Cystic Changes in COVID-19 is not an Uncommon Entity: A Case Series

Lung cyst is an atypical computed tomography (CT) thorax finding in COVID-19 pneumonia. Cyst in COVID-19 may result independent of mechanical ventilation. The cyst may rupture causing pneumomediastinum or pneumothorax or may get secondarily infected resulting in an adverse outcome in patients. Here, we describe the clinical characteristics and outcomes of 19 patients with COVID-19 pneumonia with lung cysts detected in CT thorax. A total of 17 (89%) of our patients survived uneventfully and 2 died due to complications unrelated to the cysts.

Primary vesical actinomycosis with changes of cystitis cystica presenting as bladder mass

Actinomycosis is a rare chronic granulomatous suppurative infection caused by Gram-positive bacteria. The occurrence of primary vesical actinomycosis is extremely rare and only a few cases have been reported. Pre-operative diagnosis of vesical actinomycosis is challenging as the clinical and radiological features usually point towards bladder malignancy. Therefore, in most cases, definitive diagnosis is usually made after histopathological examination of the involved tissue. A 60-year-old male presented with complaints of hematuria, burning micturition, irritative, and obstructive urinary symptoms for 15 days. USG revealed a large soft-tissue mass having a polypoidal intraluminal and extraluminal component and involving the right posterolateral urinary bladder wall. CT scan showed a large irregular soft-tissue mass with multiple cystic lesions involving the right lateral wall of the urinary bladder. Transurethral resection of bladder mass biopsy was performed and the histopathological examination showed bacterial colonies of Actinomyces with changes of cystitis cystica. The patient was treated with amoxicillin and potassium clavulanate for 3 months. Actinomycosis should be kept as a rare differential diagnosis in cases presenting as bladder mass. The diagnosis is most commonly made by histopathology and may need a repeat biopsy to arrive at the correct diagnosis. The patient should be treated by penicillin group of antibiotics for 2–3 months and followed up for years to detect any recurrence

Knowledge & attitudes of mental health professionals regarding psychiatric research.

Background & objectives: Mental health professionals have varied attitudes and views regarding informed consent and confidentiality protections in psychiatric research and clinical care. The present study was designed to understand the knowledge and views of mental health professionals (MHPs) regarding informed consent and confidentiality protection practices. Methods: Mental health professionals (n=121) who were members of the Delhi Psychiatric Society, were invited to participate in this questionnaire-based study of their knowledge and attitudes regarding informed consent and confidentiality. Half of them expressed willingness to discuss participation and gave initial oral consent (n=62); of these, 31 gave written informed consent to participate and completed the questionnaires. The questionnaires included both forced choice (yes / no / do not know) and open-ended questions. Questionnaires content reflected prominent guidelines on informed consent and confidentiality protection. Results: Attitudes of the majority of the participants towards informed consent and confidentiality were in line with ethical principles and guidelines. All expressed the opinion that confidentiality should generally be respected and that if confidentiality was breached, there could be mistrust of the professional by the patient/participant. The mean knowledge scores regarding informed consent and confidentiality were 8.55 ± 1.46 and 8.16 ± 1.29, respectively. Interpretation & conclusions: The participating mental health professionals appeared to have adequate knowledge of basic ethical guidelines concerning informed consent and confidentiality. Most respondents were aware of ethical issues in research. Given the small sample size and low response rate, the significance of the quantitative analysis must be regarded with modesty, and qualitative analysis of open-ended questions may be more valuable for development of future research. Increased efforts to involve mental health professionals in research on ethical concerns pertinent to their work must be made, and the actual practices of these professionals with regard to ethical guidelines need to be studied.

Split Post and Core: A systematic approach to restore grossly decayed teeth.

A grossly decayed tooth sometime poses difficulty in fabrication of FDP, The post core is often required to gain support from the remaining tooth structure, In a multirooted tooth where more then one root were used as support the path of insertion of post is difficult, in those cases a custom split post and core has to be fabricated. This case report describes a simple and scientific multidisciplinary approach towards management of grossly decayed tooth. The technique seems to be effective for extensively damaged teeth that lack sufficient tooth structure to create an adequate ferrule of 1.5 to 2 mm for the final crown.

Changing trends of services used as first contact by patients with mental health problems.

Background. In the past, traditional faith healers and practitioners of alternative medicine have often been reported to be the first source of contact for Indian patients with mental health problems. However, over the past few decades, this trend seems to be changing. Method. Using a semi-structured questionnaire, we assessed 200 new patients at a psychiatric outpatient service in a general hospital for the first service contact used by them for their mental health problems. Results. Psychiatrists, non-psychiatric physicians, traditional faith healers and practitioners of alternative medicine were the first service contact for 91 (45.5%), 88 (44%), 16 (8%) and 5 (2.5%) patients, respectively. Patients suffering from severe mental illnesses were more likely to choose a psychiatrist as the first contact, whereas those with neurotic, stress-related and organic mental disorders contacted a non-psychiatric physician. Conclusion. In the current scenario, psychiatrists and nonpsychiatric physicians serve as the first service contact for most patients with mental health problems in India, though traditional faith healers and practitioners of alternative medicine are contacted by a minority.

Effect of surfactants on phosphatase level of fresh water fish Labeo rohita.

Alterations in the activity of enzymes Acid phosphatase (E.C.3.1.3.2) and Alkaline phosphatase (EC 3.1.3.1) in organs such as liver, gills and muscle of rohu following its exposure to surfactants viz. CTAB, SDS and Triton X- 100 were analyzed. Different levels of exposure were given depending on the LC50 value of the surfactant used. Also, the influence of age and weight of the organisms was tested simultaneously. The activity of ACP in the tissues of fish exposed to all the three surfactants showed marked enhancement after exposure; the effect being highest in the liver followed by gill and muscle. Activity levels of ALP in different tissues of the fish exposed to the surfactants also showed an increase. Maximum increase was found in the liver followed by muscle, and gill. The increase in the levels of these enzymes indicates a stressful condition of the fish.

Corporal Punishment in Nepalese School Children Facts, Legalities and Implications.

While the Convention on the Rights of the Child (CRC) demands that children be respected as human beings with the right to dignity and physical integrity, in Nepal corporal punishment is often considered necessary to children’s upbringing, to facilitate learning and to instill discipline in the children. The existence of this cruel practice towards children is attributed to the weak national policy, unhealthy academic competition among the schools, poorly trained teachers, superstitious traditional beliefs and hierarchical social structure. Consequently, the children are doomed to suffer this practice resulting in negative physical, mental and social welfare. Besides corporal punishment, sexual abuse in school going children seems to be frequent but mostly unreported. This is high time we eliminated this violence against children in schools and it calls for holistic approach. For this, it is necessary to pursue a set code of conduct and raise awareness among the teachers for the child rights in order to stop undignified, inhuman and undisciplined tradition. The awareness and capacity of the health professionals to deal with complexities of the child abuse also needs to be promoted. Furthermore, the need of improvements in the national laws and their proper implementation is a longstanding challenge for the governmental and nongovernmental organizations.

Privacy and the Right to Information Act, 2005.

Privacy is a key component of individual autonomy, and a voluminous literature has established both its practical value in healthcare contexts and its status as a fundamental, but not absolute ethical right. Because the Right to Information Act (2005) permits citizens to gain information under government control, it might be thought to threaten the privacy of patients and research subjects, especially those in government institutions. It is important for clinicians, administrators, information officers, patients, and research subjects to understand that the RTI Act generally does not require or permit disclosure of personal health information to third parties. Only under unusual circumstances when the larger public interest is properly certified to warrant it, would information shared or created within the fiduciary relationships of clinical care or research be required to be disclosed. Against this background concerning the right to privacy and the RTI Act, we consider a 2007 legal case that used the RTI Act to expose patient information of a public official and argue that the "public interest" claimed in this case did not justify disclosure of the official's private health information. We conclude that the provisions of the RTI Act, when properly interpreted, are compatible with the important value of safeguarding patient privacy.

Antithrombotic agents in cerebral ischaemia.

The current evidence suggests that aspirin is treatment of choice when compared to anticoagulants for patients with non-cardioembolic stroke. The usefulness of combination therapy (aspirin vs. with or without warfarin) is still debated. Likewise the combination of Aspirin with clopidogrel has no added advantage (MATCH Trial). However anticoagulant therapy significantly benefits high-risk patients with atrial fibrillation in the elderly subjects whereas aspirin may still be the drug of choice in stroke prevention in low risk group in the younger age. There is dire need for well planned randomized double blind controlled studies to define the role of Antithrombotic agents in "cryptogenic stroke" (PFO/ASD related) antiphospholipid antibody syndrome, arterial dissections and intraluminal clot syndromes. Evaluation and treatment of associated risk factors in all categories needs greater emphasis.

Comprehensive stroke care: an overview.

Stroke is a global epidemic and an important cause of morbidity and mortality. It ranks next to cardiovascular disease and cancer as a cause of death. "India is likely to suffer huge social and economic burden in the rehabilitation of stroke patients owing to increased life expectancy" and urbanization. Though, there are national programs in malaria eradication and tuberculosis control, there is hardly any governmental support in stroke management and rehabilitation. We propose to formulate stroke-prevention strategies specific to our national needs and covering all the age groups. Allocation of resources towards the stroke management and research is needed. Emphasis on stroke awareness in community should be stressed and should be inclusive of means of primordial and primary prevention apart from management of stroke and its recurrence. Recent international experience in stroke management has suggested the need of specialized stroke units (comprehensive stroke care under one roof). We wish to establish the need of creating awareness regarding the urgency of specialized care in acute stroke. We also wish to motivate our national health institutions to offer affordable, evidence based management of stroke and offer opportunities in stroke training and research.

Recurrent lymphocytic hypophysitis in a woman 27 years after subtotal adrenalectomy for hypercortisolism possibly of autoimmune origin.

Lymphocytic hypophysitis commonly occurs in females in peripartum period but several unusual presentations have been reported. Here we report a rare case of recurrent lymphocytic hypophysitis in a woman who had subtotal adrenalectomy for hypercortisolism 27 years back. Polyglandular autoimmune endocrinopathy with an uncommon combination of Cushing's syndrome and recurrent hypophysitis is a strong possibility in this case. Treatment with steroids has been found to have beneficial effect.

Abulia: no will, no way.

Abulia refers to impaired ability to perform voluntary actions, show initiative, make decisions along with decrease in movements, speech, thought and emotional reactions. We describe here two patients who developed this condition following bilateral insult to different sites in the centromedial core of the brain, the first following the cerebral venous thrombosis and the second after the right ACA and MCA infarct. Both these patients improved following treatment with Bromocriptine. These cases are described for proper identification and management by the clinicians.

Prevalence of parenterally transmitted hepatitis viruses in clinically diagnosed cases of hepatitis.

Hepatitis B virus (HBV) is the most important causative agent of blood borne hepatitis in humans. Hepatitis D Virus (HDV) infection occurs either as a coinfection or superinfection in HBV carriers. Hepatitis C virus (HCV) is the major cause of transfusion non-A, non-B hepatitis and continues to be a major cause of human liver disease throughout the world. The present study was conducted on 70 clinically diagnosed cases of viral hepatitis to study the prevalence of parenterally transmitted viral hepatitis. The serum samples were tested for HBsAg, HBeAg, IgM anti-HBc, anti-HBe, anti-HCV and anti-HDV using separate ELISA kits. Of the 70 serum samples tested, 28 (40%) were positive for HBsAg out of which 3 (4.28%) were positive for HBeAg also. Five (7.1%) of the HBsAg positive cases tested positive for IgM anti-HBc also. HBsAg alone was found in 17 (24.28%) cases. The prevalence of anti-HCV was 3 (4.28%) in 70 cases. Thus early screening of clinically diagnosed cases of viral hepatitis is essential for establishing diagnosis and treatment to prevent long term sequelae.

Giant intraparenchymal neurocysticercosis: unusual MRI findings.

We report a case of surgically proven giant neurocysticercosis (NCC). MR imaging revealed an unusually large solitary parenchymal cystic lesion showing signal intensity similar to CSF on all pulse sequences, with internal septations and a small nodule in the anterior aspect of this lesion compatible with this diagnosis. Identification of a scolex in a cystic lesion with CSF intensity plays a key role in the diagnosis of NCC. The presence of internal septations is an atypical feature.

Cerebrotendinous xanthomatosis: neuroimaging findings in two siblings from an Indian family.

Cerebrotendinous xanthomatosis (CTX) is exceptionally rare in the Indian population. We present and discuss the clinical, radiological and histopathologic findings in 2 siblings with CTX. Both the patients had juvenile cataract, mental retardation and marked cerebellar ataxia. The Achilles tendon swelling was present in only 1 patient (Case 2). MR imaging showed typical bilateral and symmetrical involvement of the dentate nuclei, inferior olives, brainstem and cerebellar hemispheric white matter. Although the diagnosis of CTX was made in the 3rd decade in both our cases, early diagnosis is possible if neuroimaging is done in the early course of the disease.

A Study of Congenital and Early Acquired Impairment of Hearing

The present study included 261 patients (M:F=I.72: I) suffering from congenital and early acquired hearing loss. The aetiological breakup of the hearing loss was: genetic factors 47.5%. non-genetic factors 16.8%, congenital ear malfonnations 8.5% and cryptogenic factors in 27.2% cases. Autosomal recessive mode of inheritance was seen most commonly (62%) followed by autosomal dominant (20%) in the genetic group of hearing loss. Maternal Rubella was most common cause of prenatal group of hearing loss while perinataly birth anoxia and prematurity were common. Postnataly meningitis was most common aetiology ofhearing loss. Linkage analysis on SLINK 2 point autosomal data yielded LOD score of more than 3 in an autosomal dominant family.

The role of hypo-osmotic swelling test in recurrent abortions.

The role of male factors in abortions has not been studied extensively. We undertook this study to determine if there was any relationship between hypo-osmotic swelling test score and recurrent abortions. This was a cross-sectional case control study conducted at the semen analysis laboratory at a tertiary level referral centre. The male partners of 25 patients who had three or more first trimester abortions of unknown etiology were chosen as cases. Controls were 26 unmarried volunteers with unknown fertility potential to represent the entire population. The conventional seminal parameters were studied according to WHO guidelines. The HOS test score were obtained by the method advocated by Jayendran et al. There were no statistically significant differences in mean sperm count, percentage motility and morphology among the cases and controls. We found a low hypo-osmotic swelling test score among the cases [55.7 +/- 1.197 (SEM)] than the controls [69.3 +/- 1.143 (SEM)] which was statistically significant [P < 0.001]. The normal spermatozoal membrane is the prerequisite for the specialized cell-to-cell communications and cell-to-cell binding. In spite of apparently normal semen analysis, subtle membrane defects in the spermatozoa, which could be the cause of defective membrane functions in the embryo effecting miscarriages, can be elucidated by the hypo-osmotic swelling test.

Transcranial Doppler evaluation of blood flow velocity changes in basal cerebral arteries in cerebral AVMs following embolisation and surgery.

Blood flow velocities in the basal cerebral arteries were evaluated in 41 patients with supratentorial arteriovenous malformation (AVM), using a transcranial doppler 64-B instrument. The AVM was surgically excised in 20 patients and embolised in 21 patients. Blood flow velocities in feeding basal cerebral arteries were found markedly decreased in both the groups, at 24 hours after intervention. On follow up study at 3 months, blood flow velocity in feeding cerebral artery was found to be increased in 47 percent of patients who were embolised, but remained normal in all the patients who underwent surgery.