Histopathological evaluation of cutaneous reactions to tattoos: Study at a tertiary care center.

BACKGROUND: Tattooing has been around for many years and is becoming an increasingly common fashion trend. As there are often few regulatory laws regarding the practice, an increase in the incidence of cutaneous reactions to tattoo inks is noted. These include allergic reactions, granulomatous dermatitis, infections, lichenoid dermatoses, and sometimes malignancy. The present study examines the histopathological changes seen in patients with cutaneous reactions to tattoo ink. METHOD: A prospective observational study was conducted over 18 months in the dermatology clinic of a tertiary care center in western India. The study population included 22 patients with cutaneous reactions over the tattoos. Punch biopsy specimens were sent to study the pattern of histopathological response. RESULTS: All 22 patients studied were between the ages of 17 and 35 years. The mean duration of development of reaction was 8.1 months. Most of the reactions were seen in black ink tattoos performed by amateurs. Perivascular and spongiotic dermatitis suggestive of allergic response was the most common feature on histopathology. Granulomatous response and lichenoid response were seen in five and three biopsies, respectively. CONCLUSION: Legalization is needed for this practice to prevent tattoo reactions. Histopathological evaluation is important as tattoo reactions may be associated with skin infections and malignancies.

Role of diffusion-weighted MRI in acute pyelonephritis: a prospective study.

BACKGROUND: Imaging is vital in diagnosis of complicated pyelonephritis and has been traditionally performed by computed tomography (CT). However, CT with contrast agents cannot be performed in patients with renal failure. Diffusion-weighted (DW) magnetic resonance imaging (MRI) has the potential to overcome this disadvantage. PURPOSE: To prospectively evaluate the accuracy of quantitative apparent diffusion coefficient (ADC) values to differentiate nephritis from renal abscesses in patients with pyelonephritis. MATERIAL AND METHODS: Forty-two patients with clinical and laboratory diagnosis of pyelonephritis underwent CT and DW MRI examinations. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 0, 600, and 1000 s/mm(2). Circular regions of interest were places on areas of nephritis, normal renal parenchyma, and renal abscesses as localized by CT and DW MRI images to obtain the ADC values of each of these regions. The ADC values of these three different tissue types were statistically compared using the one-way analysis of variance test for statistical significance. A P value <0.05 was considered to be statistically significant. RESULTS: For the diagnosis of pyelonephritis, DW MRI had a higher sensitivity of 95.3% as compared to that of non-contrast CT (66.7%) and contrast-enhanced CT (88.1%). Areas of nephritis had significantly lower ADC values (P < 0.001) than the normal renal cortical parenchyma. Also, renal abscesses had significantly lower ADC values (P < 0.001) than areas of nephritis. However, CT is more useful for the diagnosis of renal calculi and emphysematous pyelonephritis. CONCLUSION: ADC values derived from the diffusion sequence have significantly lower values in renal abscesses than in areas of nephritis.

Spontaneous Bilateral Neck Femur Fracture Secondary to Chronic Liver Disease and Vitamin D3 Deficiency.

Introduction: Spontaneous bilateral neck femur fracture occurs following many conditions. It is very rare event. It can be seen in young, middle aged, and elderly people with no preceding trauma. We report a case in middle aged person who got fracture secondary to chronic liver disease and Vitamin D3 deficiency and who underwent bilateral hemiarthroplasty. Case Report: A 46-year-old man came with sudden onset of bilateral hip pain with no history of trauma. It was started with difficulty in moving the left lower limb since February 2020 and after about 1-month period patient got right hip pain which made the patient completely bedridden. He also complained of yellowish discoloration of eyes associated with weight loss, malaise. No history of tremors in hand. No history of seizures. Conclusion: It is a not a common condition. Spontaneous bilateral neck femur fracture occurs following chronic liver disease and Vitamin D3 deficiency. Both these conditions lead to increase osteoporosis and osteomalacia thus making it more susceptible to fracture.

Polycythemia vera in patients of beta-thalassemia trait and stress erythropoiesis.

A 70-year-old male with a known case of beta-thalassemia trait and was on yearly follow-up was found to have a hemoglobin of 14.8 g/dL, hematocrit of 47.7%, and RBC count of 6.0 × 1012/L. Total leukocyte count (TLC) was 5 × 109/L and platelet count was 4 × 109/L. Secondary causes of polycythemia were ruled out (e.g., renal or cardiac disease and smoking). He did not have symptoms of hyperviscosity syndrome. The abdominal ultrasound showed no abnormalities. On further investigation, a JAK-2 (Exon 14) mutation was detected in this patient confirming the diagnosis of polycythemia vera (PV).

Visceral leishmaniasis: A leucaemia mimicker: A case report.

Visceral Leishmaniasis (VL) is endemic in the northeast part of India, principally Bihar, Jharkhand, Uttar Pradesh, and West Bengal. We report a case of VL from the non-endemic Himalayan region of Kashmir. A 25-year-old female presented with a history of fever, generalized weakness, loss of appetite for one month. On clinical examination, there was hepatosplenomegaly and pancytopenia. There was no travel history to any VL endemic areas. Bone marrow examination revealed an amastigote form of Leishmania Donovan. Nested polymerase chain reaction (PCR) confirmed diagnosis. The patient was treated with 6 mg/kg liposomal amphotericin B, for ten days and improved clinically. Our case reveals that VL is expanding towards non-endemic regions of India, and physicians should remember the differential diagnosis of VL in a patient presenting with fever, pancytopenia, and hepatosplenomegaly.

Vitamin D toxicity due to self-prescription: A case report.

Apart from maintaining healthy bones, vitamin D is also required for cell differentiation, cell growth inhibition, and immune modulation. Vitamin D deficiency is common in the Indian subcontinent. Vitamin D presenting toxicity, leading to hypercalcemia, acute kidney injury, and altered sensorium is very rare. Here we present a case of a 65-year-old man who presented to emergency with persistent vomiting, altered sensorium, and acute kidney injury. The cause of which was an unchecked intake of vitamin D for non-specific musculoskeletal pain. When treated with intravenous fluid, diuretics, calcitonin, and steroids, the patient improved clinically. Therefore, for any patient presenting with persistent vomiting, altered sensorium, and hypercalcemia, with normal to low parathyroid hormone levels, a diagnosis of an overdose of vitamin D should be considered. Early treatment of this condition not only improves the symptoms but also prevents further kidney damage.

Rare snake bite- A case report.

Snake bite is an acute life threating medical emergency and is included amonst neglected tropical diseases.1 Every year in India 200,000 people bitten by snakes and >25% are fatal.2In Maharashtra, Konkan area, the green pit viper (Trimeresurus gramineus) is uncommon, though this snake has become more common. [ Figure 1].

ATRA-induced bradycardia in a case of acute promyelocytic leukemia: A case report.

A 45-year-old female, a new case of acute promyelocytic leukemia (APL), received induction chemotherapy containing all-trans retinoic acid (ATRA) and idarubicin. On the sixth day of therapy, she developed sinus bradycardia and differentiation syndrome (DS). Electrolytes and cardiac imaging were normal. The patient achieved normal sinus rhythm after ATRA was withheld, and DS was treated.

Follicular Lymphoma Secondary to Chronic Myeloid Leukemia During Treatment With Imatinib.

Tyrosine kinase inhibitors (TKIs) remain the mainstay of treatment for those with chronic myeloid leukemia (CML); nonetheless, there is concern over the possibility of additional cancers as a result of TKI use. There are not many cases in the literature where tyrosine kinase treatment caused a patient to develop secondary lymphoma. Herein we present a 49-year-old male diagnosed with CML in 2014, on Imatinib for six years with a major molecular response, who presented with generalized lymphadenopathy in July 2020. The complete evaluation was done, and histopathology and immunohistochemistry revealed follicular lymphoma. He responded well to six cycles of bendamustine and rituximab treatment (BR). It is critical for treating physicians to be aware of such occurrences, and patients on TKI must be closely monitored.

The Trend of Arterial Carboxyhemoglobin in Non-smokers as a Prognostic Tool in Severe COVID-19 Patients: A Single-Centre Prospective Study.

Introduction  Carboxyhemoglobinemia is characterised by decreased oxygen delivery to tissues. In severe and critical coronavirus disease 2019 (COVID-19) illness with hypoxia, this can herald a grave and protracted course of illness. Patients with COVID-19 experience respiratory impairment, lowering the pace at which carbon monoxide (CO) is eliminated and raising the likelihood of carboxyhemoglobinemia. We set out to explore early arterial carboxyhemoglobin (COHb) and COVID-19 patient outcomes in non-smokers and its potential as a predictive tool for mortality. Methods  Forty-five patients, non-smokers with severe/critical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring admission in a North Indian 1200-bedded tertiary care hospital, were recruited prospectively from October 2020 to March 2021. Arterial COHb% was evaluated with arterial blood gases using an analyser, which were taken at the time of admission and then every alternate day for the first 10 days. Carboxyhemoglobinemia was defined as COHb% more than 1%. The primary outcome was defined as the patient's hospital outcome (survivor/non-survivor). Results Of the total 45 subjects, 51.1% (n=23) survived. Patients developed carboxyhemoglobinemia with an incidence of 51% during the course of their hospital stay. The mean ± SD of COHb% on admission was 1.0 ± 0.58 and 1.03 ± 0.8 in non-survivors and survivors, respectively (p=0.870). Maximal individual values of 5.3% and 6.1% were seen in survivors and non-survivors, respectively. On serial COHb measurement, non-survivors had significantly higher COHb% on days 6 and 10. No co-relation of COHb% with inflammatory markers was noted. Conclusion  Arterial COHb levels in non-survivors were significantly higher than in survivors on days 6 and 10. Our study did not show a prognostic value of serial COHb measurement in patients with severe COVID-19. To establish COHb as a predictive marker in severely ill COVID-19 patients, additional research is required.

Extensive Verrucae over Healed Pemphigus Vulgaris Lesions in an Immunocompetent Female: A Rare Presentation of Wolf's Isotopic Response.

Wolf's isotopic response refers to the occurrence of a skin disorder at the site of another unrelated and already healed skin disease. The cases described so far in the literature include herpes (simplex or zoster) as the primary disease in most cases and a myriad of skin diseases as the secondary disease. Here, we report a case where extensive verrucae developed over the sites of healed lesions of pemphigus vulgaris, in an immunocompetent female. Pemphigus vulgaris being the primary disease and absence of verrucae over normal skin makes this case, a rare presentation.

Diagnostic utility of triple antibody (AMACR, HMWCK and P63) stain in prostate neoplasm.

AIMS AND OBJECTIVE: In recent period, basal cell markers high molecular weight cytokeratin (HMWCK), P63 and prostate biomarker AMACR have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity. MATERIALS AND METHODS: In this prospective study, total of 80 cases including 40 cases of malignant lesions and 40 cases of benign lesions of the prostate were taken. Tumor grade was determined according to Gleason's grading system. AMACR, HMWCK, P63 expressions were determined by immunohistochemical staining. RESULTS: This study showed AMACR had a sensitivity of 90%, specificity of 100%. AMACR was not expressed in any of the 40 cases of benign lesions of the prostate while in malignant lesions of prostate it was expressed in 36 of 40 (90%) cases; 15 of 16 (93%) of well-differentiated carcinoma were positive for AMACR expression; 17 of 19 (89.47%) moderately differentiated and 4 of 5 (80%) cases of poorly differentiated tumors were positive for AMACR. There was statistically significant difference in expression of AMACR between benign and malignant lesions of the prostate (P = 0.001). In benign lesions, HMWCK and P63 were expressed in all the 40 (100%) cases, while in malignant lesions of prostate it was not expressed in any of the (0%) case. AMACR expression was not seen in any of the benign lesion. Out of 40 malignant cases, 4 cases were negative for AMACR, HMWCK and P63, 36 cases were positive only for AMACR, but no case was positive for HMWCK and P63. CONCLUSIONS: As an adjunct to biopsy, AMACR, HMWCK and P63 have potential for combating diagnostically challenging cases.

Teratoid Wilms' tumor of kidney with neural tissue predominant: Case report with review of literature.

Wilms' tumor is most common pediatric renal tumor. Teratoid Wilms' tumor is a variant of Wilms' tumor, in which heterologous tissue predominates. Most commonly, epithelial and mesenchymal tissue present as heterologous component. Biological behavior of this tumor is very different from usual Wilms' tumor. They do not respond to chemotherapy and radiotherapy. We are presenting another case of teratoid Wilms' tumor in a 4-year female child with a review of literature.

Sinonasal Schwannoma - A Case Report.

Schwannomas are benign peripheral nerve sheath tumours that may occur throughout the body. They rarely occur in the nasal cavity. Paranasal schawannomas are uncommon lesions, representing less than 4% of all head and neck schawannomas. Here we report a case of sinonasal schwannoma in a 35-year-old man who presented with a history of nasal blockage since two years. The mass was removed successfully without any postoperative complication and there was no recurrence within a year of follow up.