Heavy chain deposition disease in a case of clear cell renal cell carcinoma- A jack in the box

Renal cell carcinoma (RCC) is the most common subtype of adult renal tumors, and its detection rate in the early stages has been increased in the dawn of advanced imaging modalities. Nephrectomy is the mainstay of treatment; determination of tumor category and staging is the primary concern of oncopathologists. Non-neoplastic renal parenchyma is overlooked majority of times and thus misses the opportunity to detect concomitant medical renal diseases which also predict the renal outcome in the postoperative era. Although any kind of glomerular or extraglomerular pathology may be encountered, vascular changes in the form of arterionephrosclerosis are the commonest one. Here, we take the opportunity to report an unusual association of heavy chain deposition disease (HCDD) with clear cell subtypes of renal cell carcinoma in a 48-year-old male of Indian ethnicity.

Influence Of Pharmaceutical Care Activities On Knowledge Attitude And Practice (KAP) Among Diabetic Patients In A Tertiary Care Hospital

Objective: To assess the influence of pharmaceutical care activities on Knowledge, Attitude and Practice (KAP) among type 2 diabetic patients. Methods: A total of about 301 patients with type 2 Diabetes Mellitus were recruited from a tertiary care hospital. Patients were educated about their disease condition, lifestyle modifications and diet regimen to be followed and were given instructions for improving medication adherence. In the initial session, no pharmaceutical care was given, in the second session patient counseling was given verbally and in the last session patient counseling was given both verbally and non-verbally by means of pamphlet distribution. KAP questionnaire and glycemic levels (glycated hemoglobin, fasting blood sugar and post-prandial blood sugar) of participants were obtained at baseline and at follow up. Results: The baseline values of FBS in patients before intervention was found to be 176.5±74.46 mg/dL and it was reduced to 140.7±43.9 mg/dL after 3 mo. Henceforth, there was also an improvement in the PPBS values which was found to be 254±77.3 mg/dL at the baseline and was 212.9±54.2 mg/dL after intervention. The baseline values of HbA1c is 8.144±1.727% and after intervention, value reduced to about 7.173±2.768%. After the intervention, it was found to be that 30%, 16% and 12% reduction in FBS, PPBS and HbA1c values and the P-value (<0.0001) found to be statistically significant. KAP scores also found to be improved after the intervention and statistically significant. The results clearly indicate that through proper guidance and educating the patients by the pharmacist is beneficial in managing the glycemic levels and reduce further complications. Conclusion: The study concluded that the pharmaceutical care by the pharmacist is highly essentially and useful for the patients to manage the glycemic index and prevent further diabetic complications.

Cost Analysis Of Emergency Visits Due To Drug Related Problems

Objective: To identify patients coming to Emergency Medicine Department (EMD) with drug related problems, classify the DRPs and calculate the direct cost spent for treating them. Methods: This was a prospective observational study conducted in emergency medicine department. The patients coming to EMD with DRPs were classified according to Cipolle’s classification and the direct medical and non-medical costs were calculated. Results: A total of around 107 patients identified with DRPs of which 99 patients were included in the study. In this study, 51% of the cases were due to ADR and 35% due to non-adherence and rest of the cases were due to overdose (10%), drug interaction (3%) and sub therapeutic dose (1%). Major portion for treatment was spent for direct medical cost in which cost for laboratory investigations have contributed the most, INR 10,93,992 (42%) followed by Health care professional cost INR 55,6814 (21%), Pharmacy cost INR 4,00,524.6 (15%), Admission cost INR 3,80,400 (15%). The direct non-medical cost includes cost for diet and travel which was found to be INR 1,68,443 and INR 71,947 respectively. Conclusion: The drug related problems adds a significant economic burden on the patients which can be reduced by imparting knowledge about the proper use of medicines and by improving collaborative efforts of the patients, physicians, pharmacists and caregivers.

Retinoblastoma discordance in families with twins

Retinoblastoma has an increased inheritance risk of germline RB1 mutations in offspring and siblings, especially twins. Three families, each having one retinoblastoma-affected twin, were selected for genetic analysis and DNA profiling. Germline RB1 mutations were found in all probands. DNA profiling carried on similar-looking twins of families I and II, proved them to be fraternal. This study demonstrates the importance of genetic analysis of RB1 gene for risk prediction in retinoblastoma families. It also emphasizes that DNA profiling is a mandate for genetic screening of families with twins, thus adding a new dimension in counseling of retinoblastoma.

Treating complexity in the older adult - the role of the geriatric giants

As people age, they accumulate medical conditions. Geriatric giants comprise a group of conditions that lead to significant mortality and morbidity and contribute to the complexity in treating geriatric patients. They are common and rarely occur in isolation. The 5 Is of geriatric giants are: iatrogenesis, immobility, instability, incontinence and impaired cognition. Consequences for the patient and their caregivers include loss of functional independence, institutionalisation and caregiver burnout. Primary care practitioners are often the first port of call for geriatric patients in South Africa and by asking a few key questions and performing a thorough examination; these conditions can be recognised early. Whilst there are often limitations to cure, the main aim is to maintain the older adult's functional independence as much as possible, and by following an organised management approach to each of these conditions, the quality of life of patients can be improved

Post-partum recurrent hypoglycemia

Hypoglycemia can be effortless to treat. Its evaluation on the other hand, needs a thorough appraisal. The studied patient had recurrent episodes of hypoglycemia post-delivery which were unprovoked. These conspicuous episodes of hypoglycemia prompted an evaluation and a swift arrival at the diagnosis. In hindsight, she had multiple, typical risk factors predisposing her to develop a Sheehan’s syndrome. This was an acute presentation of a familiar disease

A myriad of fat

Hypertriglyceridemia is a familiar issue a physician and his patients face. Writing a prescription for the same may be effortless, but without a thorough evaluation, we may miss out on a number of concealed diseases. Treating the underling secondary disease, avoids an unnecessary pill burden, eventually decreasing healthcare costs also. Unearthing prevalent diseases like diabetes mellitus (DM) is rewarding in its own way and pays dividends multifold. The physician must be aware that secondary causes of hypertriglyceridemia manifesting as lipemia can commonly be seen in disorders like obesity, primary hypothyroidism and DM. The studied patient presented to us obviously shaken with a long history of weight gain and lipemia during a blood draw. She turned out to have the commonest risk factors for hypertriglyceridemia - Obesity, hypothyroidism and DM causing the alarming lipemia. It was an oddly interesting presenting symptom of hypertriglyceridemia, obesity, hypothyroidism and DM which resulted in an appropriate and prompt management of her underlying diseases.

Scrub typhus presenting without fever

Scrub typhus may be a very a familiar reason for an acute undifferentiated fever. Although there has been an improvement in the diagnostics as well as an increased awareness regarding this disease, it still remains belatedly diagnosed and eventually turns fatal. We present a male patient who was brought to us with jaundice, tender hepatomegaly and distinctly no history fever who turned out to have a Scrub typhus infection and was salvaged owing to a diverse empirical antibiotic coverage. This represents an atypical clinical presentation of a very familiar infection: Tropical rickettsioses infection presenting with afebrile jaundice in an immunocompetent patient. It also brings into perspective the wavered nature of its disease presentation, the significant merit of procuring a good patient history and a change in empirical antibiotic policies especially in areas endemic for scrub typhus

Efectos de los medios sociales en la eficacia política, capital social y participación política de los jóvenes universitarios en México y Colombia

En los últimos años se han incrementado los estudios académicos sobre los efectos de los medios sociales en la participación política convencional. Existen dos dimensiones que aparecen de manera constante en esta línea de investigación emergente: la construcción del capital social y el sentimiento de eficacia política. En el presente estudio se compara a dos grupos de jóvenes universitarios de dos diferentes países latinoamericanos (México y Colombia) en torno a sus respuestas de acciones que confirman su sentimiento de eficacia política, así como los elementos que les permiten construir capital social con la ayuda de los medios sociales. De igual manera, se lleva a cabo una relación de estos conceptos con su participación dentro y fuera de línea. Respecto a las conclusiones, no se encontraron grandes variaciones entre los dos grupos que participaron en el estudio. No obstante, los resultados confirman una tendencia que ha aparecido en otros estudios similares: la participación política dentro y fuera de línea tiene una fuerte relación entre sí, así como con los constructos de capital social y eficacia política.

Academic studies on the effects of social media on conventional political participation have increased in recent years. There are two dimensions that appear constantly in this line of emerging research: the construction of social capital and the sentiment of political efficacy. In this study, two groups of university students from different Latin American countries (Mexico and Colombia) are compared around their responses of actions that confirm their sentiment of political efficacy, as well as the elements that allow them to construct social capital with the help of the media, social. In the same way, these concepts are related to their participation inside and outside social media. Among the conclusions we found that there were no great variations between the two groups that participated in the study. However, the results confirm a trend that has been identified in other similar projects: political participation inside and outside social media has a strong relationship with each other, as well as with the constructs of social capital and political efficiency.

Os estudos acadêmicos sobre os efeitos das mídias sociais na participação política convencional aumentaram nos últimos anos. Existem duas dimensões que aparecem constantemente nessa linha de investigação emergente: a construção do capital social e o sentimento de eficacia política. Este estudo compara dois grupos de estudantes universitários de dois países latinoamericanos diferentes (México e Colômbia) em torno de suas respostas a ações que confirmam seu senso de eficacia política, bem como os elementos que lhes permitem construir capital social com a ajuda das mídias sociais. Da mesma forma, esses conceitos estão relacionados á sua participação dentro e fora da linha. Entre as conclusões, descobrimos que não houve grandes variações entre os dois grupos que participaram da pesquisa. Não obstante o que precede, os resultados confirmam uma tendência que foi identificada em outras pesquisas similares: a participação política dentro e fora da linha tem uma forte relação entre si, assim como com as construções de capital social e eficacia política.

Dental caries and calculus status in children studying in Government and Private Schools in Malappuram, Kerala, India

Background: Dental caries status in children is influenced by a number of risk factors such as sex, age, socioeconomic status, diet, and oral hygiene practices. The objective of the study was to assess and compare the prevalence of dental caries and calculus in 12-13 year old school children. Materials and methods: A sample of 761 children aged 12-13 years of both sexes from government and private schools. Clinical examination was carried out using the DMFT index for assessing the caries prevalence and Calculus component of Simplified-Oral Hygiene Index was used for assessing calculus in these children. Results: The prevalence of dental caries was seen more in children studying in government schools than in private schools which was statistically significant (p=0.018). When the gender differences were compared it was seen that girls showed a higher prevalence of dental caries (66.37% in private schools; 87.58% in government schools) than boys (64.47% in private schools; 71.98% in government schools). There was no significant difference seen in the prevalence of calculus between government and private school children. Conclusion: High prevalence of dental caries was found in these school children which suggested a poor performance of oral hygiene practices in them

Awareness, Knowledge and Practices on Bio-Medical Waste Management Among Health Care Professionals in Mangalore- A Cross Sectional Study

"Introduction: Bio-medical wastes are of great importance due to its potential environmental hazards and health problems. The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. It is estimated that annually 0.33 million tons of hospital waste is generated in India. The objective of this study is to analyze the medical waste management practices in different health care settings, analyze the risk perceptions of health care personnel and assess the attitude towards the waste management policies.Materials and methods:A cross-sectional study is conducted using a pre-tested questionnaire to assess the awareness, knowledge and practices on medical waste management among health care personnel in different health care settings in Mangalore city.Pullishery F,Panchmal GS, Siddique S, Abraham A. Awareness, Knowledge and Practices on Bio Medical Waste Management Among Health Care Professionals in Mangalore A Cross Sectional Study. IAIM, 2016; 3(1):29-355.Page 30 Results: Doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management. Knowledge regarding the color coding and waste segregation was found to be better among nurses and laboratory staff as compared to doctors. Conclusion:The management of hospital waste requires its segregation and removal from the health care establishments in such a way that it will not be a source of health hazards to those who are directly or indirectly related to the hospital environment. The segregation of waste in almost all hospitals is not satisfactory. Proper and judicious handling of Bio-medical waste continues to be a matter of serious concern for health authorities in India."

Antiviral drug profile of human influenza A & B viruses circulating in India: 2004-2011.

background & objectives: Recent influenza antiviral resistance studies in South East Asia, Europe and the United States reveal adamantane and neuraminidase inhibitor (NAIs) resistance. This study was undertaken to evaluate antiviral resistance in influenza viruses isolated from various parts of India, during 2004 to 2011. methods: Influenza viruses were analyzed genetically for known resistance markers by M2 and NA gene sequencing. Influenza A/H1N1 (n=206), A/H3N2 (n=371) viruses for amantadine resistance and A/H1N1 (n=206), A/H3N2 (n=272) and type B (n=326) for oseltamivir resistance were sequenced. Pandemic (H1N1) (n= 493) isolates were tested for H274Y mutation by real time reverse transcription (rRT)-PCR. Randomly selected resistant and sensitive influenza A/H1N1 and A/H3N2 viruses were confirmed by phenotypic assay. results: Serine to asparagine (S3IN) mutation was detected in six isolates of 2007-2008.One dual-resistant A/H1N1 was detected for the first time in India with leucine to phenylalanine (L26F) mutation in Mm2 gene and H274Y mutation in NA gene. A/H3N2 viruses showed an increase in resistance to amantadine from 22.5 per cent in 2005 to 100 per cent in 2008 onwards with S3IN mutation. Fifty of the 61 (82%) A/H1N1 viruses tested in 2008-2009 were oseltamivir resistant with H274Y mutation, while all A/H3N2, pandemic A/H1N1 and type B isolates remained sensitive. Genetic results were also confirmed by phenotypic analysis of randomly selected 50 resistant A/H1N1 and 40 sensitive A/H3N2 isolates. Interpretation & conclusions: Emergence of influenza viruses resistant to amantadine and oseltamivir in spite of negligible usage of antivirals emphasizes the need for continuous monitoring of antiviral resistance.

Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals.

Purpose: Opportunistic viral infections are one of the major causes of morbidity and mortality in HIV infection and their molecular detection in the whole blood could be a useful diagnostic tool. Objective: The frequency of opportunistic DNA virus infections among HIV-1-infected individuals using multiplex real-time PCR assays was studied. Materials and Methods: The subjects were in two groups; group 1: Having CD4 counts <100 cells/μl (n = 118) and the group 2: counts >350 cells/μl (n = 173). Individuals were classified by WHO clinical staging system. Samples from 70 healthy individuals were tested as controls. In-house qualitative multiplex real-time PCR was standardised and whole blood samples from 291 were tested, followed by quantitative real-time PCR for positives. In a proportion of samples genotypes of Epstein-Barr virus (EBV) and CMV were determined. Results: The two major viral infections observed were EBV and CMV. The univariate analysis of CMV load showed significant association with cryptococcal meningitis, oral hairy leukoplakia (OHL), CMV retinitis, CD4 counts and WHO staging (P < 0.05) while the multivariate analysis showed an association with OHL (P = 0.02) and WHO staging (P = 0.05). Univariate analysis showed an association of EBV load with CD4 counts and WHO staging (P < 0.05) and multivariate analysis had association only with CD4 counts. The CMV load was significantly associated with elevated SGPT and SGOT level (P < 0.05) while the EBV had only with SGOT. Conclusion: This study showed an association of EBV and CMV load with CD4+ T cell counts, WHO staging and elevated liver enzymes. These viral infections can accelerate HIV disease and multiplex real-time PCR can be used for the early detection. Genotype 1 and 2 of EBV and genotype gB1 and gB2 of CMV were the prevalent in the HIV-1 subtype C-infected south Indians.

Recurrent and Troublesome Variceal Bleeding from Parastomal Caput Medusae / 대한소화기학회지

Variceal bleeding is common in chronic liver disease and is a frequent cause of acute upper gastrointestinal bleeding. The most common site of varices is the lower oesophagus but they may occur at any location where there are portosystemic anastomoses and collateral vascular formation. Location of ectopic varices at the site of enterocutaneous stomas is rare. We report on three cases of recurrent and severe bleeding from parastomal varices, requiring hospital admission. The patients had chronic liver disease but of different aetiological factors. Variceal formation results from portal hypertension due to chronic liver disease. There are various treatment options for parastomal variceal bleeding, including local, medical, and surgical interventions. Management of parastomal variceal bleeding presents a recurring and difficult problem. Bleeding may be considerable and sometimes life threatening. This diagnosis must be considered in patients with chronic liver disease presenting with stomal bleeding, even where the variceal formation may not be readily visible.

Comparison of a conventional polymerase chain reaction with real-time polymerase chain reaction for the detection of neurotropic viruses in cerebrospinal fluid samples.

Purpose : To compare a conventional polymerase chain reaction (PCR) and real-time PCR for the detection of neurotropic DNA viruses. Materials and Methods : A total of 147 cerebrospinal fluid (CSF) samples was collected from patients attending a tertiary care hospital in South India for a period from 2005 to 2008. All these samples were tested using a conventional multiplex/uniplex PCR and a real-time multiplex/uniplex PCR. This technique was used to detect a large number of herpes viruses responsible for central nervous system infections, including HSV-1, HSV-2, VZV, CMV and EBV and the polyoma virus JCV. Results : Overall, in the entire set of samples, the real-time PCR yielded 88 (59.9%) positives and conventional PCR had six (4.1%) positives. Conclusion : Our results suggest that the real-time PCR assay was more sensitive compared with the conventional PCR. The advantage of real-time PCR is that it can be performed much faster than conventional PCR. Real-time PCR is less time-consuming, less labour-intensive and also reduces the chance of contamination as there is no post-amplification procedure. In the entire study population, the major viruses detected using real-time PCR were EBV (34%), HSV-2 (10.8%) and VZV (6.8%).

Nanotechnology tools for single-virus particle detection.

The development and potential application of nanotechnology tools for single-virus particle detection by emergent nanotechnology is likely to revolutionise diagnosis and determining treatment endpoints for life threatening virus infections. Direct detection of biological macromolecules using semiconducting nanowires or carbon nanotubes for electrical field change measurements is a milestone application in this field. The promise of selective detection at a single particle level (stochastic sensing) with nanowire or nanotube field-effect transistor-based devices is a major breakthrough for outbreak situations, where a rapid and specific detection of the viral agent allows intervention at public health level. The same technology would be eminently suitable for bedside diagnosis and therapeutic intervention.

Evaluation of a rapid immunochromatographic device for the detection of IgM & IgG antibodies to Dengue viruses (DENV) in a tertiary care hospital in South India.

This study has evaluated the performance of a rapid immunochromatographic test (ICT) device in detecting antibodies to Dengue virus (DENV) in a tertiary hospital in South India. Sera from hospital attendees, with requests for DENV antibody testing, were tested with the Panbio Dengue Duo Cassette and a reference antibody capture assay for the detection of IgM (Dengue IgM capture ELISA-National Institute of Virology, India) and IgG (Dengue IgG capture ELISA-Panbio Diagnostics Inc., Australia) antibodies. The ICT results were compared with results of antibody capture tests for the detection of the IgM and IgG antibodies, respectively. Accuracy indices for IgM and IgG detection, respectively were - sensitivity 81.8% and 87.5%, specificity 75.0%, and 66.6%, positive predictive value (PPV) 61.0% and 72.9% and negative predictive value (NPV) 89.6% and 83.9%. The device performs poorly in detection of IgM and IgG antibodies to DENVs and is not recommended for use as a stand-alone diagnostic test.

Detection of opportunistic DNA viral infections by multiplex PCR among HIV infected individuals receiving care at a tertiary care hospital in South India.

Purpose: Opportunistic viral infections cause increased morbidity and mortality among human immunodeficiency virus (HIV) infected individuals, especially those who are not on antiretroviral treatment. Early diagnosis of these opportunistic viruses will be able to reduce the risk of disease progression with appropriate intervention. Materials and Methods: Multiplex PCR was attempted to detect the opportunistic herpes viruses (HSV-1, HSV-2, VZV, EBV, and CMV), adenovirus and polyoma viruses (JC and BK) in three cocktails of PCR reactions. Subsequently, all the viruses detected were quantitated by testing using monoplex real time PCR. Whole blood samples collected between 2006 and 2007 from 68 treatment naοve HIV-1 infected and 30 normal healthy individuals were tested for these eight viruses. Among the 68 HIV -1 infected individuals 35 had CD4+ T cell count less than or equal to 200 while the other 33 had greater than 200 CD4+ T cells. Results: Among the 68 HIV-1 infected individuals, 49 (72%) were positive for EBV, 5 (7%) samples were positive for CMV. All the five CMV positive individuals had CD4+ T cell count of less than or equal to 200 cells/µL. The mean EBV load among the individuals with a CD4+ T cells of less than or equal to 200 cells/µL was 3.88 log 10 while among those with greater than 200 CD4+ T cells it was 3.75 log 10 . The mean CMV load was 6.98 log 10. Three samples were positive for both CMV & EBV. None of the samples was positive for HSV-1, HSV-2, VZV, Adenovirus, JC and BK viruses. Conclusions: In our study, multiplex PCR based detection system was found useful in detecting opportunistic viruses in HIV infected individuals. Though EBV is the most prevalent opportunistic viral infection among HIV infected individuals, there was no significant association between EBV load, CD4+ T cell counts and HIV-1 virus load. CMV was seen in HIV infected individuals with low CD4+ T cell counts (less than 200 cells/μL).

A molecular method for typing Herpes simplex virus isolates as an alternative to immunofluorescence methods.

BACKGROUND: Typing of Herpes simplex virus (HSV) isolates is required to identify the virus isolated in culture. The methods available for this include antigen detection by immunofluorescence (IF) assays and polymerase chain reaction (PCR). This study was undertaken to standardize a molecular method for typing of HSV and compare it with a commercial IF reagent for typing. OBJECTIVES: To compare a molecular method for typing HSV isolates with a monoclonal antibody (MAb) based IF test. STUDY DESIGN: This cross-sectional study utilized four reference strains and 42 HSV isolates obtained from patients between September 1998 and September 2004. These were subjected to testing using an MAb-based IF test and a PCR that detects the polymerase ( pol ) gene of HSV isolates. RESULTS: The observed agreement of the MAb IF assay with the pol PCR was 95.7%. Fifty four point eight percent (23/42) of isolates tested by IF typing were found to be HSV-1, 40.5% (17/42) were HSV-2, and two (4.8%) were untypable using the MAb IF assay. The two untypable isolates were found to be HSV-2 using the pol PCR. In addition, the cost per PCR test for typing is estimated to be around Rs 1,300 (USD 30), whereas the cost per MAb IF test is about Rs 1,500 (USD 35) including all overheads (reagents, instruments, personnel time, and consumables). CONCLUSION: The pol PCR is a cheaper and more easily reproducible method for typing HSV isolates as compared to the IF test. It could replace the IF-based method for routine typing of HSV isolates as availability of PCR machines (thermal cyclers) is now more widespread than fluorescence microscopes in a country like India.