Etiological and clinicopathological study of secondary small vessel vasculitis in elderly: A case series of 12 patients.

BACKGROUND: Inflammation involving the postcapillary venular wall is defined as small vessel vasculitis. Small vessel vasculitis has various clinical manifestations. Etiologically, it can be primary or secondary. Literature regarding secondary vasculitis in elderly is scanty. AIM AND OBJECTIVES: In this case series, we aimed to assess the clinical features and etiologies of biopsy-proven secondary small vessel vasculitis in the elderly. METHODOLOGY: Twelve elderly patients with biopsy-proven small vessel vasculitis were included in this study. All patients were thoroughly evaluated to assess the etiology and presence of major organ involvement. RESULTS: Secondary small vessel vasculitis involved both the sexes equally. Constitutional symptoms including fever and weight loss were noticed by most of the (70%) patients. Neurological deficits were present in 83% of the study population. The most common finding in an electromyographic examination was an asymmetric sensory motor distal predominant polyradiculopathy. Fifty percent of the patients did fulfill the criteria for a definite autoimmune disease. More than 30% of the vasculitis was secondary to malignancies. CONCLUSIONS: Neurological manifestations are the most common systemic involvement in elderly patients with secondary vasculitis. Meticulous search for underlying malignancies is mandatory in elderly patients with secondary small vessel vasculitis.

Analysis of silver stained nucleolar organizing regions in odontogenic cysts and tumors.

OBJECTIVE: The present study aimed to investigate the probable differences in cell proliferation index of odontogenic cysts and tumors by means of a comparative silver stained nucleolar organizing region (AgNOR) quantification. STUDY DESIGN: This descriptive cross-sectional study was done on archival paraffin blocks (n = 62), consisting of 10 odontogenic keratocysts, 10 dentigerous cysts, 10 radicular cysts, 10 conventional ameloblastomas, 10 adenomatoid odontogenic tumors, 10 calcifying epithelial odontogenic tumors and 2 ameloblasic carcinomas. RESULTS: The mean AgNOR count of odontogenic cysts was 1.709 and the benign odontogenic tumors was 1.862. Highest AgNOR count was recorded in odontogenic keratocyst and lowest was seen in radicular cyst. Statistically significant difference in AgNOR counts of ameloblastoma and adenomatoid odontogenic tumor, amelobalastoma and calcifying epithelial odontogenic tumor, benign odontogenic tumors and ameloblastic carcinoma were seen. AgNORs in ameloblastic carcinoma were more in number and more widely spread. CONCLUSION: AgNOR technique may be considered a good indicator of cell proliferation in odontogenic cysts and tumors.

Osteochondroma of the palate: An interesting and an unusual case presentation.

A 40-year-old Indian male patient was referred to the Department of Oral and Maxillofacial Surgery with a slowly enlarging intra-oral, right-sided palatal swelling of one-year duration, with a previous diagnosis of osteochondroma. Extraorally, patient presented with a mild right-sided facial swelling. On intraoral examination, the palatal swelling was extending from the distal aspect of canine to the distal aspect of second molar with involvement of the maxillary tuberosity. The swelling was non-tender, bony-hard in consistency and covered by normal mucosa. The medical history was non-contributory with no relevant family history of any skeletal disease. Despite the attempt for complete removal of the tumor previously, it recurred within six months. The present article reports an extremely rare clinical case of endosteal (central) osteochondroma, manifesting itself as a radiopaque mass in the right posterior aspect of the palate.

Influenza A (H1N1) 2009 pandemic: was there a difference in the two waves in patients requiring admission to the intensive-care unit?

Influenza virus is prone to mutations that may alter the intensity of subsequent waves of infection. In this study, we evaluated whether outcomes were different in the two waves of the influenza A (H1N1) 2009 pandemic in patients admitted to the intensive-care unit. Age, gender, lag-time to presentation and APACHE-II scores were similar in both waves. Although ventilatory requirements were similar (36/37 vs. 36/39), non-significant reductions in the durations (days) of ventilation (10.3 ± 8.0 vs. 7.8 ± 9.4, p 0.11) and hospitalization (14.9 ± 10.5 vs. 12.3 ± 14.1, p 0.20) were observed in the second wave. The clinical profile and outcomes were not significantly different between the two waves among severely ill patients.

Azadirachtin poisoning: a case report.

The use of neem-based products is widespread in the Indian Subcontinent. Neem-based pesticides obtained from neem kernels are considered natural and safe. The toxic effects of ingestion and overdose of this pesticide in adults have not been described in this literature. We report the case of a 35-year-old lady who had consumed Azadirachtin in an attempt of deliberate self-harm. The patient had features of neurotoxicity because of Azadirachtin requiring intensive medical care with mechanical ventilation. The patient survived the overdose with no long-lasting side effects of the toxin.

The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India.

INTRODUCTION: Delirium is common in hospitalized geriatric patients with hip fractures. A number of peri-operative predisposing and postoperative precipitating factors have been identified in Western literature but data regarding this problem within the Indian context is scarce. METHOD: The objectives of the study were to ascertain the incidence of delirium in geriatric patients admitted for the treatment of hip fractures in the Department of Orthopaedics of a tertiary care referral centre in South India, to delineate their clinical profile and identify probable contributing factors for development of delirium in this group of patients. The study was a prospective, cohort study design that was conducted on patients above the age of 60 years, admitted to the orthopaedic ward with hip fracture and who underwent hip surgery. A total of 81 patients were recruited from May 1st 2004 to April 30th 2005 (total duration of one year). RESULTS: Of the 81 patients 17 (21%) of the patients developed post-operative delirium. On multivariate analysis the presence of underlying dementia (OR 16.97), duration of surgery > 2.5 hrs (OR 8.23) and preoperative packed cell volume < 25 (OR 8.07) were found to be independent predisposing risk factors that were associated with the development of postoperative delirium. Postoperative infections, metabolic abnormalities and vascular events were found to be important detected medical causes for precipitating post-operative delirium. Patients who had delirium had longer hospital stays and poor ambulation at discharge. CONCLUSIONS: Delirium in geriatric patients undergoing hip fracture surgery results in poor postoperative outcomes and increased cost. The etiology of delirium is multi-factorial. A number of potentially modifiable factors have been identified as risk factors for delirium. Appropriate intervention strategies involving physicians and geriatricians need to be implemented within the Indian context to reduce the incidence of delirium.

Endotracheal tuberculous stenosis: ventilation rescue and bronchography guided stenting.

We present the case of a 16-year-old female patient who presented with dyspnoea, cough and noisy breathing that progressed further in hospital with the development of stridor and severe respiratory compromise requiring mechanical ventilatory support. Investigations were consistent with a diagnosis of endotracheal tuberculosis with tracheal and bronchial stenosis. Despite adequate anti-tuberculous therapy and ventilation the patient had high airway pressures, low tidal volumes and hypercapnia, which prevented weaning from mechanical ventilation. Balloon dilatation and stenting of the 4.5cm long, 2.3mm diameter stenotic tracheal segment was performed under radiological guidance. The patient was weaned successfully from the ventilator post-procedure. This report illustrates the successful management of an uncommon presentation of a common disease with modern endoscopic therapy.

Drug interaction: rifampicin and glibenclamide.

BACKGROUND: Rifampicin is a potent inducer of the hepatic microsomal enzyme system. However, the drug has been shown to cause clinically important interactions with many drugs. This study was designed to test the interaction of rifampicin with the oral hypoglycaemic agent glibenclamide. METHODS: Twenty-nine well-controlled diabetic patients on a combination therapy of diet and glibenclamide, and willing to participate in the trial, received a daily dose of 450 mg (body weight < 50 kg) or 600 mg (body-weight > 50kg) of rifampicin for 10 days. RESULTS: There was a significant (p < 0.001) worsening of fasting and post-prandial blood sugar after administration of rifampicin. Dose modification of glibenclamide was required in 15 of the 17 patients in whom the diabetes became uncontrolled. Blood sugar normalized by day 6 after stopping rifampicin in all patients. CONCLUSION: Rifampicin and glibenclamide interact. Therefore, necessary dose modifications should be made in order to achieve euglycaemia if these two drugs are given together.