Search

A cross sectional study to determine the antibiotic usage trend in children with URTI and Diarrhea in 140 children under 15 years of age visiting the Pediatric OPD. Forty four (31%) patients received antibiotics of which 5 (11.3%) patients received combination antibiotics. Eighteen (24%) patients with nasopharyngitis, 2(16%) patients with pharyngitis, 7(100%) patients with tonsillitis, 7(22.5%) patients with acute diarrhea, 5(62.5%) patients with dysentery and 5(83%) patients with chronic diarrhea received antibiotics. (p=0.014). Amoxicillin (33%) and macrolides (44%) are preferred for nasopharyngitis and only macrolides are used for pharyngitis (100%), while cefixime is used predominantly for acute diarrhea (29%) and dysentery (40%). Metronidazole (60%) is the preferred antibiotic for chronic diarrhea. All five (11%) combination antibiotics prescriptions were for diarrhea and no combinations were given for URTI [p value = 0.003]. From 110 children having symptoms < 1week, only 30 (27%) were given antibiotics while out of 29 children having symptoms for > 1week, 14 (48%) were given antibiotics (p value=0.031). Antibiotic prescriptions were judicious and seen in 31% of children with URTI and diarrhea. However use of antibiotics in nasopharyngitis should be minimized. Also use of combination antibiotics especially in children with diarrhea should be discouraged [ABSTRACT FROM AUTHOR]

Introduction: Breast carcinoma is the most common cancer among women in the urban Indian population. Conventionally, immunohistochemistry (IHC) is done to determine the hormone receptor status of the tumor. Immunocytochemistry (ICC) on fine‑needle aspiration cytology (FNAC) was carried out to determine the same hormone receptor status of the tumor. Objective: The study was undertaken to evaluate the diagnostic reliability of performing estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2/neu) receptor status on FNAC by ICC and to compare the results with IHC. Materials and Methods: A 2 years 6 months prospective study conducted in the Department of Pathology, ESIC Medical College and PGIMSR and ESIC Model Hospital, Rajajinagar, Bengaluru, wherein 100 breast carcinoma patients’ samples both cytology and histology were collected. IHC and ICC were done by peroxidase antiperoxidase technique. Validations of the receptor status were analyzed using sensitivity, specificity, positive and negative predictive values (PPV and NPV), and kappa statistics for agreements between ICC and IHC. Results: ICC was positive for ER, PR, and Her2/neu in 53, 50, and 22 cases, respectively. For ER, a cytohistologic correlation of 98%, with a sensitivity of 96.3%, specificity of 100%, and PPV and NPV being 100% and 95.7%. For PR, concordance of 97%, with a sensitivity of 94.3%, specificity of 100%, and PPV and NPV being 100% and 94%. Her2/neu had an agreement of 89%, with a sensitivity of 72%, specificity of 95.5%, and PPV and NPV being 85.7% and 90.1%. Conclusion: ICC has been a boon and can be a paramount diagnostic adjunct to the routine investigations.

Paget′s disease is a rare form of breast cancer often associated with an underlying ductal carcinoma in situ or invasive cancer. A 47-year-old female patient presented with bleeding from the left nipple since 4 months. Imprint smears from the lesion showed pleomorphic malignant epithelial cells in singles and in small clusters, many of them containing dark brown cytoplasmic pigment granules. There was no palpable breast lump or axillary lymph node enlargement. Based on the physical examination and cytological features, a diagnosis of malignant melanoma with a differential of Paget′s disease of the nipple was made. Biopsy showed features of Paget′s disease and immunohistochemistry was positive for HER-2/neu, negative for HMB-45 and S-100, thus confirming the diagnosis. This case has been reported to emphasize the fact that Paget′s cells can contain imbibed brown cytoplasmic pigment and should not be mistaken for melanoma cells on cytology smears.

A 30-year-old woman presented with a huge exophytic lobulated mass in the right breast, clinically and radiologically resembling phylloides tumor. Fine needle aspiration cytology smears showed clusters and singly scattered spindle cells along with structures reminiscent of verocay bodies. However, the epithelial elements were absent. A cytological diagnosis of benign mesenchymal spindle cell lesion, suggestive of schwannoma was rendered. Subsequent histopathological examination and strong S-100 positivity of tumor cells on immunohistochemistry confirmed the diagnosis.Breast is an uncommon location for benign schwannoma. The present case describes the unusual clinical picture, highlights cytological features and discusses the differential diagnoses of schwannoma from other benign spindle cells lesions of the breast on cytology smears.

In some mammalian systems small interfering RNAs (siRNA) targeting homologous sequences in promoter regions of genes induce transcriptional gene silencing (TGS). We have previously reported the induction of TGS by an siRNA (prom-A siRNA) targeting the tandem NF-κB-binding motifs within the human immunodeficiency virus, type 1 (HIV-1), promoter region. Here we report that induction of TGS by prom-A siRNA is accompanied by immediate and sustained local recruitment of Argonaute-1 (Agol), histone deacetylase-1 (HDAC1), and induction of dimethylation of histone 3 at lysine 9 (H3K9me2), processes known to be associated with transcriptional silencing. Elevated levels of H3K9me2 and HDAC1 spread upstream of the target sequence, and elevated H3K9me2 levels also spread downstream into the coding region. Moreover, this siRNA induces an immediate change in DNA accessibility to restriction enzyme digestion in the region of the transcription initiation site of the HIV-1. This change in accessibility is because of the relocation of a nucleosome known to be associated with this region of the integrated pro-virus. Although there is a theoretical possibility that the observed viral suppression could be mediated by the PTGS mechanism with this siRNA acting at the 3′-long term repeat of the virus, we demonstrate that this siRNA, and three other U3 targeted siRNAs, are inefficient inducers of PTGS. These data strongly suggest that siRNA targeting the promoter region acts predominantly at a site within the 5′-long term repeat of HIV to induce transcriptional silencing and alterations to chromatin structure of the HIV promoter region that extend well beyond the immediate siRNA target site. These induced changes are consistent with those described in latent HIV-1 infection. [ABSTRACT FROM AUTHOR]

Objective: To study clinical characteristics and outcome of children with admitted to a paediatric hospital in Mumbai, India., Methods: Review of medical records of 969 children admitted between 19 March and 7 August, 2020, to assess the clinico-demographic characteristics, disease severity and factors predicting outcome in COVID-19 children. Variables were compared between children who were previously healthy (Group I) and those with co-morbidity (Group II)., Results: 123 (71 boys) children with median (IQR) age of 3 (0.7- 6) years were admitted, of which 47 (38%) had co-morbidities. 39 (32 %) children required intensive care and 14 (11.4%) died. Male sex, respiratory manifestation, oxygen saturation <94%; at admission, mechanical ventilation, inotrope, hospital stay of <10 days were independent predictors of mortality. Oxygen saturation <94% at admission (OR 35.9, 95% CI 1.5-856) and hospital stay <10 days (OR 9.1, 95% CI 1.04-99.1) were significant., Conclusion: COVID-19 in children with co-morbidities causes severe disease. Association of mortality with oxygen saturation by pulse oximeter <94% on admission, and hospital stay <10 days, needs further evaluation.

Background: Fanconi Bickel Syndrome is a rare, autosomal recessive, disorder of carbohydrate metabolism. Presence of hypercalciuria is rare., Case Characteristics: 4.5-years-old boy presented with growth failure, hepatomegaly, rickets, fasting hypoglycemia with postprandial hyperglycemia, fanconi syndrome and hypercalciuria., Outcome: A rare mutation in GLUT-2 gene suggestive of Fanconi Bickel Syndrome., Message: Fanconi Bickel Syndrome may present with hypercalciuria with proximal renal tubulopathy along with fasting hypoglycemia and postprandial hyperglycemia.

The current study was planned to assess the immunogenicity and reactogenicity of a fully liquid pentavalent combination vaccine containing diphtheria, tetanus, pertussis, Haemophilus influenzae type B and hepatitis B vaccines. Infants six to eight weeks of age were enrolled and administered the study vaccine at 0, 4 and 8 weeks of enrollment. The children were kept under observation for 30 minutes after each vaccination for local and systemic reactions. A record was maintained of suspected adverse drug reactions (ADRs) for the subsequent three days. Blood was collected for antibody titer estimations prior to the first dose and four to six weeks after the third dose. 100% of children developed protective antibody titres to D, T and HepB. 97% and 81% of vaccinees responded (2-4 fold rise in antibody titres) to the anti-fimbrial and anti-pertactin components of the pertussis antigen respectively. 100% infants developed short-term protective antibody titres to Hib (> 0.15 microg/ml) and 90% developed titres indicative of long-term protection (> 1.00 mg/ml). Fever was most commonly reported adverse event but none of the children had fever more than 102 degrees F. A few infants had mild, expected local and systemic side effects such as tenderness, erythema, induration, excessive fussiness and a change in feeding pattern. Except for one child who was withdrawn from the study for persistent crying, there were no other severe or unexpected adverse reactions reported.

Objectives: Nodal osteoarthritis of the hand (hand OA) is a subset of OA with a strong heritable component. Multiple genetic analyses of this condition have been performed and are underway. Highest yield from any genetic study depends upon a clear clinical phenotype for case definition. Radiographs may provide the most detail about the nature of the lesion. Physical examination is an imperfect means of evaluating each patient, particularly when hundreds or thousands of patients are required for study. Our study evaluated the accuracy, relative to a radiograph, of a digital photograph of the hands for the presence of OA in a particular joint, as well as for the diagnosis of nodal hand OA., Methods: Consecutive patients were evaluated as part of the I-NODAL study (Investigation of Nodal Osteoarthritis to Detect an Association with Loci encoding Interleukin-1 [IL-1]). Evaluation included a physical examination by a trained rheumatologist, a postero-anterior radiograph of the hands, and a digital photograph of each hand. Radiographs were read by one trained observer using the Kellgren-Lawrence scale. Photographs were taken by one individual and were analyzed by an experienced rheumatologist. Kappa statistics were determined for each modality and accuracy was assessed using radiographic readings as a gold standard., Results: Intra-reader reliability for radiograph interpretation was good for the overall diagnosis of hand OA (kappa0.76 [0.45,1.07]), but varied widely for the presence or absence of K-L grades 2-4 in individual joints (median kappa0.70, range 0.49-0.87 for ACR index joints). Distal interphalangeal joint (DIP) nodes on physical examination were sensitive (median 96.27, 93.94-100), but not specific for radiographic hand OA in the corresponding joint (median 33.0, 17.24-42.86). Physical examination evidence of OA in the 1st carpo-metacarpal (CMC) and proximal interphalangeal (PIP) joints provided only moderate sensitivity and specificity. However, the negative predictive value of the examination of individual joints was good (median negative predictive value was 82.58 for IP joints with a range 68.29-100.00), particularly in the DIP joints. Specificity of a node visualized on hand photograph was variable (median for all IP joints and 1st CMC 83.77, range 53.37-96.97), with greatest specificity for radiographic OA in the corresponding joint found in the 1st CMC and the PIP joints. Clinical hand OA was sensitive, but not specific for the radiographic diagnosis of hand OA; while, photographic OA was moderately specific, but insensitive., Conclusion: The visualization of a node on a digital photograph of the hand provides fair to moderate specificity for radiographic hand OA in the corresponding joint, with generally poor sensitivity. A photograph has limited value as a screening tool for the diagnosis of radiographic hand OA.