Dedifferentiated adenoid cystic carcinoma of the lacrimal gland

A rare variant of adenoid cystic carcinoma is the dedifferentiated sarcomatoid form, which has previously been reported in the hard and soft palate, maxillary sinus, submandibular glands, and nasal cavity. The authors report the first case of a dedifferentiated sarcomatoid adenoid cystic carcinoma occurring in the lacrimal gland, that of a 52-year-old man. The patient presented with a 4-month history of diplopia, decreased vision, and right upper eyelid swelling. Radiographic imaging showed a soft tissue mass in the extraconal compartment superolateral to the right eye. The patient subsequently underwent surgical debulking. Histologic examination of the tissue revealed classic cribiform adenoid cystic carcinoma and a sarcomatous component consisting of malignant spindle cells and fusiform cells arranged in whorls. Dedifferentiation is a well-established phenomenon in salivary gland tumors that is associated with aggressive behavior and poor prognosis; however, the exact nature of such dedifferentiated neoplasms remains unclear.     

Sporotrichosis in Uttarakhand (India): a report of nine cases

Background Sporotrichosis is a chronic granulomatous infection caused by Sporothrichum schenckii. The disease has worldwide distribution. Majority of cases from India are reported from North‐eastern states. Methods The demographic, clinico‐investigative profile and therapeutic results of nine patients with cutaneous sporotrichosis attending the Dermatology Outdoor Department between January 2005 and June 2006 have been compiled. Results Out of nine (male‐4, female‐5) patients, five had lymphocutaneous‐type sporotrichosis while four had fixed cutaneous sporotrichosis. The average age of these patients was 40.8 years. The duration of complaints ranged from 1 month to 15 months (average 8.6 months). Two patients were able to recall traumatic injury. Six patients had lesions over lower extremities, two over face and one over upper extremity. Histopathologically, all cases showed granulomatous process with mixed inflammatory infiltrate comprising of lymphocytes, plasma cells, histiocytes and small neutrophil abscesses. Two cases were positive for fungal cells on PAS staining. Fungal culture on skin tissue was positive in all cases. Eight patients were treated with saturated solution of potassium iodide (SSKI) and they responded very well to SSKI in 12–16 weeks. One patient was pregnant and therefore was advised thermotherapy. Conclusion Sporotrichosis is also present in north‐western region of India as it is reported from north‐eastern part. This is the first series of cutaneous sporotrichosis being reported from Uttarakhand, a state situated in the north‐western region of India.     

Peak expiratory flow rate of rural school children from Wardha district,Maharashtra in India

Background  Peak expiratory flow rate (PEFR) recording is an essential measure in the management and evaluation of asthmatic children. The PEFR can be measured by a simple instrument—peak expiratory flow meter. The aim of this study was to determine the normal PEFR in rural school children from Wardha district of Maharashtra state, India. Methods  The PEFR was measured in 1078 healthy rural school children, living in Wardha district, Maharashtra using the Mini-Wright peak flow meter. All measurements were obtained in a standing position and the best out of three trials was recorded. Anthropometric measurements, weight, height, and mid-upper-arm circumference (MAC) were recorded, and body surface area (BSA) and body mass index (BMI) were calculated. Results  Positive correlation was seen between age, height, weight and PEFR. The regression equations for PEFR were determined for boys and girls separately. The boys had higher values than the girls at all heights. The prediction equation for PEFR based on height was PEFR = 3.64 height (cm) − 257.86 (R=0.47, R ²=0.22) for female; PEFR = 4.7 height (cm) − 346.51 (R=0.62, R ²=0.38) for male. Conclusion  PEFR is a reliable measurement, which can be used routinely and regularly in rural areas for assessment of airway obstruction and prediction formula derived for use in this population.     

Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging

This longitudinal follow-up study of 203 patients with serologically confirmed chikungunya (CHIK) virus infection describes the clinical features of CHIK fever during the first and tenth months of illness. During the acute stage CHIK fever presents with a wide array of symptoms. The foremost chronic symptoms at the end of a month were rheumatism (75%) and fatigue (30%). During the tenth month of follow-up the symptoms/signs observed were joint pain/swelling (46%), fatigue (13%) and neuritis (6%). The cure rate at the end of 9 months was 51%. Among the patients who had joint pain, 36% (34/94) met the American College of Rheumatology criteria to classify them as having rheumatoid arthritis. A subpopulation of the patients with joint pain (20/94) was tested for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody, and the joints were imaged by X-ray and magnetic resonance imaging (MRI). All tested negative for RF and one tested positive for anti-CCP. A radiolucent lesion in the X-ray was seen in the bones of five patients. The MRI findings were joint effusion, bony erosion, marrow oedema, synovial thickening, tendinitis and tenosynovitis. The study proves with relative certainty that CHIK arthritis is chronic inflammatory erosive arthritis, which has implications for management of the infection.     

Inferior Turbinate osteoma — rare cause of nasal obstruction

Osteomas are common benign tumors of the paranasal sinus, with a predilection for the frontal sinus. We report a rare case of inferior turbinate osteoma in a 54 year old lady. The osteoma was resected completely by endoscopic sinus surgery and the patient was relieved of symptoms.     

Comparative evaluation of glutamate-sensitive radiopharmaceuticals: Technetium-99m-glutamic acid and technetium-99m-diethylenetriaminepentaacetic acid-bis(glutamate) conjugate for tumor imaging

Single-photon emission computed tomography has become a significant imaging modality with huge potential to visualize and provide information of anatomic dysfunctions that are predictive of future diseases. This imaging tool is complimented by radiopharmaceuticals/radiosubstrates that help in imaging specific physiological aspects of the human body. The present study was undertaken to explore the utility of technetium-99m (??(m)Tc)-labeled glutamate conjugates for tumor scintigraphy. As part of our efforts to further utilize the application of chelating agents, glutamic acid was conjugated with a multidentate ligand, diethylenetriaminepentaacetic acid (DTPA). The DTPA-glutamate conjugate [DTPA-bis(Glu)] was well characterized by IR, NMR, and mass spectroscopy. The biological activity of glutamic acid was compared with its DTPA conjugate by radiocomplexation with ??(m)Tc (labeling efficiency ≥98%). In vivo studies of both the radiolabeled complexes ??(m)Tc-Glu and ??(m)Tc-DTPA-bis(Glu) were then carried out, followed by gamma scintigraphy in New Zealand albino rabbits. Improved serum stability of ??(m)Tc-labeled DTPA conjugate indicated that ??(m)Tc remained bound to the conjugate up to 24 hours. Blood clearance showed a relatively slow washout of the DTPA conjugate when compared with the labeled glutamate. Biodistribution characteristics of the conjugate in Balb/c mice revealed that DTPA conjugation of glutamic acid favors less accumulation in the liver and bone and rapid renal clearance. Tumor scintigraphy in mice showed increasing tumor accumulation, stable up to 4 hours. These preliminary studies show that ??(m)Tc-DTPA-bis(Glu) can be a useful radiopharmaceutical for diagnostic applications in single-photon emission computed tomography imaging.     

Immunogenicity and safety study of Indirab: A Vero cell based chromatographically purified human rabies vaccine

A chromatographically purified Vero cell rabies vaccine, Indirab manufactured by Bharat Biotech International Limited, Hyderabad, India was subjected to safety and immunogenicity studies by both intramuscular and intradermal routes of administration in parallel with a reference vaccine, Verorab. A Pre-exposure study was undertaken in 239 subjects by intramuscular (IM) route (Study I), Post-exposure study in 188 patients by intramuscular route (Study II) and Simulated post-exposure study in 134 subjects by intradermal (ID) route (Study III). All subjects in these studies were administered with either the test or the reference vaccine as per WHO approved intramuscular and intradermal regimens. The blood samples were collected on days 0, 14 and 35 in case of Study 1, and days 0, 14, 28 and 90 in case of studies II and III. In all studies both vaccine groups had adequate antibody titers (>0.5 IU/mL) on all days tested post-vaccination and there was no significant difference in the titers observed (p > 0.05). Some side effects like pain, induration, itching and fever were noted in both vaccine groups in all studies. Both vaccines were well tolerated. Hence it can be concluded that Indirab is as safe and immunogenic as Verorab when administered by both intramuscular and intradermal routes.     

Diabetes Burden and Access to Preventive Care in the Rural United States

Context: National databases can be used to investigate diabetes prevalence and health care use. Guideline-based care can reduce diabetes complications and morbidity. Yet little is known about the prevalence of diabetes and compliance with diabetes care guidelines among rural residents and whether different national databases provide similar results.
Purpose: To examine rural-urban differences in the prevalence of diabetes and compliance with guidelines, and to compare the Behavioral Risk Factor Surveillance System (BRFSS) and the Medical Expenditures Panel Survey (MEPS).
Methods: Data for 2001-2002 were analyzed and compared by rural-urban status. Prevalence was calculated as simple unadjusted, weighted unadjusted, and weighted adjusted using a multivariate approach. Results from the 2 databases were compared.
Findings: A slightly higher prevalence of diabetes among rural residents, 7.9% versus 6.0% in MEPS and 7.6% versus 6.6% in BRFSS, was found and persisted after adjustment for age, BMI, insurance coverage, and other demographic characteristics (adjusted OR 1.16 [1.02-1.31] in MEPS; 1.19 [1.01-1.20] in BRFSS). Rural persons in MEPS were less likely to receive an annual eye examination (aOR = 0.85) and a feet check (aOR = 0.89). A significantly ( P < .05) smaller proportion of rural residents in BRFSS received an annual eye examination (aOR = 0.88), feet check (aOR = 0.85), or diabetes education (aOR = 0.83). Rural residents in both datasets were more likely to get a quarterly HbA1c test done.
Conclusion: Rural residents in both datasets had higher prevalence of diabetes. Though not always statistically significant, the trend was to less guideline compliance in rural areas.