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Acromioclavicular joint tuberculosis is an extremely rare presentation with only 16 cases reported so far and has a relatively high propensity to be misdiagnosed. India being a tuberculosis endemic region accounts for almost 27% of cases worldwide (global index of 2018 was 10 million). With a higher index of suspicion an earlier diagnosis can be made. We report two patients of AC joint tuberculosis, treated with multidrug chemotherapy resulting in a good functional outcome.

Introduction: Crescents in glomeruli mean proliferation of parietal epithelium of Bowman's capsule with the presence of macrophages, lymphocytes, neutrophils, fibrin, and collagen. When crescents are present in >50% of nonfibrosed glomeruli, it is called crescentic glomerulonephritis (CGN). The presence of crescents is indicative of poorer prognosis. CGN can be pauci immune (PI), immune complex mediated (ICM), and anti-glomerular basement membrane (anti-GBM) disease. Aim: The aim was to study the clinicopathological spectrum of CGN over a period of 10 years in our center. Materials and Methods: Forty kidney biopsies with the presence of crescents over a period of 5 years were retrieved retrospectively from the histopathology records of the department of pathology. The clinical history, laboratory parameters, histopathology report, and the direct immunofluorescence (DIF) findings were analyzed. Results: Totally 40 cases had crescents on light microscopy. Out of these, 17 cases qualified for CGN. The mean age of the patients was 20 years. Nephritic syndrome was the most common presentation in these 17 cases. The mean creatinine level was 3.55 mg/dL. PI (7/17, 41.1%) was the most common category, followed by ICM (6/17, 35.2%) and anti-GBM (4/17, 23.5%). Out of the ICM, two cases were of IgA nephropathy with crescents and one of lupus with crescents. Conclusion: PI is the most common type of CGN. DIF examination is essential for exact categorization of CGN. Kidney biopsy in these cases can guide management and benefit patients with timely initiation of aggressive therapy.

The recent outbreak of COVID-19 pandemic has caused a havoc worldwide leading to high morbidity and mortality. A very high transmission rates and limited data available on the pathophysiology of the virus, poses a big challenge in the development of effective treatment options for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of this article is to provide a short and crisp review of the rationalia and recommendations on the use of multiple therapeutic options available at different scenarios of the disease development and progression. The treatment options approved by the USFDA and CDSCO are being discussed to be used in specific population set and disease severity. Furthermore, drugs authorized as EUA but not as standard treatment of care such as monoclonal antibodies are also discussed in the article. The future of the global pandemic depends on adequacy of the treatments options for all population groups in a cost-effective manner to minimize the mortality associated with the disease. Keywords: COVID- 19, SARS- CoV- 2, Antiviral protease, Immunomodulators, Monoclonal antibodies.

Background: Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately. Aim: The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population. Materials and Methods: This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded. Results: A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form “No-Scar” preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone. Conclusion: Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse.

Background There is concern about the effect of the COVID-19 pandemic on psychosocial functioning among school-age children, who have faced unusual stressors during this time. Our goal was to assess mental health symptoms and social risks during COVID-19, compared to before the pandemic, for urban, racial and ethnic minority school-age children, and investigate the relationship between mental health and social risks. Methods We conducted a cohort study from September 2019 until January 2021 of children age 5–11 years old recruited from an urban safety net hospital-based pediatric primary care practice. We measured emotional and behavioral symptoms (including attention, internalizing, and externalizing symptoms) before and during the pandemic with the Pediatric Symptom Checklist (PSC-17). We measured social risks (including food and housing insecurity) before and during the pandemic with the THRIVE screener. We measured additional mid-pandemic COVID-related stressors with items on school participation, screens/media use, illness exposure, and caregiver mental health. We compared pre- and mid-pandemic PSC-17 symptom scores across 4 domains (total, attention, internalizing, and externalizing) and used path analysis to examine the relationship between mental health and social risks pre- and mid-pandemic. Results Caregivers of 168 children (54% non-Hispanic Black, 29% Hispanic, and 22% non-English speaking) completed the study. Children had significantly higher levels of emotional and behavioral symptoms midpandemic- vs. pre-pandemic in all domains. Significantly more children had a positive PSC-17 total score (18% vs. 8%, p Conclusion The COVID-19 pandemic has led to a dramatic increase in depression/anxiety problems and social risks among urban, racial and ethnic minority school-age children compared to before the pandemic. More research is needed to understand if these changes will persist.

Congenital syphilis is a severe, disabling infection that occurs due to transmission of Treponema pallidum across the placenta. An increase in the incidence of congenital syphilis has been observed in developing countries. Here, we are reporting a case of early congenital syphilis who presented with desquamating papulosquamous lesions over multiple body parts along with moist erythematous and erosive lesions in the perianal and perioral regions. Reactive venereal disease research laboratory and T. pallidum hemagglutination assay test in child and parents confirmed the diagnosis of congenital syphilis.

Introduction: Immunofluorescence (IF) microscopy is an essential tool for the analysis of glomerular diseases. In this study, we studied the significance of the IF technique together with light microscopy (LM) and clinical details in the diagnosis of different types of diffuse proliferative glomerulonephritis (GN). We intended to evaluate the spectrum of Diffuse Proliferative Glomerulonephritis (DPGN) in our institute. Materials and Methods: We evaluated a total of 95 kidney biopsies received in the past 10 years. All biopsies were scrutinized by LM and IF techniques. Clinical details were documented in a predesigned form. Results: The predominant clinical presentation in this study was nephrotic syndrome (49.4%) followed by systemic lupus erythromatosus with suspected renal involvement (24.2%). On microscopy, lupus nephritis (LN) was the most common DPGN in the study (35.7%), followed by immunoglobulin (Ig) A nephropathy (25.2%) and postinfectious GN (PIGN) (16.8%). The majority of patients were in the

Dowling-Degos Disease is a rare, pigmentary disorder with variable presentations. The most common among them are hyperpigmented macules and reticulate pigmentary anomaly of flexures. Many other phenotypic variations of Dowling-Degos disease have been reported in literature. We present here a case of Dowling-Degos disease with comedo-like lesions and pits without typical flexural hyperpigmented macules.

Objective The authors report their successful experience of treating 14 cases of pial arteriovenous fistula (PAVF) by direct surgery. Methods During the period January 2010 to April 2017, 14 patients with PAVF were treated by surgery. Only those patients were selected who had a single arterial feeding channel. There were 9 male patients and 5 female patients, and their ages ranged from 5 to 53 years (average, 19 years). Ten patients were younger than 20 years of age. Five patients presented clinical and radiologic features that suggested hemorrhage from the PAVF. Ten patients had seizures. Two patients had hemispheric symptoms or neurologic deficits at the time of presentation. In 12 patients, there were no gross neurologic deficits. The diagnosis was made on the basis of digital subtraction angiography in all patients and computed tomographic angiography in 8 patients. Angiography revealed that the PAVFs in 8 patients were supplied by the middle cerebral artery, in 5 patients by the anterior cerebral artery, and in 1 patient by branches of the basilar artery. Surgical procedures involved identification of the site of fistula, obliteration of the feeding artery, and resection of the entire venous varix. Results The PAVF was successfully excluded from circulation in all patients. There were no neurologic deficits related to the surgical procedure. Conclusions Direct surgical resection of the entire PAVF is a safe, effective, and probably curative method of treatment.

Objective The authors analyze 124 cases with fracture of odontoid process. All patients were surgically treated by posterior atlantoaxial fixation. Methods There were 96 male and 28 female patients. The ages of the patients ranged from 12 to 80 years. Apart from Anderson and D'Alonzo type I (6 cases), type II (93 cases) and type III (25 cases), three sub-types of odontoid fractures were included in the classification. In type A (118 cases), there was vertical compression fracture that resulted in malalignment of the fractured odontoid process segments. Type B (49 cases) resulted when the fracture resulted in malalignment of the facets of atlas and axis. Type C (25 cases) included cases in which the fracture line involved the facet of axis. Fractures were divided into acute type when the injury was less than 3 months old (50 cases), delayed type when the injury was between 3 months to one year (34 cases) and chronic type when the injury was more than 1 year in duration (40 cases). All patients were treated with posterior atlantoaxial fixation with the techniques described in 1994 and 2004. Follow-up period ranged from 6 to 156 months (average 72 months). Results All patients improved in symptoms after surgery. There were no significant postoperative complications. Conclusions Posterior atlantoaxial stabilization forms a safe surgical strategy for all kinds of odontoid fractures. Additional characteristics of odontoid fractures further subclassified them and assisted in surgical decision-making and in formulating the surgical strategy.

Background: FLT3-ITD and NPM1 mutations are considered to be the major determinants of the patient response to therapy and outcome. The primary aim of this study was to establish the correlation between these molecular mutations and the clinico-hematologic parameters as well as the prognostic outcome of the Indian acute myeloid leukemia (AML) patients. Materials and Methods: This prospective study involved newly diagnosed nonpromyelocytic AML patients who had undergone complete diagnostic workup, including immunophenotyping, conventional cytogenetics and molecular analysis for NPM1 and FLT3-ITD mutation by reverse transcriptase polymerase chain reaction at presentation. Results: Overall, the prevalence of NPM1 and FLT3-ITD mutations was found to be 14.4% and 10.8%, respectively. Among patients with normal karyotype, leukocytosis was significantly associated with NPM1+ group than the NPM1− group (P = 0.0019) and more severe degree of anemia was observed in the FLT3-ITD+ patients than the other groups (P = 0.025). No significant correlation was found in terms of age at presentation (P = 0.56), sex ratio (P = 0.467), median platelet count (P = 0.27), and blast percentage between NPM1+ and FLT3-ITD+ groups. Complete remission (CR) rates were better in the NPM1+/FLT3-ITD− group than the other three groups. Unlike most other studies, improved CR rates as well as disease-free survival were observed in the NPM−/FLT3-ITD− group than the FLT3-ITD+ groups although not reaching statistically significant levels. Conclusion: Some differences in the clinical behavior of the Indian AML patients in comparison to that of the West in the presence of NPM1 and FLT3-ITD suggests that comprehensive studies are required to confirm the definitive role of these mutations among AML patients, especially with normal karyotype.

Aim The present state-of-art study is an attempt to decipher how adversely the air pollution and its constituents affect the fate of a developing fetus. This involves a detailed study on criteria pollutant and its impact on various pregnancy outcomes, i.e., low birth weight, premature birth, intrauterine growth retardation, and reduction in fetus size. Materials and methods All the concerned research and review papers from the virtual dataset were segregated and have been studied specifically. Results In relevance to the specific pollutants, the particulate matter (PM) seems to be greatly responsible for causing neonatal deaths and high infant mortality rates, whereas the exposure to nitrogen dioxide (NO2) reveals low-birth-weight fetus. Proceeding further, sulfur dioxide (SO2) greatly targets expectant mothers in the second and last trimesters of pregnancy, resulting in low-birth-weight fetuses. The impact of carbon monoxide (CO) during pregnancy was also studied and found to be responsible for structural malformations. Active and passive smoking both boost pregnancy complications in terms of ectopic pregnancy, low birth weight, and infant mortality. Discussion Very few studies have been reported that reveal the dependency of pollutant exposure and reproductive outcomes. One strong interpretation is not sufficient enough to meet the complexity related to plethora of information. Due to variation in the number of factors like spatial and temporal variation, maternal thresholds, period of pregnancy, period of exposure, etc., the extrapolation of result is multifaceted. Different epidemiological studies with different adaptation in methodology report diverse consequences. Conclusion The evidence is satisfactory enough to reveal that the most potent pollutant seems to be PM. The detailed biologic mechanism regarding how these pollutants find their way to placental membrane and disturb the fetal destiny is still vague. The review suggests that reproductive awareness programs should be initiated by the government and policy analysts should be done to lessen the increasing economic burden on human health. How to cite this article Saxena R, Jain S. Adverse Effects of Pollutants on Expectant Mothers—From Womb to Grave: A Retrospective Review. J South Asian Feder Obst Gynae 2016;8(2):157-162.

Background Nutritional modulation remains central to the management of metabolic syndrome. Intervention with cinnamon in individuals with metabolic syndrome remains sparsely researched. Methods We investigated the effect of oral cinnamon consumption on body composition and metabolic parameters of Asian Indians with metabolic syndrome. In this 16-week double blind randomized control trial, 116 individuals with metabolic syndrome were randomized to two dietary intervention groups, cinnamon [6 capsules (3 g) daily] or wheat flour [6 capsules (2.5 g) daily]. Body composition, blood pressure and metabolic parameters were assessed. Results Significantly greater decrease [difference between means, (95% CI)] in fasting blood glucose (mmol/L) [0.3 (0.2, 0.5) p = 0.001], glycosylated haemoglobin (mmol/mol) [2.6 (0.4, 4.9) p = 0.023], waist circumference (cm) [4.8 (1.9, 7.7) p = 0.002] and body mass index (kg/m2 ) [1.3 (0.9, 1.5) p = 0.001] was observed in the cinnamon group compared to placebo group. Other parameters which showed significantly greater improvement were: waist-hip ratio, blood pressure, serum total cholesterol, low-density lipoprotein cholesterol, serum triglycerides, and high-density lipoprotein cholesterol. Prevalence of defined metabolic syndrome was significantly reduced in the intervention group (34.5%) vs. the placebo group (5.2%). Conclusion A single supplement intervention with 3 g cinnamon for 16 weeks resulted in significant improvements in all components of metabolic syndrome in a sample of Asian Indians in north India. Trial registration The clinical trial was retrospectively registered (after the recruitment of the participants) in ClinicalTrial.gov under the identification number: NCT02455778 on 25th May 2015.

Background: Pediatric meningiomas are infrequently encountered in clinical practice. In comparison to adults, they have a distinct pathophysiology and clinical presentation. They are benign but locally aggressive tumors. Radical excision often culminates in good outcome. Aim: The aim of this study was to study the demographic profile, clinico-radiological features, pathophysiology, and surgical outcome of childhood meningiomas. Materials and Methods: The case records of patients

Amyloidosis is a complex multi-system disorder characterized by deposition of an aberrant protein in tissues with kidney being the main target organ. The age of presentation of amyloid A (AA) amyloidosis is highest among adults aged 60–80 years followed by 45–55 years. However, presentation in younger age group is rare. We aimed to study the clinicopathological spectrum of patients with biopsy-proven renal AA amyloidosis aged

To study the diagnostic potential of optical imaging and its comparison with colposcopy, in detecting early cervical dysplasia.The study was conducted on 200 patients attending the outdoor of UISE maternity hospital with symptoms suspicious of cervical lesions. All patients were subjected to colposcopy, followed by histo-pathological examination. Out of all HPE, 18 samples each from normal and dysplastic histology were sent to IIT Physics lab, Kanpur for optical imaging. Statistical analysis was done using sensitivity, specificity, PPV, and NPV. Chi square test was applied to calculate p value.In optical imaging, depolarization images had shown significant changes in the epithelium region of the dysplastic tissue as compared to normal one. It is found that the mean value of depolarization power for normal cervix tissues is less than 0.32, while for dysplastic tissues it is greater than 0.32.Optical imaging is fast, non-invasive tool with high sensitivity and specificity, comparable to colposcopy (sensitivity 88.9 vs 100 %, specificity 83.3 vs 86.6 %) and thus is useful in both for screening and diagnosis of cervical dysplasia.

Flow cytometry with its rapidly increasing applications is being used essentially in all fields of diagnostic medicine. In hematological disorders it is most commonly used in diagnosis, characterization, prognostication and even selecting target therapy of acute leukemia and to some extent lymphomas. It is increasingly finding place in other fields of hematology i.e., non-malignant disorders of all blood cell types including RBCs and platelets along with leukocytes. In this review the authors have discussed some of these applications with an emphasis on disorders specific to pediatric patients.

Minimal residual disease is currently the most powerful prognostic indicator in Precursor B lymphoblastic leukemia. Multiparameter flow cytometry is the most commonly used modality. Seventy three B ALL cases and 15 normal marrows were evaluated for expression patterns of leukemia markers (CD38, CD58, CD73) in all 73 cases and CD66c, CD86 and CD123 in 23 cases. CD73 was aberrantly expressed in 90.41% cases and CD86 in 60.87% B ALL cases. Thus addition of these markers in MRD panels can increase the sensitivity of the assay.

Myoelectric artificial limbs can significantly advance the state of the art in prosthetics, since they can be used to control mechatronic devices through muscular activity in a way that mimics how the subjects used to activate their muscles before limb loss. However, surveys indicate that dissatisfaction with the functionality of terminal devices underlies the widespread abandonment of prostheses. We believe that one key factor to improve acceptability of prosthetic devices is to attain human likeness of prosthesis movements, a goal which is being pursued by research on social and human–robot interactions. Therefore, to reduce early abandonment of terminal devices, we propose that controllers should be designed so as to ensure effective task accomplishment in a natural fashion. In this work, we have analyzed and compared the performance of three types of myoelectric controller algorithms based on surface electromyography to control an underactuated and multi-degrees of freedom prosthetic hand, the SoftHand Pro. The goal of the present study was to identify the myoelectric algorithm that best mimics the native hand movements. As a preliminary step, we first quantified the repeatability of the SoftHand Pro finger movements and identified the electromyographic recording sites for able-bodied individuals with the highest signal-to-noise ratio from two pairs of muscles, i.e., flexor digitorum superficialis/extensor digitorum communis, and flexor carpi radialis/extensor carpi ulnaris. Able-bodied volunteers were then asked to execute reach-to-grasp movements, while electromyography signals were recorded from flexor digitorum superficialis/extensor digitorum communis as this was identified as the muscle pair characterized by high signal-to-noise ratio and intuitive control. Subsequently, we tested three myoelectric controllers that mapped electromyography signals to position of the SoftHand Pro. We found that a differential electromyography-to-position mapping ensured the highest coherence with hand movements. Our results represent a first step toward a more effective and intuitive control of myoelectric hand prostheses.

Objective: Many controversies exist regarding the extent of resection for insular gliomas and the timing of resection. Several techniques and adjuncts are used to maximize safety during resection of these tumors. We describe the use of indocyanine green (ICG) to identify the branches of the middle cerebral artery and discuss its utility to increase safety for resection for insular gliomas. Materials and Methods: Five patients with insular gliomas were surgically treated by the authors from June 2013 to June 2014. The patients presented with complaints of either a headache or recurring episodes of convulsions. All the patients were operated with the aid of neuronavigation and tractography. The long perforating branches of the middle cerebral artery course through the insula and pass onward to supply the corona radiata. It is essential to preserve these vessels to prevent postoperative neurological deficits. ICG (Aurogreen) was used to identify and preserve the long perforating arteries of the middle cerebral artery. Results: ICG dye correctly identified the long perforating branches of the middle cerebral artery and easily distinguished these vessels from the short perforating branches. All the branches of the middle cerebral artery that coursed through the tumor and had an onward course were preserved in all the patients. Only one patient developed a transient right sided hemiparesis that had improved at follow-up. Conclusions: Surgery for insular gliomas is challenging due to its location adjacent to eloquent areas, important white fiber tracts and the course of the middle cerebral artery within it. ICG is useful to identify and preserve the long perforating branches of the middle cerebral artery that course through the tumor and traverse onward to supply the corona radiata.

Objective The authors present reports of 2 cases in which there was manifest atlantoaxial instability and presence of retro-odontoid pseudotumor. The retro-odontoid tumor disappeared in the immediate postoperative phase after surgery, which involved facetal distraction and atlantoaxial fixation. The cases are discussed. Although regression of the retro-odontoid pseudotumor has been reported after atlantoaxial fixation, its disappearance in the immediate postoperative phase has not been recorded. Methods Two patients (42 years and 16 years old) presented with progressive quadriparesis. Investigations revealed presence of retro-odontoid “pseudotumor” and evidence of cord compression. There was radiologic evidence of atlantoaxial instability in both cases. Both patients were treated by atlantoaxial lateral facet distraction and fixation. No attempt was made to directly manipulate or handle the retro-odontoid tissue. Results The patients had remarkable clinical improvement after surgery. Immediate postoperative imaging showed disappearance of pseudotumor. Conclusions The retro-odontoid pseudotumor appears to be related to buckling of the posterior longitudinal ligament. Distraction of the facets probably assists in stretching of the posterior longitudinal ligament. Our experience reconfirms that retro-odontoid pseudotumor could be a manifestation of atlantoaxial instability and need not be directly handled by surgery.

Acute megakaryoblastic leukemia (AMKL) is a rare subtype of acute myeloid leukemia. Although known as a distinct entity for a very long time, because of lack of distinct clinical features and morphological criteria, it is difficult to diagnose this variant correctly. We herein present the clinical, morphological, cytochemical, and immunocytochemical features of five cases of AMKL. Certain morphological features such as presence of abnormal platelet count, giant platelets, and cytoplasmic blebbing in blasts were found to be important pointers towards the diagnosis. However, none of the features were found to be consistent and thus morphological diagnosis has to be confirmed by cytochemistry and immunocytochemistry.

Background: This study is done to study the clinical profile of community acquired pneumonia in patients admitted in medical wards at MNR Hospital, Sangareddy and to find out the associated risk factors of community acquired pneumonia.Methods: 75 Patients admitted in the department of medicine of MNR Medical college and Hospital, Sangareddy with clinical manifestations of Community acquired pneumonia from august 2012 to January 2015 (Two years and 6 months) were taken into the study. All adult patients of both genders aged above 14 yrs, who presented with acute onset of fever associated with chills and rigors, having cough with expectoration and/ or chest pain and breathlessness were included in the study. All the patients were subjected for detailed clinical examination to make a provisional diagnosis of community acquired pneumonia (CAP). Patients with hospital acquired pneumonia, aspiration pneumonia and PCP pneumonia in patients with HIV were excluded.Results: Among 75 cases studied, the mean patient age was 52.1 years with Male: Female patient ratio 3.17:1. The associated diseases in this study are COPD (30.67%) and DM (12.0%).The most common presenting symptoms were fever (100%), cough (100%), and expectoration (100%); other symptoms included chest pain (60%), dyspnoea (61.33%). The respiratory signs included bronchial breath sounds, increased VF and VR, and presence of whispering pectorolique in all subjects. Conclusions: Identification and determining the clinical patterns of community acquired pneumonia helps in adoption of regionally optimized diagnostic approach.

We report a series of four patients aged 4, 5, 14, and 27 years (1 male and 3 female patients) with severe shortening of the neck and torticollis since early childhood who presented with complaint of pain in the nape of neck as the primary symptom. All four patients had relatively well preserved neurological functions. One patient had vertical mobile and reducible atlantoaxial dislocation, and 3 patients had anteroposterior mobile and reducible dislocation. There was assimilation of atlas in 1 patient. The arch of atlas was bifid in 3 patients. Two patients underwent atlantoaxial fixation. Both the patients were relieved of neck pain after their surgery. The potential surgical difficulties due to the presence of severe shortening of neck height and marginal presenting symptoms favored conservative observation in the other 2 patients. Follow-up ranged from 6 to 84 months. All patients are functionally and socially active.

The breast cancer is one of the most critical cancer types that are found in women. Significant number of researches has been going on this disease. Post diagnosis treatments results into side effect on the patient’s health. The only way to survive from this disease is its early detection. This paper is aimed to survey the frameworks proposed by researchers to detect the breast cancer at initial stage leading to its treatment with minimum side effects. The paper also suggests improvements in the direction of development of such frameworks.

SummaryIntroduction Acute myeloid leukemia is a heterogenous disease with respect to prognosis. Early response assessment has an established role as predictor of remission rate, and overall and disease-free survival. Assessment of blast percentage on bone marrow aspirate smears at this stage has its own limitations. Materials and method In this study, a total of 100 AML cases that were positive for CD34 at the time of diagnosis were included in the study. Blast percentage obtained in bone marrow aspirate smears by morphology was compared with that obtained in bone marrow biopsy using CD34 immunohistochemistry. Results Bone marrow aspirate and biopsy were discordant in 19% of the cases. In 15% of the cases, bone marrow aspirate blast count was ≤5% and bone marrow biopsy blast percentage was >5%. Conclusion Early response assessment plays an important role in management of acute myeloid leukemia. In patients with CD34-positive blasts, the CD34 IHC can improve the detection of residual blasts on Day 14 bone marrow biopsy in comparison with morphological assessment of blast percentage in bone marrow aspirate.

Precursor Natural Killer (NK) cell lymphoblastic leukemia/lymphoma is a rare entity defined clearly by WHO (2008 WHO classification). However, the pathobiology of this subset of neoplasms is not clearly defined. There is wide disparity in the literature regarding the nomenclature and diagnostic criteria used to diagnose and characterize acute leukemias of presumed NK cell origin. In the present article we report a case of Precursor NK cell lymphoblastic leukemia/lymphoma and review the cases reported after 2008 WHO classification came into vogue, as acute leukemias of NK cell origin.

Hemoglobin estimation is an integral part of donor screening in blood banks. Various methods are available for hemoglobin estimation and each one of them has its advantages and limitations. Hemocue as a hemoglobinometer is gaining widespread popularity not only for donor screening but also as a bedside hemoglobinometer. We conducted a study involving 535 donors with an aim to assess the accuracy of hemocue readings and compared it with cell counter values. We also compared the hemocue readings using capillary blood with the venous blood.

Sir,Intestinal obstruction is a common cause for emergency surgical intervention in the newborn infant. Intestinal atresia accounts for about one-third of all cases of neonatal intestinal obstructi...

Angiomyxoma is a rare, slow-growing myxoid neoplasm that occurs almost exclusively in the genital, perineal, and pelvic regions of adult women. It mostly occurs during the reproductive years. It has propensity for local recurrence [1–4]. Macroscopically, they are soft, partly circumscribed, polypoids; across cross section, they have a glistening, homogeneous, gelatinous appearance; and sizes range from a few cm to 20 cm. The typical characteristics are slow growth, gelatinous appearance and locally infiltrative without evidence of nuclear atypia or mitosis [4, 5]. Treatment consists of local excision with tumour-free margins; however, local recurrence is high inspite of apparently complete surgical resection [5, 6].

Abdominoscrotal hydrocele is an uncommon clinical entity and so is intestinal malrotation. We report a case of 15 year old boy who presented with lump in abdomen previously diagnosed as mesenteric cyst on ultrasound. A multislice CT scan and repeat ultrasound not only diagnosed the case as abdominoscrotal hydrocele but also detected intestinal malrotation with positive whirl sign. This is the first reported case of abdominoscrotal hydrocele with intestinal malrotation.

Tubercular dactylitis, a term used for tuberculosis of short and tubular bones of hands and feet, rarely shows involvement of the foot. It is more commonly found in children as compared with adults. A 27-year-old male, came with history of discharging sinus over dorsum of great toe of right foot. Clinical assessment led to the suspicion of tuberculosis which was later confirmed by biopsy. This case highlights the importance relying on clinical impression and considering tuberculosis as an aetiology even at unusual sites of involvement.

Tuberculosis has always been a menace for both clinicians and radiologists due to its often non-specific and protean manifestations. Isolated tubercular involvement of sacrum is very rare. The authors present the case of a 38-year-old man with history of low-grade fever, pain and swelling in the sacral region. Skiagram revealed an osteolytic lesion of sacrum leading to the provisional diagnosis of chordoma and osteoclastoma. However, MRI was suggestive of a chronic infective condition like tuberculosis and fine needle aspiration cytology was positive for acid-fast bacilli and revealed epitheloid granulomas with caseous necrosis. Culture was positive for Mycobacterium tuberculosis. Antitubercular therapy was commenced and surgical decompression of cold abscess was done and with good clinical response. This case highlights the importance of remaining cognisant of the manifestations and the importance of considering tuberculosis as a diagnosis at unusual sites of involvement.

Abdominal pregnancy is a rare and life-threatening ectopic pregnancy, defined as an intraperitoneal implantation exclusive of tubal or ovarian implantation. Ectopic pregnancy represents about 1–2 % of all pregnancies with 95 % occurring in the fallopian tube. Abdominal pregnancies represent just 1 % of all ectopic pregnancies. The incidence of abdominal pregnancy is 1:10,000 live births, but advanced abdominal pregnancy is seen in 1:25,000 live births [1]. Its prognosis is poor, with a maternal mortality rate of 5–18 % and perinatal mortality rate of 40–90 %. Abdominal pregnancy with a live fetus at term is a rare condition. We present one such case.

Malignant melanoma with its varied clinical presentations and histomorphological patterns is a perplexing problem both for the diagnosticians and clinicians. A small proportion of melanomas present with metastatic tumors with unknown primary sites and at these sites they mimic the more common primary neoplasms. We hereby report a case of malignant melanoma presenting as a submandibular lump in a 40 year old female. This lump was present for six months and was rapidly increasing in size. On cytology it was diagnosed as salivary gland neoplasm.

Tuberculosis is a major health issue in developing countries. The authors present a case of a 28-year-old male doctor, working as resident in the department of radiodiagnosis who attended orthopaedics outdoor with complaint of wrist pain over ulnar aspect. Radiograph of left wrist showed an oval shaped osteolytic lesion. Fine needle aspiration cytology was performed which produced only haemorrhage. Therefore, open biopsy was planned; yellowish coloured material was obtained which was sent for histopathological examination. Finally, Mycobacterium tuberculosis was isolated and thus the patient was immediately started with antitubercular therapy. This brief report emphasises upon the rare sites of skeletal tuberculosis which should always be kept in mind while diagnosing such lesions.

Pantoea agglomerans infections in humans are uncommon. Most common infections reported are septic arthritis or synovitis. We report the case of a 25-year-old, healthy male, who presented with indurated swelling over the posterolateral aspect of his right thigh, associated with pain for one month. Magnetic resonance imaging (MRI) revealed muscle edema with cystic areas in the posterior-most part of the vastus lateralis of the right thigh. The condition was clinically diagnosed as a right-sided benign tumor of the vastus lateralis muscle. However, Pantoea agglomerans was isolated on a culture of the excised muscle tissue. On the basis of the awareness of the common association of Pantoea with penetrating trauma by vegetation, the patient was asked to recollect any prior such injury. He then gave a history of a fall in the field and a plant thorn prick in the thigh four years back, when he was an agricultural worker. We emphasize the importance of Pantoea agglomerans infection of the soft tissues that can have an atypical presentation as a non-suppurative, indurated, muscle cyst in our case. Thorn injuries are usually ignored as trivial incidents, however, Pantoea infections should always be borne in mind when encountering soft tissue lesions, as antibiotic treatment is required for complete resolution of the lesion.

Neuropathic arthropathy of the shoulder is reported in only 5% of cases. Here, we report a rare case of neuropathic arthropathy of the shoulder, secondary to Chiari malformation Type I with associated syringomyelia, that remained undetected for four years. A 38-year-old female presented to our Department with a swelling over the right shoulder that had persisted for four years. X-ray of the joint showed destruction of the head of the right humerus, with typical blunt amputated appearance of the bone and increased joint space. Magnetic resonance imaging showed destruction and lateral dislocation of the head of the humerus. Large amount of fluid collection was seen in and around the right shoulder joint. Neuropathic osteoarthropathy can be defined as bone and joint changes that occurs secondary to loss of sensation. In our case, neuropathic shoulder joint was secondary to syringomyelia associated with Chiari I malformation.