetic resonance imaging (MRI) data of human breast and to compare these parameters with the existing tracer kinetic parameters, semi-quantitative and qualitative T1-perfusion analysis in terms of lesion characterization. MATERIALS AND METHODS: MRI of the breast was performed in 50 women (mean age, 44±11 [SD] years; range: 26-75) years with a total of 15 benign and 35 malignant breast lesions. After pre-processing, T1-perfusion MRI data was analyzed using qualitative approach by two radiologists (visual inspection of the kinetic curve into types I, II or III), semi-quantitative (characterization of kinetic curve types using empirical parameters), generalized-tracer-kinetic-model (tracer kinetic parameters) and first pass analysis (hemodynamic-parameters). Chi-squared test, t-test, one-way analysis-of-variance (ANOVA) using Bonferroni post-hoc test and receiver-operating-characteristic (ROC) curve were used for statistical analysis. RESULTS: All quantitative parameters except leakage volume (Ve), qualitative (type-I and III) and semi-quantitative curves (type-I and III) provided significant differences (P<0.05) between benign and malignant lesions. Kinetic parameters, particularly volume transfer coefficient (Ktrans) provided a significant difference (P<0.05) between all grades except grade-II vs III. The hemodynamic parameter (relative-leakage-corrected-breast-blood-volume [rBBVcorr) provided a statistically significant difference (P<0.05) between all grades. It also provided highest sensitivity and specificity among all parameters in differentiation between different grades of malignant breast lesions. CONCLUSION: Quantitative parameters, particularly rBBVcorr and Ktrans provided similar sensitivity and specificity in differentiating benign from malignant breast lesions for this cohort. Moreover, rBBVcorr provided better differentiation between different grades of malignant breast lesions among all the parameters.

Tuberculosis infection and disease in people living with HIV in countries with low tuberculosis incidence.

In countries with low tuberculosis (TB) incidence, TB is concentrated in vulnerable populations, including people living with the human immunodeficiency virus (PLHIV), who have a substantially greater risk of TB than people without HIV. We searched PubMed, EMBASE and Web of Science for studies evaluating the risk factors for latent tuberculous infection (LTBI) or active TB in PLHIV in countries with TB incidence 10 per 100 000 population. Due to the number of risk factors evaluated and heterogeneity in study designs, we present summary data and a narrative synthesis. We included 45 studies: 17 reported data on the risk factors for LTBI and 32 on active TB. Black, Asian or Hispanic ethnicity, birth or long-term residence in a country with high TB incidence, and HIV acquisition via injecting drug use (IDU) or heterosexual sex were strong predictors of both LTBI and active TB. History of contact, a greater degree of immunosuppression at diagnosis or higher viral load increased the TB risk. Early HIV diagnosis to allow timely initiation of antiretroviral therapy is essential for the prevention of TB in PLHIV. Screening and treating PLHIV for LTBI to reduce the risk of progression to active TB disease should also be considered to further reduce the burden of active TB in low TB incidence settings. Research to support the expansion of TB and HIV prevention and treatment globally is essential to eliminate TB in low-incidence settings.

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era.

Vulnerable populations, including homeless persons, high-risk drug and alcohol users, prison inmates and other marginalised populations, contribute a disproportionate burden of tuberculosis (TB) cases in low-incidence settings. Drivers of this disease burden include an increased risk of both TB transmission in congregate settings, and progression from infection to active disease. Late diagnosis and poor treatment completion further propagate the epidemic and fuel the acquisition of drug resistance. These groups are therefore a major priority for TB control programmes in low-incidence settings. Targeted strategies include active case finding (ACF) initiatives and interventions to improve treatment completion, both of which should be tailored to local populations. ACF usually deploys mobile X-ray unit screening, which allows sensitive, high-throughput screening with immediate availability of results. Such initiatives have been found to be effective and cost-effective, and associated with reductions in proxy measures of transmission in hard-to-reach groups. The addition of point-of-care molecular diagnostics and automated X-ray readers may further streamline the screening pathway. There is little evidence to support interventions to improve adherence among these risk groups. Such approaches include enhanced case management and directly observed treatment, while video-observed therapy (currently under evaluation) appears to be a promising tool for the future. Integrating outreach services to include both case detection and case-management interventions that share a resource infrastructure may allow cost-effectiveness to be maximised. Integrating screening and treatment for other diseases that are prevalent among targeted risk groups into TB outreach interventions may further improve cost-effectiveness. This article reviews the existing literature, and highlights priorities for further research.

Degradation kinetics of bioactive components, antioxidant activity, colour and textural properties of selected vegetables during blanching.

Bioactive components of fruit and vegetables play an important role in scavenging free radicals and protect the body from degenerative diseases. A kinetic study was conducted to quantify the losses occurring in bioactive components, antioxidant activity and changes in colour and firmness of four commonly used vegetables (beetroot, green pea, eggplant and green pepper) during heat treatment (70-90 °C). The study revealed that logistic model can predict the variation in bioactive components and antioxidant activity with higher R2 and lower root mean square error (RMSE) as compared to first order model due to logarithmic reduction in these properties in the beginning of the process itself. However zero and first order kinetic models were found suitable to predict the changes occurring in colour and firmness respectively during blanching. D, z value, activation energy (Ea), activation enthalpy and entropy were calculated for all measured parameters for selected vegetables in the temperature range of 70-90 °C. These finding would be useful in designing thermal processes and related calculations for these vegetables.

Extensive subclinical sinusitis leading to Moraxella osloensis meningitis.

We report a case of a 31 year old male with extensive subclinical sinusitis leading to erosion in the cribriform plate and subsequent meningitis caused by the organism Moraxella osloensis. The patient presented to the emergency department with rapid onset confusion, neck stiffness and headache. Inflammatory markers, renal and liver function, and a chest radiograph were all normal. CT Head showed extensive polyp disease in the paranasal sinuses with expansion of the left frontal sinus and CT Sinuses revealed an area of low attenuation in the cribriform plate consistent with bony erosion. MRI Head showed thick loculated sinus inflammation. Lumbar puncture yielded CSF with a high white cell count of predominantly mononuclear cells, no visible organisms and an elevated protein. CSF microscopy, culture and viral PCR were not diagnostic, and so the CSF was sent for 16S rDNA PCR screening, which identified the rDNA of Moraxella osloensis. Moraxella osloensis is a rare cause of bacterial meningitis, with only a few reported cases. This case illustrates that sinusitis, while a common condition, when severe can predispose to intracranial infection with atypical and low virulence organisms such as Moraxella species, which do not commonly cause invasive CNS disease. This case represents the first case of Moraxella osloensis meningitis reported from the United Kingdom.

Pharmacovigilance of Miltefosine in Treatment of Visceral Leishmaniasis in Endemic Areas of Bihar, India.

Miltefosine, the only oral drug for visceral leishmaniasis (VL), is being used as the first-line drug under the VL elimination program in the Indian subcontinent. Miltefosine is an oral drug which was used as a topical application for skin metastasis of breast cancer. It was found to be effective against Leishmania donovani The main adverse events (AE) reported previously with miltefosine use includes diarrhea, vomiting, and dehydration. Other AEs include, raised serum alanine transaminase/aspartate aminotransferase and renal parameters such as creatinine. In this study, we report AEs in a large patient cohort of VL treated with miltefosine. The purpose of this pharmacovigilance study was to assess adverse drug reactions (ADRs)/AE of miltefosine treatment under unrestricted condition in the field setup. Patients were followed up to 6 months for therapeutic effectiveness. Outcomes of a larger data set of patients treated with this regimen from April 2012 to March 2015 were recorded. In the present study, 646 patients of VL were given miltefosine. Majority of the study subjects (58%) were male. Relapse occurred in 7% during follow-up period. Main causes of death were VL-pulmonary tuberculosis coinfection, extreme diarrhea, and acute pancreatitis which were reported in 1.7% subjects. Of 553 (85.6%) patients completing full course of treatment, 463 (83.7%) showed ADR with miltefosine during the study period. About 2.3% were suffering severe ADR, 51% from moderate, and the rest had mild ADR. The initial and final cure rate was 97.4% and 85.6%, respectively.

Optimization of food materials for development of nutritious pasta utilizing groundnut meal and beetroot.

Present study was undertaken to optimize the level of food materials viz. groundnut meal, beetroot juice and refined wheat flour for development of nutritious pasta using response surface methodology. Box-benken design of experiments was used to design different experimental combinations considering 10 to 20 g groundnut meal, 6 to 18 mL beetroot juice and 80 to 90 g refined wheat flour. Quality attributes such as protein content, antioxidant activity, colour, cooking quality (solid loss, rehydration ratio and cooking time) and sensory acceptability of pasta samples were the dependent variables for the study. The results revealed that pasta samples with higher levels of groundnut meal and beetroot juice were high in antioxidant activity and overall sensory acceptability. The samples with higher content of groundnut meal indicated higher protein contents in them. On the other hand, the samples with higher beetroot juice content were high in rehydration ratio and lesser cooking time along with low solid loss in cooking water. The different level of studied food materials significantly affected the colour quality of pasta samples. Optimized combination for development of nutritious pasta consisted of 20 g groundnut meal, 18 mL beetroot juice and 83.49 g refined wheat flour with overall desirability as 0.905. This pasta sample required 5.5 min to cook and showed 1.37 % solid loss and rehydration ratio as 6.28. Pasta sample prepared following optimized formulation provided 19.56 % protein content, 23.95 % antioxidant activity and 125.89 mg/100 g total phenols with overall sensory acceptability scores 8.71.

Prospective glioma grading using single-dose dynamic contrast-enhanced perfusion MRI.

AIM: To evaluate the sensitivity and specificity of single-dose dynamic contrast-enhanced (DCE) perfusion magnetic resonance imaging (MRI) in prospective evaluation of glioma grading and to correlate the relative cerebral blood volume (rCBV) values with mitotic and ki-67 indexes obtained at histopathology. MATERIALS AND METHODS: A total of 53 histologically proven patients with glioma were included in this study. DCE-MRI perfusion with a single dose of contrast medium was included in brain tumour protocol and prospective grading of glioma into low and high grade was done based on a previously reported rCBV cut-off value of 3. Tumours with rCBV ≥ 3 were considered to be high grade and rCBV < 3 were considered to be low grade. The sensitivity and specificity of the cut-off value were estimated. Ki-67 and mitotic indexes were also obtained on histopathological analysis along with histological grading. RESULTS: Based on pre-defined rCBV cut-off values, prospective grading of low- and high-grade glioma was achieved with a sensitivity and specificity of 97.22% and 100%, respectively. Significant correlation was found between the mitotic/ki-67 indexes and rCBV values when data for high- and low-grade tumours was combined. CONCLUSION: DCE-MRI performed with a single dose of contrast medium is as effective as a protocol with a double-dose of contrast medium for glioma grading using 3 T MRI and could be added to the routine evaluation protocol of brain tumours.

Laparoscopic management of transverse testicular ectopia with persistent mullerian duct syndrome.

A 4-month-old male child presented with right undescended testis and left inguinal hernia with funiculitis. Ultrasonography showed funiculitis on the left side testis along with presence of 1.5 × 1 cm testis like structure just above left testis and empty right scrotal sac without any evidence of mullerian structures. On diagnostic laparoscopy, right testicular vessels were crossing from right to left and had uterus with both testes in left hernia sac. Mobilization of vessels, division of uterus, and hernia repair was done laparoscopically. On the review of literature, there is only one case report of total laparoscopic repair of transversetesticular ectopia (TTE) with hernia without persistent mullerian duct (PMDS). The uniqueness of our case is that it had TTE with hernia and PMDS, which were totally managed by laparoscopy. On 6 months of follow-up, both the testes are palpable in scrotum.

Development of sprouted wheat based probiotic beverage.

Present study was carried out to evaluate the potential of Lactobacillus acidophilus (L. acidophilus) for development of wheat based probiotic beverage and to optimize the proportion of different ingredients viz. sprouted wheat flour, sprouted wheat bran, oat and stabilizer using response surface methodology. Acidity, pH and probiotic count of samples prepared with L. acidophilus NCDC-14 was higher than that of L. acidophilus NCDC-16 culture. Being more compatible, L. acidophilus NCDC-14 was selected for this study. Acidity (in terms of lactic acid), pH and probiotic count of the different samples ranged from 0.21 to 0.45 %, 4.0 to 4.9, and 8.30 to 10.95 log10 cfu mL(-1), respectively. Probiotic count increased with increasing amount of sprouted wheat and oat. Optimized levels for sprouted wheat flour, oat, wheat bran and guar gum were 7.86, 5.42, 1.42 and 0.6 g, respectively per 100 mL of water. Optimized probiotic beverage provided 13.19 % total solids, 1.19 % protein, 0.33 % fat, 0.10 % ash, 0.42 % crude fibre, 1.45 mg iron, calcium 15.74 mg, 11.56 % carbohydrates, 54 kcal calories and 10.43 log10 cfu mL(-1) probiotic count. Thus, Lactobacillus acidophilus NCDC-14 can be used for development of potentially probiotic beverage with sprouted wheat and oat.

Impact of smoking on microalbuminuria and urinary albumin creatinine ratio in non-diabetic normotensive smokers.

Smoking is associated with an excessive morbidity and mortality from a variety of diseases. The aim of this study was to find out the effects of smoking on renal function study in non-diabetic, normotensive subjects. A community-based, prospective, cross-sectional cohort study was conducted on 120 subjects; 80 (66.66%) were smokers and 40 (33.33%) age matched non-smokers; with age range of 30 to 70 years. Measurement of fasting sugar, urea, creatinine, lipids and one time screening of urinary albumin and urinary creatinine was done. Smokers had significantly higher urinary albumin and albumin creatinine ratio (ACR) (52.84 ± 46.42 mg/L, 93.98 ± 78.68 µg/mg) than non-smokers (19.25 ± 7.77 mg/L, 18.99 ± 6.65 µg/mg), respectively (P =< 0.001, P =< 0.001). Microalbuminuria and urinary ACR level were directly related to the amount of smoking (pack-years). Among smokers, 73 (91.25%) had microalbuminuria (>20 mg/L) and 64 (80%) had increased urinary ACR (>30 µg/mg). Smoker had significantly lower high-density lipoprotein level (36.66 ± 10.28 mg/dl) compared to non-smokers (41.22 ± 11.72 mg/dl) (P = 0.031). Urea, creatinine, creatinine clearance, total cholesterol, low density lipoprotein, triglyceride levels were comparable (p = NS). In conclusion, smokers have a 4-fold higher prevalence of microalbuminuria than non-smokers.

Mapping of glycine distributions in gliomas.

BACKGROUND AND PURPOSE: Increased glycine concentration in the brain is associated with altered metabolism in cancer and can be detected by using in vivo MR spectroscopy. This has been proposed as a marker for grade IV gliomas; however, little is known about the potential significance and frequency of in vivo glycine observation. The purpose of this study was to examine the rate of occurrence and spatial distribution of glycine observation with respect to other MR imaging parameters. MATERIALS AND METHODS: Data from volumetric whole-brain MR spectroscopic imaging of 59 subjects with glioma were analyzed with glycine included in the spectral model. The associations of the signal amplitude and spatial distributions of glycine with findings from contrast-enhanced T1, perfusion, and diffusion MR imaging were then examined. RESULTS: Glycine was detected in 24% of all studies, though with a wide range of signal amplitude and extent of the spatial distributions. While more commonly seen in grade IV tumors (42% of studies), relatively large concentrations were also detected in grade II and III gliomas. Coanalysis with other metabolites indicated a strong association with choline and that glycine was frequently seen to be overlapping with, and adjacent to, areas of high lactate concentration. Increased glycine was always associated with contrast enhancement and areas of increased cerebral blood flow, but without any clear association with other image parameters. CONCLUSIONS: Detection of increased glycine in gliomas appears to identify a subgroup of tumors and areas of increased proliferation.

Mature cystic retroperitoneal teratoma with well differentiated renal elements: relation to spinal dysraphism.

Retroperitoneum is a relatively uncommon site for pediatric teratomas. Rarely, such tumors can have an intraspinal extension and few cases of retroperitoneal teratomas associated with spinal dysraphism have been reported. Teratomas consist of tissues arising from all three embryonic layers. However, mature renal tissues in the form of glomeruli and tubules are sparingly found in teratomas. A 15-day-old female presented with spina bifida occulta and on evaluation a cystic presacral mass was detected. Intraoperatively the cyst was found densely adherent to the hemivertebrae but not entering the spinal canal. Histopathological examination confirmed a mature cystic teratoma but also demonstrated presence of mature renal elements in the cyst wall. The teratomas lying in proximity to spine and associated with spinal dysraphism are likely to contain mature renal tissues or even nephroblastic elements. It supports the dysembryogenic model of origin of intradural teratomas from native progenitor cells rather than aberrantly migrated germ cells.

Colorectal carcinoma up to the second decade of life: An 8-year experience in a tertiary care center.

AIMS AND OBJECTIVES: To evaluate the demographic pattern, incidence, and histological characteristics of colorectal carcinomas (CRCs) in very young adults diagnosed in the center. MATERIALS AND METHODS: We retrieved and reviewed slides and data pertaining to all the cases of CRCs and "segregated into decade wise age-groups" from the archives of Department of Pathology. Patients with age ≤20 years diagnosed during the last 8 years (2006-2013) were further evaluated. RESULTS: Totally, 590 cases of CRCs diagnosed over last 8-year period, of which 4.2% (25 cases) presented in the study group (age ≤20 years) with a mean age of 17 years. About 50% of the tumors were either signet ring cell, mucin-secreting or poorly differentiated carcinomas. Four cases occurred in a background of familial adenomatous polyposis (FAP), three of which showed high-grade dysplasia, while in one case, carcinoma-in-situ was diagnosed. In all but two cases, rectum was the site of involvement except FAP cases in which colorectal location was noted. CRCs show a sharp rise in earlier age onset (≤40 years) and an increasing trend was followed in patients between age groups third, fourth, and fifth decades of life over the last 8 years. CONCLUSION: Colorectal carcinomas show an increasing trend in young age (≤40 years). This change may be attributed to dietary, lifestyle changes, and newer genetic alterations in developing countries. In very young age group (≤20 years), a higher grade and stage at the time of diagnosis and predominantly rectal involvements are the distinct features.

Bile duct injuries during open and laparoscopic cholecystectomy: management and outcome.

BACKGROUND: The widespread application of laparoscopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published reports locally regarding the perioperative management of BDI. Purpose of this review was to analyze our experience in diagnosis, management and prevention of BDI. METHODS: This study was conducted in department of surgery at B. P. Koirala Institute of Health Sciences. From January 2001 to September 2010, a observational study of all patients with a BDI following cholecystectomy was maintained. Patients' charts were retrospectively reviewed to analyze incidence, type of injury, presentation, and perioperative management of BDI. RESULTS: A total of 92 patients had BDI which occurred during cholecystectomy, were analysed retrospectively. There were 60/92 (65.5%) patients with BDI resulting from the wrong identification of the anatomy of the Calot's triangle during cholecystectomy. Abdominal ultrasonography was diagnostic for BDI in 71/90 (78.8%). Magnetic resonance cholangiography could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 22/23 (95.6%). The most common injury was Strasberg's E2 in 65/92 (70.7%). A transection or stricture of the bile duct was repaired by hepaticojejunostomy (83 cases in this series). Seventy-five (81.5%) patients were followed up. The mean follow-up time was 2.6 years (range 0.16-6). Good results were achieved in 62/75 (82.6%) of the patients. CONCLUSIONS: The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.