Evaluation of HbA1c and tuberculin test in wound complications of surgical patients with diabetes.

Background: Diabetes is a global epidemic and India is regarded as the “diabetes capital of world”. Wound healing deficit are often seen in patients with diabetes mellitus. Aims & Objective: The present study was undertaken to correlate HbA1c level and plasma glucose level with wound complications in postoperative wounds in diabetic patients, to find out relationship of HbA1c and tuberculin test with wound complications, to correlate the role of HbA1c and tuberculin test in prediction of wound complications. Materials and Methods: The study is a prospective analysis of 100 patients from June 2006 to June 2008, in University Hospital in North India. All known diabetic and recently diagnosed diabetic patients with surgical illness were included in the study. All patients were investigated for HbA1c (by micromatTM Hemoglobin A1c test), Mantoux test (intradermally injecting 0.1 ml Tuberculin PPD with tuberculin syringe), blood sugar F/PP, serum albumin. Wound complications have been noted in postoperative period along with co-morbid condition of patients. Selected patients are divided in four group (i) clean wound; (ii) clean contaminated; (iii) contaminated and (iv) diabetic foot / dirty wound. Results: Out of 100 diabetic patients, male to female ratio was 3:2. Maximum number of patients are in age group of 51-60 years, 51 out of 100 patients were associated with comorbid condition. HbA1c level in diabetic patients were < 6 in 13%, 6-8 in 43%, 8-10 in 30% and >10 percent in 14% patients. Mantoux test was positive in 31 out of 92 patients. Wound complication was present in 54 patients, mostly in uncontrolled diabetes. Out of 99 patients, 41 have clean wound, 31 have clean contaminated, 6 contaminated and 21 patients having dirty / diabetic foot. Conclusion: Study show a fair correlation between HbA1c, Mantoux test and wound complication. There is decrease in cell mediated immunity leading to decrease in mantoux test positivity and increase in wound complication.

Cytomorphological patterns in the Diagnosis of Tuberculous lymphadenitis.

The reliable diagnosis of tuberculous lymphadenitis by FNAC has important implications in a developing country like India. The aim is to study various cytomorphological patterns seen in tuberculous lymphadenitis and their correlation with AFB positivity. Fine needle aspiration cytology (FNAC) was performed on three hundred and twenty two patients with lymphadenopathy referred to the cytopathology section of pathology department, Sri Guru Ramdas Institute if Medical sciences and research Amritsar from August 2010 to July 2012. The patients with cytological diagnosis of tuberculous lymphadenitis were followed for their response to antitubercular treatment. A total of 322 FNACs were performed on patients with lymphnode lesions; out of which the most common (119) cytological diagnosis was tuberculous lymphadenitis. The most common pattern observed was (group II) presence of epitheloid granuloma with caseation necrosis which was seen in about half (50.5%) of the cases followed by smears with caseation necrosis only (group III) (27.7%) and smears with epitheloid granulomas only (group I) (21.8%).The overall AFB positivity was seen in 19.3% cases of tuberculous lymphadenitis. Maximum (30.3%) AFB positivity was seen in smears (group III) with only necrotic debris without granuloma and was least in group I (7.6%).While comparing Group I smears with that of group III using Fisher’s exact test, the difference in AFB positivity between the smears was statistically significant as the two-tailed p value was 0.0496. Thus FNAC is safe, easy, quick reliable as well as conclusive for the diagnosis of tuberculous lymphadenitis when done along with Zeihl Neelsen stain for acid fast bacilli.

Blood Levels of Pyrazinamide in Children at Doses Administered Under the Revised National Tuberculosis Control Program.

Objectives: To evaluate the blood levels, pharma-cokinetics and pharmacodynamic indices of pyrazinamide (PZA) in children suffering from tuberculosis, at doses administered under the weight band system of Revised National Tuberculosis Control Program of India (RNTCP) of India. Design: Prospective, open-label, non-randomized single-dose study. Setting: 20 children in the age group 5-12 years attending outpatient tuberculosis clinic of a tertiary hospital. Outcome Measures: Blood levels of pyrazinamide after single dose administration, as per the weight band system of RNTCP. Results: Group I (n=7) included children who received pyrazinamide within the recommended 30-35 mg/kg dose (mean 31.9+0.8 mg/kg) and Group II (n=13) included those who received a dose lower than 30 -35 mg/kg (mean 28.1±0.3 mg/ kg). The Cmax (95% CI of difference 2.2, 13.2; P=0.008) and AUC (95% CI of difference 28.6, 208.1; P=0.01) were significantly lower in Group II. The duration of time for which the concentration was maintained above 25 μg ml-1 was 4-8 h in Group I and 3-5.5 h in Group II (95% CI of difference 0.1, 2.0; P=0.03). The half life, elimination rate constant, clearance and volume of distribution were comparable in the two groups. The ratios of Cmax and AUC to MIC (25 μg ml-1) in children were lower than that recommended for PZA in adults. Conclusions: Lower blood concentrations are being attained in children receiving PZA doses under the existing weight band system of RNTCP of India. The weight bands may need to be revised and dose recommendations be based on pharmacokinetic and efficacy data in children.

Desmoid tumors: experience of 32 cases and review of the literature.

BACKGROUND: Desmoids are infiltrative, locally destructive, soft tissue tumors. Although they do not metastasize, the incidence of local recurrence is quite high. AIM: Present study aimed at reporting the 10-year experience of 32 desmoid cases and reviewing some facts with symptoms, investigation, and treatment of the disease. MATERIALS AND METHODS: Thirty two cases of desmoid tumors were reviewed over a 10-year span. Surgical resection and adjuvant radiotherapy were the treatments of choice whenever histological margins were positive. RESULTS: Multiparous women in reproductive age were the most commonly afflicted. The commonest site of presentation was the abdominal wall. Ninety one percent (20/22) were infraumbilical. The tumors were found in the rectus sheath in 14 patients (64%) and were laterally situated in 8 patients (36%). Local infiltration was found in six patients and the urinary bladder was most commonly involved (3/6). Locally recurrent desmoids were seen in eight patients (25%). CONCLUSIONS: In our experience, 25% of the desmoid tumors (8/32) were recurrent and postoperative radiotherapy did not seem to influence the local recurrence rate. The most important predictor for recurrence was tumors of > 5 cm.

Abdomino-scrotal hydrocele in 35 years old: a case report.

Abdomino-scrotal hydrocele is a condition usually affecting children. It is unusual to find an abdomino-scrotal hydrocele in middle aged adult. Most of the patients are asymptomatic except cystic abdominal mass and discomfort occasionally. We hereby report an unusual presentation of abdomino-scrotal hydrocele at age of 35 years and presenting as large cystic abdominal mass extending into scrotum.

Leiomyosarcoma of stomach: a case report.

We report a rare case of leiomyosarcoma of stomach infiltrating into the spleen and tail of pancreas, which presented at the age of 28 years of age with haematemesis and was diagnosed after exploratory laparotomy. En block excision of tail of pancreas, spleen and part of the greater curvature of stomach containing the mass was done.

Penile fracture presenting as eggplant deformity.

Penile fracture is caused by sudden trauma to erect penis leading to tear of corpora cavernosa. Although penile fracture is a rare condition, it can lead to crippling penile deformity and erectile impotence, if intervention is delayed. We describe a case of penile fracture caused by masturbation and satisfactory outcome after early surgical intervention. Usually only clinical assessment is sufficient for diagnosis.

Isolated tuberculosis of testis.

Isolated epididymo-orchitis is an uncommon presentation of tuberculosis. We report a case of left sided epididymo-orchitis and scrotal involvement due to tuberculosis in a young male patient. The diagnosis was suspected on clinical examination of scrotum and confirmed by FNAC of scrotal and testis. Patient improved after taking antitubercular treatment. Key words: infection, scrotum, treatment.

Lipid peroxidation and antioxidant enzyme status in oral carcinoma patients.

OBJECTIVE: To measure the lipid peroxidation and endogenous antioxidant enzyme status in oral carcinoma and the protective role of exogenous antioxidants. MATERIAL AND METHODS: 20 new cases of histologically proven oral squamous cell carcinoma, 20 of leukoplakia and 20 age and sex matched healthy conrols were included. Intra oral pH of patients and controlled were measured by quantitative litmus paper test and serum was analysed for malonialdehyde (MDA), super oxide bismutase (SOD), catalase and glutathione peroxidase (GP). Patients with leukoplakia were treated with exogenous antioxidants for 3 months and the same were reassessed. RESULTS: Oral pH of oral cancer patients was neutral (PH-7) but that of leukoplakia and controls were mildly acidic (6.64 and 6.58 respectively). Serum malonialdehyde levels were highest in oral cancer group. With antioxidant enzymes super oxide bismutase, catalase and glutathione peroxidase different pattern was noticed. Antioxidant enzymes remained almost the same (P > 0.005 each) in patients with leukoplakia after 3 months of vitamin A,C and E. but there was marginal increase in catalase level (P<0.05). CONCLUSION: This study shows the positive benefit of vitamin (A,C,E) and nutrition supplementation on the antioxidant enzyme defense system hence prevention of oral carcinogenesis in patients with leukoplakia.

Influence of colchicine on pulmonary silicotic fibrogenesis in rats.

With an aim to evaluate the antifibrotic action of colchicine in experimental model of pulmonary silicosis, the effect of colchicine on developing and developed pulmonary silicosis induced by quartz was studied in rats in vivo and on alveolar macrophages exposed to quartz particulates in vitro. A progressive increase in wet and dry weight of lungs exposed to quartz dust alone, and quartz dust and colchicine injected orally was investigated. An increase in collagen contents, with lapse in time, in animals exposed intratracheally to quartz dust, or exposed similarly to quartz dust but receiving colchicine simultaneously through oral route was observed. A blindfold evaluation of histological sections of lungs of silicotic animals with or without colchicine administration during development of lesions did not reveal any difference between two groups of silicotic rats. Administration of colchicine for 4 weeks after the lesions were developed neither inhibited nor retarded the laying down of collagen. The studies were extended to investigate the effect of colchicine on quartz-induced alveolar macrophage cytotoxicity. The presence of varying concentrations of colchicine in the culture medium did not significantly alter cytotoxic potential of quartz. The results reveal that colchicine administration during the development of and on developed silicosis does not significantly alter pathogenesis of silicotic lesions. At the cellular level colchicine does not modulate quartz-induced alveolar macrophage cytotoxicity, believed to be a significant event for the onset of pulmonary silicotic fibrogenesis.

In vivo model for dyslipidemia with diabetes mellitus in hamster.

Due to similarities in lipid metabolism to those in humans, hamster is considered as a good model for the study of regulatory mechanisms of plasma lipoproteins in response to cholesterol or fatty acid-enriched diet. This model of hyperlipidemia has been modified to produce dyslipidedmia with diabetes complexities by feeding with high fat diet added with 9% (w/w) fructose. Feeding this diet to hamster for 10 days markedly increases plasma levels of triglyceride, cholesterol, fatty acids followed by a significant increase in glycerol, beta lipoproteins, high density lipoprotein, glucose and glycosylated proteins. This model is being used for research and development of lipid lowering drugs with hypoglycemic activity in collaboration with Novo Nordisk, Denmark. The modified high fat diet formulation has now been prepared (Research diet D.99122211) and supplied by Research Diets Inc, Burnswick USA.

Idiopathic cases of male infertility from a region in India show low incidence of Y-chromosome microdeletion.

Chromosomal and Y-chromosomal microdeletion analysis has been done in cases of idiopathic infertility with the objective of evaluating the frequency of chromosomal and molecular anomaly as the causal factor of infertility. Barring a few cases of Klinefelter syndrome (XXY or XY/XXY mosaics), no chromosomal anomaly was encountered. Y-microdeletion was analysed by PCR-screening of STSs from different regions of the AZF (AZFa, AZFb, AZFc) on the long arm of the Y, as well as by using DNA probes of the genes RBM, DAZ (Yq), DAZLA (an autosomal homologue of DAZ) and SRY (Yp; sex determining gene). Out of 177 cases examined, 9 (azoospermia - 8 and oligoasthenospermia - 1) showed partial deletion of AZF. The size of deletion varied among patients but AZFc was either totally or partially removed in all of them. In contrast, no deletion was detected in AZFa. Testis biopsy done on a limited number of cases (50) showed diverse stages of spermatogenic arrest with no specific correlation with the genotype. The frequency of Y-chromosome microdeletion in our samples (approximately 5%) is much lower than the frequency (approximately 10%) reported globally and the two previous reports from India. We contend that the frequency may be affected by population structures in different geographical regions.

Inferior meso-caval shunt for portal hypertension with bleeding esophageal varices.

We report a 12-year-old boy with cavernomatous malformation of the portal vein who presented with repeated hematemesis. Inferior meso-caval shunt was performed to decompress the portal hypertension. There was minimal dissection and disturbance of periportal collateral channels in comparison to using the superior mesenteric vein. One year later, esophagoscopy showed no varices, and he has had no further episode of bleed.

Intravaginal foreign body--a rare cause of large bowel obstruction.

Intravaginal foreign body rarely causes bowel obstruction. A 60-year-old female presented with pain in lower abdomen. On examination, her abdomen was found distended with muscle guard. Per rectal examination revealed a hard mass 3-4 cm away from the anal verge. There was leucocytosis and straight x-ray showed features of large bowel obstruction. Exploratory laparatomy was performed. The large bowel was distended with a hard mass felt in the pelvis. On manipulation the mass of about 15 cm x 12 cm x 12 cm size came out of the vagina and it happended to be a brick. The recovery was uneventful.

Malignant eccrine spiradenoma: an unusual presentation.

An unusual case of a 60-year-woman with a progressively increasing painless, ulcerated plaque-like lesion in her right groin is described. The lesion was associated with multiple satellite nodules involving the right thigh with massive lymphoedema oft he involved limb. Histology established the diagnosis of an eccrine spiradenoma with malignant transformation in a satellite nodule. Wide surgical excision was not possible and the patient was subjected to palliative radiotherapy.

Correlation of Helicobacter pylori and gastric carcinoma.

BACKGROUND: Difference of opinion about the prevalence of H. pylori association with gastric cancer exists in the literature. AIMS: To study the correlation of Helicobacter pylori (H. pylori) to gastric carcinoma. METHODS: 50 proved cases of gastric cancer were studied by rapid urease test, culture, histopathology and ELISA test for H. pylori IgG. RESULTS: 68% of cases of gastric cancer were found to be positive for H. pylori infection as compared to 74% of healthy controls. CONCLUSIONS: The prevalence rate of H. pylori infection in our patients of gastric cancer was lower than in the control population though statistically not significant, suggesting that H. pylori may not be responsible for gastric carcinogenesis in this population.

Non-Hodgkin's lymphoma with pure red cell aplasia.

Pure red cell aplasia (PRCA) associated with non-Hodgkin's lymphoma, is an extremely rare condition, with few cases reported worldwide. More commonly PRCA is associated with thymoma or viral infections. Steroids and other immunosuppressive drugs are the preferred treatment of PRCA.