Evaluation of a two step AFB cold staining method and simplified concentration technique for diagnosis of pulmonary tuberculosis

Ziehl Neelsen (Z-N) stain is the commonly used procedure for demonstration for AFB. A Simple cold stain technique and Simplified concentration technique were compared with the conventional methods on 1484 sputum samples over a period of 3 months. A positivity rate of 9.3% was observed on direct microscopy with an increase in the yield by 30% after concentration. It was observed that the simple cold staining and simplified concentration are viable alternatives for demonstration of mycobacteria in busy clinical laboratories.     

Posterior scleritis mimicking macular serpiginous choroiditis

An unusual case of posterior scleritis mimicking macular serpiginous choroiditis is reported.     

Colorectal tuberculosis

Our objective was to evaluate the incidence of colorectal tuberculosis in our series and to study its radiological spectrum. A total of 684 cases of proven gastrointestinal tuberculosis with positive barium contrast findings seen over a period of more than one decade were evaluated. The study did not include cases where colon was involved in direct contiguity with ileo-caecal tuberculosis. Seventy-four patients (10.8%) had colorectal tuberculosis. Commonest site involved was transverse colon, closely followed by rectum and ascending colon. Radiological findings observed were in the form of strictures (54%), colitis (39%) and polypoid lesions (7%). Complications noted were in the form of perforations and fistulae in 18.9% of cases. Colorectal tuberculosis is a very common site for gastrointestinal tuberculosis. Typical findings of colorectal tuberculosis are strictures, signs of colitis and polypoid lesions. Common complications are perforation and fistulae.     

Fetal gastrointestinal malformations

In an audit to evaluate fetal gastrointestinal (GIT) malformations, case sheets of all mothers who gave birth to newborns with GIT malformations were analysed regarding the maternal history, prenatal ultrasound and the postnatal structural malformations and perinatal management. In 1999, eleven babies were born with gastrointestinal malformations, one was a still birth. Nine had associated malformations of other systems, two had trisomy 21. Eight babies were operated in the immediate newborn period, 5 survived. Ultrasound was not very accurate in the diagnosis of GIT anomaly in this series. In view of associated chromosomal and structural anomaly a fetal ECHO and genetic amniocentesis is warranted. Most of these babies require immediate surgery after birth, so they need to be delivered in a centre which is equipped with good neonatal and pediatric surgery care.     

Sonographic diagnosis of diastematomyelia in utero: a case report and literature review

Fetal diastematomyelia is a rare form of spinal dysraphism that is characterized by a complete or incomplete division of the spinal cord by an osseous or fibrocartilaginous septum. A case of diastematomyelia, which was detected on the routine third trimester detailed ultrasound scan, is presented. The diagnosis was based on the detection of an echogenic focus in the posterior aspect of the spine in association with widening of the interpedicular vertebral space. The case illustrates that diastematomyelia can occur in the absence of overt spina bifida and that prenatal detection will allow timely postnatal investigation and treatment. Prenatal literature is further reviewed to assess the clinical significance of this finding.     

Bloom's syndrome--a first report from India

A 6‐year‐old boy presented with complaints of redness and scarring over the face to the outpatient clinic of the Dermatology Department of Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. The child was apparently normal until the age of 6 months when his mother noticed an erythematous eruption with small blisters and mild discomfort over the face on exposure to sunlight. Gradually, the eruption became more progressive, extending to the forehead, nose, and ears with the development of oozing, crusting, atrophy, and telangiectasias over the face, despite treatment. Over the last 3 months, he had developed ulceration of the skin over the right cheek just below the lower eyelid without any signs of healing. No history suggestive of constitutional symptoms, bowel and bladder complaints, Raynaud's phenomenon, alopecia, discoloration of urine on standing, and chronic systemic or cutaneous infections could be obtained. The patient is a product of a full‐term pregnancy with normal vaginal delivery of nonconsanguineous parents. His developmental milestones were delayed, with sitting at 2.5 years and standing and speech at 3 years. Our patient is a Hindu by religion and Rajput by caste. India is a vast land mass, bounded by the Himalayan mountains to the north‐west, lush green forests to the east, and the scenic Kashmir valley to the north; the land tapers into the Indian Ocean at the southern peninsula where the Bay of Bengal and Arabian Sea meet. India is a republic consisting of different states and union‐territories with Christians, Hindus, Muslims, Sikhs, and people from other religions. Among the Hindus, several castes exist, such as ‘‘Brahmins,’' ‘‘Kshatriyas’' (Rajputs–‐the warrior clan), ‘‘Vaishyas,’' and ‘‘Shudras,’' classified according to their profession from ancient times. The parents of our patient had migrated from the Multan region of Pakistan back to India at the time of partition, and are presently residing in the hilly region of Uttar Pradesh ( Fig. 1 ). There was no history of consanguinity in the family members presented in the pedigree chart ( Fig. 2 ).

Figure 1 Open in figure viewer PowerPoint Political map of India showing the neighboring countries, location of the patient's home in the state of Uttar Pradesh (U.P), and Multan from where the parents of the patient had migrated     

Autistic spectrum disorder traits in children with attention deficit hyperactivity disorder

Background Current classification systems do not allow for comorbid diagnoses of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). Children with ADHD are often screened for ASD during clinical assessment and when recruited to clinical trials. We predicted that children with ADHD would have more autistic traits than controls and that certain traits would be more prevalent. Methods The clinically referred sample consisted of 30 children with ADHD and 30 matched controls aged 9–15 years. Children were screened for ASD traits using the Social Aptitudes Scale (SAS) and the Social Communication Questionnaire (SCQ). Results We found that ASD traits were significantly higher in children with ADHD than controls. None of the children received a diagnosis of autism or ASD. However, a large proportion (28% using the SCQ and 62% using the SAS) of children with ADHD reached screening thresholds for a predictive diagnosis of ASD. Relative to controls, children with ADHD had significantly higher levels of communication and social deficits, but not repetitive behaviours. Conclusion Further work is needed to establish whether autistic‐like communication and social difficulties in children with ADHD are part of the broader ASD phenotype or are specific to ADHD.     

Fine needle aspiration cytology of rectal masses.

This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure.     

Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness,research, and response

Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely – and at times uniquely – affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response efforts to combat emerging and re-emerging infectious diseases. Historically, pregnant women and their offspring have been largely excluded from research agendas and investment strategies for vaccines against epidemic threats, which in turn can lead to exclusion from future vaccine campaigns amidst outbreaks. This state of affairs is profoundly unjust to pregnant women and their offspring, and deeply problematic from the standpoint of public health. To ensure that the needs of pregnant women and their offspring are fairly addressed, new approaches to public health preparedness, vaccine research and development, and vaccine delivery are required. This Guidance offers 22 concrete recommendations that provide a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance was developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group – a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy – in consultation with a variety of external experts and stakeholders.     

Return of fertility following discontinuation of an injectable contraceptive — Norethisterone oenanthate (NET EN) 200mg dose

The return of fertility following discontinuation of norethisterone oenanthate (NET EN) 200 mg injectable contraceptive after use for a minimum period of six months or more was studied in 69 women who discontinued the method for planning pregnancy. Former users of copper intra-uterine device (CuT 200) were enrolled as a control group. Another 161 women who had discontinued NET EN due to other reasons (e.g. amenorrhoea, excessive bleeding or personal reasons) were also studied for return of fertility after ensuring that they were not using any other method of contraception and were exposed to the risk of pregnancy. The subjects from both groups were followed for a period of one year. The cumulative conception rates at one year were 72.5 and 83.6 per 100 subjects for ex-NET EN and ex-CuT 200 users who had discontinued the method for planning pregnancy and this difference was not statistically significant (P > 0.05). The median time for conception for ex-NET EN users was 7.8 months as compared to 3.7 months in ex-CuT 200 users but the cumulative conception rates at the end of one year show that future return of fertility in NET EN users does not appear to be adversely affected.

In 51 subjects who had discontinued NET EN due to amenorrhoea, the return of fertility was predictably slower and less. The return of fertility in subjects who discontinued NET EN for other reasons (e.g. excessive bleeding and other personal reasons) was similar to ex-NET EN and ex-CuT 200 users.