IgG4-Related Disease with Selective Testicular Involvement- A Rare Entity: Case Report with Review of Literature.

Immunoglobin-G4 related disease (IgG4-RD) is an auto-immune inflammatory condition where patients present with a tumour-like mass that shows infiltration by plasma cell and subsequent fibrosis. It is a systemic condition that primarily involves the salivary glands, pancreas, kidneys, aorta, and retroperitoneum amongst other organs. Testicular involvement is a rare occurrence in this disease entity. A 55-year old male patient presented with the complaints of pain and swelling in the right scrotal region. Right-sided orchidectomy was carried out which on histopathology showed features suggestive of IgG4-RD which was later confirmed on immunohistochemistry. Whole body MRI revealed that no other organ was involved in the disease process in this patient. IgG4-RD has a variable clinical course and considerable overlap with its differentials. Imaging studies and serum IgG4 levels are neither confirmatory nor customarily diagnostic in every case. The only confirmatory diagnostic investigation is histopathological examination, which shows infiltration of IgG4+ plasma cells and fibrosis in the involved tissue. Whenever a mass-forming lesion with typical histomorphological features is encountered with involvement of multiple organs/anatomic sites, IgG4-related disease should be considered among the differentials, and clinicians of all disciplines should be familiar with this disease entity.

Granulomatous inflammation by candida presenting as a hard subcutaneous nodule: A rare case report with review of literature.

Fungal infections are very important infectious causes of granulomatous inflammation. Isolated subcutaneous fungal infections are uncommon and only seen in immunosuppressed patients or in those with other comorbidities. Such cases are usually mistaken as noninfectious benign lesions and fine-needle aspiration cytology (FNAC) can be used for an adequate diagnosis.

An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India).

BACKGROUND: Trauma is one of the leading causes of death and disability in Indian population. AIM: To correlate various variables like epidemiology, clinical status, severity of TBI & associated co-morbid conditions and its outcome. SETTINGS AND DESIGN: This study involved retrospective collection, prospective management and follow up of 796 cases of TBI admitted to the neurosurgery department of a tertiary care hospital in New Delhi during one year study duration. MATERIALS AND METHODS: All the relevant variables recorded and analyzed with Glasgow Outcome Scale (GOS) in 6 months into 3 groups i.e. group 1 (GOS-1/Dead), group 2 (GOS-2&3/Bad) and group 3- (GOS-3&4/good). STATISTICAL ANALYSIS: Compiled data collected, analyzed and difference between two proportions was analyzed using Chi Square test. RESULTS: This study included 791 cases with 569 (72%) males and 222 (28%) females with average age of 24 years. Fall from height was the main cause of TBI (56%) followed by road traffic injury (RTI) (36%). Majority (61%) patients reached the hospital within 6 hours of injury out of which 27% patients were unconscious. As per Glasgow coma scale mild, moderate & severe grade of TBI was seen in 62%, 22% &16% cases respectively. Radiological examination of other body parts revealed injuries in 11% cases. Only 11% cases required surgical management, rest was managed conservatively. Good outcome noted in 80% cases and 20% cases expired. Average duration of hospital stay was 5 days. According to multivariate analysis, the factors which correlated with poor prognosis are presence of radiological injuries to other body parts, GCS, abnormal cranial nerve examination, abnormal plantar and abnormal pupillary reflex. (P < 0.05). CONCLUSION: TBI predominantly affects young male population and most of these are preventable. Early transportation to the hospital and first aid results in good outcome. Mortality increases with the severity of TBI and associated injuries therefore multimodality approach in polytrauma is essential.

FNAC of inflammatory myofibroblastic tumour of the subcutis: a diagnostic dilemma.

Inflammatory myofibroblastic tumour formerly also known as inflammatory pseudotumour, was recognized initially in the lung and has been described in other visceral organs. It's occurrence in the subcutis is not well documented and its cytological appearance may be misinterpreted as malignant. This is the first case report of inflammatory myofibroblastic tumour of the subcutis in pediatric age group. A 12 year old female child presented with a subcutaneous swelling in the left anterior chest wall. FNA was performed and the cytological appearances were interpreted as malignant. Histopathology and immunohistochemistry revealed an inflammatory myofibroblastic tumour of the subcutis. FNA cytology is not very helpful in distinguishing inflammatory myofibroblastic tumour from malignant lesions especially soft tissue sarcomas. Awareness of it's occurrence in the subcutis is of importance for it's proper identification and treatment.

Spectrum of anemia in pregnant Indian women and importance of antenatal screening.

Anemia is a common health problem but control of anemia in pregnant women is less well studied. The purpose was to study prevalence of anemia in young pregnant women, correlate with indices and study significance of identification of hemoglobinopathies. Of the 120 pregnant women, Hb was less than 8 g% in 58 (44.2%). Seventy-eight (65%) had iron deficiency, 22 (18.3%) had dimorphic anemia, and 14 (11.6%) had hemolytic anemia. Megaloblastic anemia was present in 6 (5%). Of hemolytic anemia, 50% were thalassemia trait. MCV< 76 fl was observed in 88 (73.3 %) cases. MCV<76 fl and MCH < 27 pg had 100 % sensitivity and 28.7 % specificity for screening of beta-thalassemia trait. NESTROFT had comparable sensitivity but lower specificity (14.9%). Sixty-three percent (60/78) of IDA had increased RDW whereas 78 % (11/14) of hemolytic anemia had RDW value in normal range (p value< 0.05). MCV/RBC of <14 was more specific parameter (96.8%) for beta-thalassemia trait. Four high-risk couples were identified. Thus, moderate to severe anemia was observed in most pregnant women. Hemoglobinopathies should be screened in antenatal clinics to identify the couples that would need a prenatal test. A lower MCV/RBC with RDWin the normal range may be useful in screening for thalassemia trait in pregnant women.