Sinonasal epithelial-Myoepithelial carcinoma-A rare entity

Epithelial-myoepithelial carcinoma is a rare salivary gland tumor. It comprises less than 1% of all salivary gland tumors. It generally arises from the parotid gland. Unusual sites of occurrence include sinonasal tract, lung, trachea, lacrimal gland and breast. Histopathologically epithelial-myoepithelial carcinoma comprises a dual population of ductal and myoepithelial cells. We report an extremely rare case of epithelial-myoepithelial carcinoma occurring in the sinonasal tract of young man.     

Invasive Meningococcal Infection: Analysis of 110 cases from a Tertiary Care Centre in North East India

Objectives

To report an outbreak of invasive meningococcal disease from Meghalaya, in the north east India, from January 2008 through June 2009.

Methods

Retrospective review of case sheets was done. One hundred ten patients with invasive meningococcal disease were included for the study.

Results

Of the total patients, 61.8 % were boys and 38.2 % were girls (boy to girl ratio?=?1.62:1). The average age of presentation was 8.48 ± 5.09 y. Meningococcal meningitis was seen in 61.8 % of cases, meningococcemia in 20 % and 18.2 % had both. Fever was the most common manifestation (100 %) followed by meningeal signs (78.2 %), headache (56.4 %), vomiting (53.6 %), shock (38.2 %), low Glasgow coma scale (GCS) (25.5 %), purpura and rashes (23.6 %), seizures (9.1 %), abdominal symptoms (4.5 %), irritability and excessive crying (4.5 %) and bulging anterior fontanalle (23 %) in those below 18 mo of age. Raised intracranial pressure (ICP) was the most common complication (28.2 %) followed by coagulopathy (16.4 %), hepatopathy (10 %), herpes labialis (9.1 %), syndrome of inappropriate ADH secretion (SIADH) (8 %), pneumonia (7 %), arthritis (6 %), purpura fulminans, respiratory failure, sixth nerve palsy and diabetes insipidus in 4.5 % each, subdural empyema, optic neuritis, ARDS and ARF in 1.8 % each, cerebral salt wasting syndrome, third nerve palsy, cerebritis and hearing impairment in 0.9 % each. Culture was positive in 35.5 %. Patients were treated initially with ceftriaxone and dexamethasone but later on with chloramphenicol due to clinical drug resistance. Mortality was 6.4 %.

Conclusions

This is the first epidemic report of invasive meningococcal disease from the north east India. Chloramphenicol acts well in areas with penicillin or cephalosporin resistance. Mortality reduces significantly with early diagnosis and prompt intervention.     

Women’s Reproductive Health in Slum Populations in India: Evidence From NFHS-3

The urban population in India is one of the largest in the world. Its unprecedented growth has resulted in a large section of the population living in abject poverty in overcrowded slums. There have been limited efforts to capture the health of people in urban slums. In the present study, we have used data collected during the National Family Health Survey-3 to provide a national representation of women’s reproductive health in the slum population in India. We examined a sample of 4,827 women in the age group of 15–49 years to assess the association of the variable slum with selected reproductive health services. We have also tried to identify the sociodemographic factors that influence the utilization of these services among women in the slum communities. All analyses were stratified by slum/non-slum residence, and multivariate logistic regression was used to analyze the strength of association between key reproductive health services and relevant sociodemographic factors. We found that less than half of the women from the slum areas were currently using any contraceptive methods, and discontinuation rate was higher among these women. Sterilization was the most common method of contraception (25%). Use of contraceptives depended on the age, level of education, parity, and the knowledge of contraceptive methods (p < 0.05). There were significant differences in the two populations based on the timing and frequency of antenatal visits. The probability of ANC visits depended significantly on the level of education and economic status (p < 0.05). We found that among slum women, the proportion of deliveries conducted by skilled attendants was low, and the percentage of home deliveries was high. The use of skilled delivery care was found to be significantly associated with age, level of education, economic status, parity, and prior antenatal visits (p < 0.05). We found that women from slum areas depended on the government facilities for reproductive health services. Our findings suggest that significant differences in reproductive health outcomes exist among women from slum and non-slum communities in India. Efforts to progress towards the health MDGs and other national or international health targets may not be achieved without a focus on the urban slum population.     

Emergence of manifestations of HIV infection in a case of systemic lupus erythematosus following treatment with IV cyclophosphamide

Systemic lupus erythematosus (SLE) and infection with human immunodeficiency virus are rarely seen in the same patient. We describe a case of a 32-year-old lady, who was diagnosed with systemic lupus erythematosus (anti-dsDNA antibody positive) and was initially serologically negative for human immunodeficiency virus (HIV) infection. Following three cycles of IV cyclophosphamide, she was subsequently found to be infected with HIV, with marked depletion of peripheral CD4-positive T lymphocytes. While her SLE remained completely inactive, the course of HIV was rapidly progressive, suggesting that retroviral replication may have been enhanced by the underlying immunomodulation caused by cyclophosphamide and also by SLE per se.     

Generalized Hailey–Hailey disease with flexural keratotic papules: An interesting presentation and remarkable response with minocycline

Hailey–Hailey disease is a hereditary blistering disorder characterized by episodic vesicles, pustules, erosions, and maceration mainly in intertriginous areas with generalized eruptions encountered rarely. We present a case of generalized HHD with keratotic papules over flexural areas along with its dermoscopic features; treated successfully with minocycline alone.     

Determination of transforming growth factor activity in effusions from cancer patients

Transforming growth factors (TGF) are polypeptides that stimulate anchorage-independent growth of various nontransformed cells in vitro. Transforming growth factors have been found in tumor extracts and in the urine of cancer patients. The specific questions of our study were whether TGF activity can be detected in malignant effusions, how different assays for TGF correlate with each other, and how assays for TGF correlate with soft agar tumor colony formation as measured by the human tumor cloning assay (HTCA). The TGF activity was measured by a normal rat kidney transformation assay (NRKA), a 125I-EGF radioreceptor assay (RRA), and a radioimmunoassay (RIA) for TGF-alpha. Cells from effusions were cytologically examined and plated in the HTCA. A total of 104 effusions from cancer patients and 17 effusions from non-cancer patients was tested. Transforming growth factor activity was detected in some specimens. Only the TGF-alpha RIA and the HTCA showed significant differences between cancer and noncancer patients. Immunoreactive TGF-alpha was measurable in some cases by RIA even when cytologic testing failed to detect malignant cells. Spearman correlations between assays indicated that RIA results correlate significantly with all other assays. It is concluded that TGF-alpha activity might be important for in vitro colony formation of human tumor cells.