Diagnostic Signs and Symptoms of Cyanocobalamin Deficiency at Rural Setting in India: Novel Method of Supplementation.

BACKGROUND: Cyanocobalamin or B12 deficiency is common in the Indian population, and responsible for anemia. Various clinical manifestations include central nervous system and cardiovascular manifestations, secondary to a rise in serum homocysteine levels. METHOD AND PATIENTS: In a routine outpatient department at Bawaskar Hospital and Clinical Research Centre, Mahad, patients with suspected clinical signs and symptoms suggestive of cyanocobalamin deficiency were studied in detail regarding their dietary habits, serum hemoglobin, B12, and homocysteine levels. FINDINGS: A total of 1,992 (female 1,009, 50.75%) were clinically examined in detail. Of these, 945 (49.94%), 999 (50.17%), and 48 (2.40%) were strict vegetarians, both vegetarian and nonvegetarian, and strict nonvegetarians, respectively. Common occupations associated with B12 deficiency include 666 (33.4%) housewives, 396 (19.9%) service workers, 316 (15.9%) businesspeople, 180 (9%), and 198 (9.9%) retired and industrial populations, respectively. Clinical manifestations include recurrent scalp hair loss in 268 (13.5%), poor memory in 240 (12%), tingling and numbness in 200 (10%), and generalized weakness in 387 (19.4%) patients. Additionally, 541 (27.15%) patients had pigmentation of the nail bed, knuckles, oral mucosa, and tongue, while 237 (10.81%) suffered from hypertension and ischemic heart disease. During the process of preparation of vegetarian and nonvegetarian food, there is a 30-48% reduction in vitamin content. Supplementation of vitamin by adding table salt to food on a plate at the time of eating improves the vitamin level in the blood. CONCLUSION: In the absence of laboratory investigations in rural settings, clinical signs and symptoms are helpful in detecting B12 deficiency. Directly adding vitamin powder, similar to table salt, to cooked food on the plate improved blood vitamin levels.

A Rare Case of Unilateral Xanthogranulomatous Ureteritis Mimicking an Inferior Vena Cava Tumor.

Xanthogranulomatous pyelonephritis (XPG) is a known clinical entity; however, the further progression of this inflammatory pathology to adjacent organs, including the ureter, bladder and urethra, is extremely rare. Xanthogranulomatous inflammation of the ureter is a chronic inflammatory state where foamy macrophages are seen in the lamina propria along with multinucleated giant cells and lymphocytes forming a granulomatous inflammation, which is benign. Based on its appearance on computed tomography (CT) scan images, it can easily be misidentified as a malignant mass, and the patient can be subjected to surgery that can lead to complications. Here we present a case of an elderly male with a known case of chronic kidney disease with uncontrolled type 2 diabetes mellitus who presented with fever and dysuria. Upon further radiological investigations, the patient had underlying sepsis and was seen to have a mass involving the right ureter and inferior vena cava. Upon biopsy and histopathology, he was diagnosed with xanthogranulomatous ureteritis (XGU). The patient underwent further treatment and was followed up.

Ultrasound-Guided Pigtail Catheter Drainage: An Effective Alternative to Exploratory Laparotomy.

Introduction It has been long established that open surgeries were the only options available for the management of intra-abdominal abscesses or collections. These were associated with increased morbidity and mortality. Traditionally, the idea of percutaneous needling could not gain popularity due to poor localization of collections. However, with the advent of ultrasound, percutaneous pigtail-catheter drainage has proven to be minimally invasive and allows precise localization of the drainage site. Objectives To study the effectiveness of ultrasound-guided pigtail catheter drainage as an alternative to exploratory laparotomy for the management of intra-abdominal abscesses or collections. Materials and methods A total of 48 patient cases, which included liver abscesses, perinephric collections, malignant ascites, splenic collections, pseudocysts, and psoas abscesses, were studied prospectively in a medical college in India from October 2020 to October 2021. The efficacy of the drainage was assessed by serial ultrasound. Results Out of 48 patients, 34 were male and 14 were female, ranging in age from 19 to 64 years, who were diagnosed with intra-abdominal abscesses or collections and underwent ultrasound-guided pigtail catheter drainage. The average hospital stay for patients was 2.5 days. They were followed up periodically for three months post-procedure, and none had significant complications or recurrence. Conclusion The pigtail catheter is the treatment of choice for liquefied intra-abdominal collections or abscesses, which helps to reduce post-procedure hospital stays and complications. Contribution This article reiterates the use of minimally invasive techniques in place of open surgeries with less morbidity.

Role of circulating tumour cells (CTCs) in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC).

Background: Liquid biopsy is emerging as a non-invasive tool, providing a personalized snapshot of a primary and metastatic tumour. It aids in detecting early metastasis, recurrence or resistance to the disease. We aimed to assess the role of circulating tumour cells (CTCs) as a predictive biomarker in recurrent/metastatic head and neck cancer (head and neck squamous cell carcinoma (HNSCC)). Methodology: Thirty-five patients receiving palliative chemotherapy underwent blood sampling [2 mL in Ethylenediaminetetraacetic acid (EDTA) vial] at baseline and at 3 months intervals. The CTCs were isolated and evaluated using anti-epithelial cell adhesion molecule antibody-based enrichment using the OncoDiscover platform. Results: CTCs isolated from 80% of patients (n = 28) showed the sensitivity of cell detection at the baseline and 3 months intervals. The median CTC count was 1/1.5 mL of blood and the concordance with clinic-radiological outcomes was 51.4%. The median CTC count (1 (range:0-4) to 0 (range:0-1)) declined at 3 months in responders, while the non-responders had an increase in levels (0 (range :0-2) to 1 (range :0-3)). Although CTCs positively correlated with progression-free survival (PFS) and overall survival (OS), the association of CTCs did not show a significant difference with these parameters (PFS: 6 months versus 4 months; hazard ratio: 0.68; 95% confidence interval (CI): 0.29-1.58, p = 0.323; OS: 10 months versus 8 months; hazard ratio: 0.54; 95% (CI):0.18-1.57 p = 0.216) between CTC positive and CTC negative patients at 3 months. Conclusion: This study highlights the utility of CTC as a disease progression-monitoring tool in recurrent HNSCC patients. Our findings suggest the potential clinical utility of CTC and the need for exploration in upfront settings of the disease as well (NCT: CTRL/2020/02/023378).

Are we overconcerned about secondary hyperparathyroidism and underestimating the more common secondary hypoparathyroidism in our dialysis patients?

OBJECTIVES: The aim of the study was to determine the prevalence of hyper and hypo-parathyroid state in prevalent dialysis patients. The second part of the study was to look for the prevalence of vascular calcification (abdominal aortic) and factors predicting calcification in these patients. METHODS: All adult patients, who were more than 1 month on dialysis, were included in the study. A total of 68 patients, of which 75% were on hemodialysis and 25% on peritoneal dialysis, were finally studied. Patients' parathyroid status was defined as per target recommendation of KDOQI--hypoparathyroid with iPTH < or = 150 pg/ml and hyperparathyroid with iPTH > 300 pg/ml. Vascular calcification was determined by X ray of lateral lumbar spine to look for abdominal aortic calcification (AAC). The AAC was scored as validated. The prevalence of hyper- and hypoparathyroidism in dialysis patients was determined as percentage of total dialysis patients. The prevalence of AAC and factors predicting it was analyzed by 'univariate' and 'multiple logistic regression analyses. RESULTS: The mean age of patients was 50.04 +/- 14.15 years, 58.82% were males and 42.64% were diabetics. Mean duration of dialysis was 22.36 +/- 19.17 months. Hyperparathyroidism was seen in only 27.94% of all dialysis patients, while hypoparathyroidism was in 45.58%. Abdominal aortic calcification was seen in 79.41% of overall patients and 13.23% had significant calcification (score 7-24). On univariate analysis, age (0.000) and iPTH (0.03) were the only variables predicting AAC and on logistic regression analysis, age was the only independent predictor of abdominal aortic calcification (p = 0.002, OR 1.11, CI 1.038-1.186). CONCLUSION: Hypoparathyroidism is more common (46%) in our dialysis patients as compared to hyperparathyroidism (28%). There is high prevalence of vascular (abdominal aortic) calcification (80%) in our dialysis patients.

Painful Abdominal Lump in the Pediatric Age Group: A Diagnostic Dilemma.

Any cystic lesion occurring in the mesentery which may or may not extend into the retroperitoneum is referred to as a mesenteric cyst; they have an infrequent incidence rate in the pediatric age group. Definitive etiology of the cystic lymphatic malformations is still not known but there are multiple hypotheses. A young male child presented with acute onset abdominal pain and palpable intra-abdominal mass and ultrasonography revealed presence of two lesions, one of them as an encysted turbid fluid collection in the right lumbar region and the other as a dilated, tortuous, intercalated structure. On CT, the first one was identified definitively as a mesenteric cyst while the other as a possible neoplastic mass in close proximity to the first one. Histopathology confirmed the diagnosis as a cystic lymphatic malformation of the mesenteric cyst. The limited awareness of its existence along with its usually asymptomatic nature, are the likely reasons that it still remains an elusive diagnosis. Based on our case we discuss, the use of a multi-modality approach towards diagnosing cystic malformation disorders and how the use of MRI is under-utilised when it could prove decisive.

Lake contamination by accumulation of heavy metal ions in Eichhornia crassipes: a case study of Rankala Lake, Kolhapur (India).

The absorption of heavy metals into biomaterial derived from the plant Eichhornia crassipes was investigated. The root, stem and leaf samples of the plant collected from the Rankala Lake of Kolhapur city (India) were analyzed for the metal ion concentrations using Atomic Absorption Spectrometer. It has been observed that in root, stem and leaf, Pb ions get absorbed, while the extent of absorption for each element found different in the parts analyzed. In root, the order for metal ion absorption found to be Fe>Mn>Cu>Zn>Cr>Pb>Ni>Co>Cd ions. Thus, it is clear that Eichhornia crassipes absorbs heavy metal ions and can be used for minimizing the pollution taking place due to toxic metal ions in the effluents from various industries.