A unique coexistence of a plurihormonal pituitary adenoma with granulomatous hypophysitis

Dual pathology in the pituitary gland is a unique phenomenon. Coexistence of a pituitary adenoma with primary hypophysitis has been reported rarely with very few cases in the literature. Among the primary hypophysitis, primary granulomatous subtype has been proposed to be idiopathic and autoimmune in nature. Plurihormonal pituitary adenomas produce hormones of more than one different pituitary cell lineage. Pituitary adenoma with a single hormonal content has been documented with concurrent primary granulomatous hypophysitis. The present case describes the unique coexistence of a plurihormonal adenoma showing somatotroph, lactotroph, and corticotroph lineage with primary granulomatous inflammation in the sellar region in a 36-year-old woman.

Extra-adrenal peripheral neuroblastic tumors: A clinicopathological study of 18 cases

Background: Peripheral neuroblastic tumors arise from the sympathoadrenal lineage of the neural crest. They have been classified according to the International Neuroblastoma Pathology Committee (INPC) into Four categories according to International Neuroblastoma Pathology Committee (INPC): a) Neuroblastoma (NB) b) Ganglioneuroblastoma (GNB), nodular c) Ganglioneuroblastoma, intermixed, and d) Ganglioneuroma (GN). Because of the rarity of extra-adrenal peripheral neuroblastic tumors, limited information is available regarding the chemotherapy of NB and GNB. A few case reports or case series with a small number of patients have been documented in the literature. Aim: To describe the clinicopathological characteristics of extra-adrenal peripheral neuroblastic tumors. Materials and Methods: Clinical, histopathological, and immunohistochemistry (IHC) findings of 18 cases were retrieved. Immunohistochemistry at the time of diagnosis was performed using Ventana Benchmark XT. The mean value was calculated using the Microsoft Office Excel 2019 software. Results: The posterior mediastinum was the most commonly affected extra-adrenal site in our study. Neuroblastoma consisted of eight cases (six in children, two in adults), of which four cases were poorly differentiated and the other four cases were differentiating. Two cases had favorable histology. The bone marrow and cervical lymph node metastasis were documented. Of the four GNB cases, one patient developed bone metastasis. All patients of NB and GNB received combination chemotherapy. One out of six GN patients presented with a large retroperitoneal mass encasing the aorta and renal vessels, mimicking a sarcoma. Conclusion: Extra-adrenal peripheral neuroblastic tumors do not pose any diagnostic issue in adequate tissue sampling. In limited material, immunohistochemistry is needed. The chemotherapy regimen has not been standardized due to rarity. Further molecular testing and targeted therapy may be of help in the future.

Distant delayed hypersensitivity reactions after taking spike protein containing adenoviral vector vaccine for COVID-19

COVID-19 epidemic is still going on and various SARS-CoV-2 vaccines are available for emergency administration since December 2020. It has many side effects as other vaccines, but as it is a new vaccine, different side-effects are not well-known to us. Here, we are reporting one side-effect, appearance of distant delayed hypersensitive reaction lesions after covid vaccine.

A correlation of the spirometric outcomes of follow up patients of COVID-19 pneumonia with their admission time computed tomography severity score on high resolution computed tomography thorax

Background: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people who fall sick with COVID-19 experience mild to moderate symptoms and recover without any special treatment. However, some become seriously ill and require serious medical attention. The respiratory system has been the main organ affected by COVID-19 along with other organs such as heart, kidneys and liver. Spirometry is the most common of the pulmonary function tests. Spirometry is helpful in assessing respiratory outcomes that identify conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD. Methods: A total of 100 COVID-19 pneumonia patients coming for follow-up 6-10 weeks post-discharge in OPD at Department of General Medicine, Dr. D. Y. Patil Medical College Hospital and Research Institute, Kolhapur, Maharashtra, satisfying the inclusion criteria and exclusion criteria were enrolled. High resolution computed tomography (HRCT) thorax reports during their admission were collected and Computed tomography severity score (CTSS) was noted. Their spirometry was done and pattern of spirometric outcome noted. Admission-time CTSS and spirometric outcome were correlated. Results: In majority of the patients, CT severity score during course of illness had strong correlation with spirometric outcome after 6 weeks of follow up and the association was statistically significant. Conclusions: CT severity score during course of illness had strong correlation with spirometry findings after 6 weeks of follow up. Higher age and higher HRCT score are good predictors for impaired pulmonary function after discharge.

Stabilization of refraction and timing of spectacle prescription following manual small-incision cataract surgery

Purpose: To determine the stabilization of refraction at 2 weeks following MSICS by comparing the difference in spherical, cylindrical component and also spherical equivalent of refraction of 2 weeks follow-up with that of 6 weeks following surgery. Methods: The difference of spherical, cylindrical component and also spherical equivalent of refraction at 2 weeks and 6 weeks follow-up of 194 eyes that underwent uncomplicated MSICS with implantation of PMMA IOL conducted by a single experienced surgeon were compared to find out the amount of change and its significance was statistically tested by Wilcoxon-Signed Rank Test. Results: The difference in spherical power (0.04 � 0.30), cylinder power (0.03 � 0.40), and spherical equivalent (0.06 � 0.34) were very small and not significant statistically (P-value ?0.05). Conclusion: Necessary spectacle correction can safely be prescribed after 2 weeks following MSICS as subjective refraction stabilizes by that time without undergoing significant change. However, our observation was applicable in patients who had an uneventful cataract surgery without any risk factor, which can delay wound healing or cause poor visual outcome.

Duration of screen time and its effect on reaction time in 1st year MBBS students in a medical college of Southern Odisha

Background: Smartphones, PC, tablets, and TV have become integral parts of our lives. The smartphone in particular is the lifeline of everyone, regardless of their age group. Overuse of smartphones is increasing, resulting in a great deal of physical and psychological effects. It is found to negatively impact health and increase the risk of stress, depression, and anxiety. In addition to this, sleep disorders, restlessness, and fatigue are also being reported which can lead to cognitive impairment. The reaction time (RT) is the interval between the application of a stimulus and the response. It is an indication of neural processing between a stimulus and the response which is expressed in milliseconds. Aims and Objectives: The primary objective of this study was to estimate screen time, auditory and visual RTs, and the association between screen time and RT (visual reaction time [VRT] and auditory reaction time [ART]). Materials and Methods: The present cross-sectional study was conducted on 232 1st year MBBS students in the age group of 18–23 years. Average screen time was noted from their respective gadgets. RT for the targeted stimulus, yellow light for the VRT and beep sound for the ART, was determined using the Biochart application system by Biostar Health care (Computer software) on the laptop. The task was to press the space bar as soon as the stimulus was presented. Average RT for both the stimuli (ART and VRT) were calculated using ten readings for each. Data obtained were analyzed. Results: Our study shows that ART is faster than VRT for both males and females. Screen time with VRT has a moderate positive significant relationship (P < 0.001), while for the ART, it has a weak positive relation. Conclusion: Based on our findings, it can be concluded that there is a positive correlation between screen time and RT. Screen time alone has a 21% effect on the RT as per our study. It also suggests that ART is faster than VRT. The females have a higher RT than the males in a similar age group.

Soft tissue aneurysmal bone cyst of left hemithorax: An extremely rare case

Aneurysmal bone cyst (ABC) is a benign expansile cystic lesion that can affect any bone of the skeleton, especially the femur, tibia, and humerus. Lesions with histologic features of an ABC can be originated within soft tissue in exceedingly rare cases. Extra-skeletal ABC may mimic a variety of benign and malignant lesions and can be confused with other common or rare giant cell-rich tumors of soft tissue. Clinical, radiological and histologic correlation are crucial in reaching the correct diagnosis. Here we report a case of an extra-skeletal ABC arising in left hemithorax in a 13-year-old girl and discuss the common differential diagnosis of this rare entity.

Phosphaturic mesenchymal tumor: An underdiagnosed rare entity

Tumor-induced osteomalacia is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. Phosphaturic mesenchymal tumors represent a rare etiology of tumor-induced osteomalacia. They are exceptionally rare, probably accounting for < 0.01% of all soft tissue tumors. Most PMTs present as small inapparent lesions that require very careful clinical examination and radionucleotide scan for localization. Here we describe a case in a 65 years old woman with recurrent multiple bone fractures and subsequent detection of a tumor involving right femur and adjacent soft tissue, low phosphate level and elevated serum Fibroblast growth factor-23 (FGF-23).

Study on biology of tea bunch caterpillar Andraca bipunctata on alternative host plant Eurya acuminata of Meghalaya

Aim: The present study was carried out to study the biology of tea caterpillar Andraca bipunctata on Eurya acuminata as an alternate host which will be useful for tea growers of Meghalaya and nearby area to monitor the incidence and timely management of this pest on alternative host itself.Methodology: Insect population was collected from Umiam, Ri-Bhoi district situated in the mid altitude hills (Khasi hills) of Meghalaya. Six locations were selected randomly within the locality for the collection of eggs, larval instars and pupae from the host plant. Host plant was identified at Agro-forestry Division, ICAR-Research Complex for NEH, Umiam. Observations on all the biological parameters were recorded under laboratory conditions and analysed accordingly. Results: In present study, an alternative host of A. bipunctata was found in mid-altitude hills of Meghalaya state during survey which was identified as Eurya acuminatea. The insect was able to easily survive and complete its whole life cycle on this host plant, E. acuminata. Interpretation: E. acuminate acted as an alternative host and safe reservoir site for all the stages of A. bipunctata and thereby this host plant helps to survive the pest during unfavorable condition in main host (tea plantation). A. bipunctata is able to multiply their population on E. acuminata and get ready to damage on the main host for successive years.

Benzophenyl urea insecticides – useful and eco-friendly options for insect pest control

Insecticides play a very important role in increasing production by protecting crops from destructive insect pests. But indiscriminate use of conventional and broad spectrum insecticides, leads to development of resistance, resurgence and environmental pollution. Therefore, it is necessary to select new, safe and less persistent products for ecofriendly and sustainable pest management. Benzophenyl urea based insecticides fit well in this aspect. These are basically inhibitors of the chitin synthesis in insects which make them strong candidate for the integrated pest management. Extensive research has been carried out on different aspects to assess the potentiality and environment friendliness of this group of insecticides. Thus, the aim of this review is to gather comprehensive information about benzophenyl urea insecticide related to its development, mode of action, bio-efficacy, environmental fate and eco-toxicity, which may be helpful for the researchers for future endeavour.

Formulation, Development And In Vitro Evaluation Of Tramadol Extended Release Tablets

Objective: The objective of the present study was to develop “once daily” extended release tablets of tramadol (100 mg) by wet granulation using hydrophilic polymer like hydroxy propyl methyl cellulose K100M,K15M and polyethylene oxide (PEO). Methods: The tramadol matrix tablets were prepared by using different polymers like hydroxy propyl methyl cellulose (HPMC K15M and K100M), polyethylene oxide (PEO) as the nontoxic and easily available suitable matrix system. The extended release tablets of tramadol (400 mg) were prepared wet granulation technique. Different pre compression and post compression were performed. In vitro dissolution tests were performed and percentage drug release was calculated. The fourier-transform infrared spectroscopy (FTIR) studies conducted on pure drug tramadol and the optimize formulation (T6). Different release models like zero order, first order, higuchi and Korsemeyer-Peppas were applied to in vitro drug release data in order to evaluate the drug release mechanisms and kinetics. Results: Pre compression and post compression parameters satisfied with pharmacopeia specifications. The In vitro release studies were performed using USP type II apparatus showed that optimized formulation T6 consisting of polyethylene oxide (PEO) with 25 mg of the polymer was found to extended release of tramadol over a period of 24h. The optimized formulation T6 followed the zero order kinetics as correlation coefficient (r2) values are higher than that of first-order release kinetics. In order to understand the complex mechanism of drug release from the optimized formulation T6 matrix system, the in vitro release rate were fitted to Korsemeyer-Peppas model and the release exponent value (n) obtained was 0.82105 exhibited anomalous (non fickian) diffusion mechanism. Conclusion: The present study shows that polyethylene oxide was found to play a great role in controlling release of tramadol from the matrix system. Accordingly it can be concluded that the formulation is robust in the performance is less likely to be affected by the various factors studied.

Edward’s syndrome with a novel karyotype.

Edward’s syndrome was first described as a clinical entity in 1960 as a disorder of trisomy 18 (47 XX/XY; + 18) in babies with particular pattern of malformations. The Karyotype found in our case was (47 XX + 18 add (22) (p13) which has not been published so far in the literature. The less common findings noted in the baby were rocker bottom feet, syndactyly of 2nd and 3rd toes, microcephaly and corneal opacities. Though we didn’t find any significant association between phenotypic ranges with genotypic variation in literature, but further research is needed for it. We are reporting this case as the genotype is found to be novel.

Homelessness: a hidden public health problem.

Homelessness is a problem, which affects not only the people who are homeless but the whole society. This problem is not well recognized among the public health professionals. This paper attempts to discuss the issues in the context of homelessness starting from the definition used to methodology of estimation of their numbers as well as their health problems and health care needs. There is lack of data on the health problems of homelessness from India. There is no special health or social programmes or services for this subsection of the society. The existing number of shelters is inadequate and as there are multiple barriers, which prevent them to have proper access to the existing health care system. With the changing social and economic scenario, homelessness is likely to increase. We need to recognize homelessness as a public health problem and attempt to target this group for special care in order to promote equity in health system.

Crohn's disease in rheumatology clinic--an Indian experience.

BACKGROUND: Prevalence of Crohn's disease (CD) among patients with rheumatic illnesses in India is grossly under estimated, especially when it has overtaken that of Ulcerative Colitis in the West. AIM: To study the frequency of histologically unequivocal CD amongst clinically suspected patients with enteropathic arthropathy and to ascertain if the arthritics with CD have any independent clinical predictor. Settings and designs: Retrospective datasheet analysis from a Rheumatology clinic of a large tertiary care centre. MATERIALS AND METHODS: Patients of suspected enteropathic arthropathy were studied by ileocolonoscopy and segmental colonic biopsy for histological evidence of Crohn's disease and followed up. STATISTICAL ANALYSIS: Logistic regression analysis was done to find out any clinical predictor of histologically proven CD. RESULTS: Fourteen of the twenty-nine patients studied had histologically confirmed CD. Those with CD were younger than those without (34.7 yr vs 41.6 yrs, p=0.057). The CD group also had significantly higher number of people with loss of weight (12 vs 1), fever (11 vs 0), perianal fistula (4 vs 0), abdominal pain (8 vs 2), history of dysentery (4 vs 0) and uveitis (6 vs 1) (p=0.00002, 0.00001, 0.026, 0.013, 0.026 & 0.01 respectively). However logistic regression analysis of the most relevant ones among these, namely, loss of weight, fever, and perianal fistula showed loss of weight as only independent predictor of CD in this subset of patients (p=0.03 with odds ratio of 28). CONCLUSION: Presence of significant loss of weight in an Indian patient with clinically suspected enteropathic arthropathy is an independent predictor of CD.

Toxic megacolon in a renal allograft recipient with cytomegalovirus colitis.

We report a 35-year-old man, a renal allograft recipient, who presented with toxic megacolon. Segmental biopsies from the colon were consistent with cytomegalovirus colitis. Serum polymerase chain reaction for cytomegalovirus DNA confirmed the diagnosis. He was treated with ganciclovir but, though his abdominal condition improved initially, he worsened later and succumbed to his illness.

Use of serology, the urease test & histology in diagnosis of Helicobacter pylori infection in symptomatic & asymptomatic Indians.

Age-specific prevalence of IgA and IgG antibodies in 714 subjects without gastrointestinal complaints aged 6 months to 90 yr was measured by an enzyme linked immunoassay using an acid-glycine extract of H. pylori as the antigen. The urease test and histology were used for the diagnosis of H. pylori infection in 83 subjects with a clinical diagnosis of dyspepsia, and these results were compared with measurement of IgG, IgA and IgM antibodies. The age specific prevalence of IgG and IgA antibodies respectively was 57 and 43 per cent for subjects aged 6 months to 4 yr and showed an increase with age to a maximum of 90 per cent for IgG in subjects > 60 yr of age and to 87 per cent for IgA in subjects between 51 and 60 yr. In symptomatic patients, there was a high degree of correlation between severity of H. pylori infection on histopathological examination and IgG (P < 0.02) levels. The use of IgG and IgA estimation could have identified H. pylori infection without endoscopy in 50 of the 83 patients. Serology for IgG and IgA antibodies against H. pylori may play a major role in decreasing the need for endoscopy, but cut-off values must be determined for each assay based on the prevalence of antibodies in the population.