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  Citation statistics : Table of Contents
   2017| July-September  | Volume 6 | Issue 3  
    Online since September 25, 2017

 
 
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CASE REPORTS
Primary intracranial granulocytic sarcoma: A case report and review of literature
Dhruv Pankaj Mehta, Priti Trivedi, Asha S Anand, Sonia Parikh, Pushpak Chirmade
July-September 2017, 6(3):169-173
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_42_17  
Granulocytic sarcoma (GS) is a rare extramedullary proliferation of myeloblasts or immature myeloid cells leading to the disruption of normal architecture of tissue in which it is found. It may precede, be concomitant with or appear after diagnosis of acute/chronic leukemia, in acute or relapse setting. Herein, we report a case of 12-year-old male who presented with left-sided hemiparesis. Neuroimaging revealed a space occupying lesion in basal ganglia and thalamus. Stereotactic biopsy with immunohistochemistry (IHC) studies was suggestive of lymphoid malignancy versus GS. However, immunophenotyping (IPT) done on cerebrospinal fluid leukemic blasts was positive for GS. The patient initially received therapeutic cranial radiotherapy with biweekly triple intrathecal chemotherapy followed systemic high-dose cytarabine chemotherapy. Since bone marrow examination failed to reveal any evidence of hematologic malignancy, a diagnosis of aleukemic, primary, or isolated GS of brain was made. Our case emphasizes the importance of early suspicion, diagnostic dilemma associated with GS, the role of histopathology, IHC, and IPT in diagnosis, and various treatment modalities of aleukemic intracranial GS.
  1 1,044 87
Ischemic stroke consequent to snake bite
Pothukuchi Venkata Krishna, Shaik Ahmed, Katreddy Venkata Narasimha Reddy
July-September 2017, 6(3):192-193
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_246_13  
Neurological deficits following snake bite are usually due to intracerebral hemorrhage as a result of depletion of clotting factors. Ischemic stroke following snake bite is rare. We are presenting a case report of a female who developed seizures within 4 hours of snake bite; her computed tomography scan of the brain revealed an infarct.
  1 1,521 134
Arachnoid cyst with bilateral subdural hygroma: Rare case report
Maddala Sundeep, Mustafa Ghulam Faisal, Syed Abdul Jaleel Kirmani, Mortha Premjit Ray
July-September 2017, 6(3):194-196
DOI:10.4103/2277-8632.215524  
Arachnoid cysts are benign, congenital, nonneoplastic, extra-axial, intra-arachnoid lesions filled with similar to or exactly like cerebrospinal fluid. These cysts are reported to account for at least 1% of all intracranial mass lesions. Most patients present during the first two decades of life; however, presentation during adulthood is not uncommon. Arachnoid cysts are often discovered as incidental findings on cranial imaging. Surgical treatment of arachnoid cysts with bilateral subdural hygroma is controversial. We report a rare presentation of an arachnoid cyst with bilateral subdural hygroma.
  - 1,988 101
Lymphohistiocyosis
Prabhat Agrawal, Abhishek Raj, Manish Bansal, Ayush Agrawal, Shalini Upadhyay
July-September 2017, 6(3):197-199
DOI:10.4103/2277-8632.215527  
Hemophagocytic lymphohistiocytosis (HLH) is a life threatening condition characterized by uncontrolled hyperinflammation caused by various inherited or acquired immunodeficiency states. Cardinal symptoms are prolonged fever, hepatosplenomegaly, lymphadenopathy, rash, and central nervous system symptoms. Laboratory findings include high triglycerides, ferritin, transaminases, bilirubin and alpha chain of the soluble IL2 receptor, and decreased fibrinogen. A hallmark of HLH is impaired or absent function of natural killer cells and cytotoxic T cells. Hemophagocytosis, which has given the disease its name, is found in only a minority of cases at presentation, and its occurrence increases as the disease progresses.
  - 1,061 79
Intussusception due to colon carcinoma in a young man: An unusual presentation
Prashanth Mamidipalli, Suresh M Bakle, Bhaskara Narayana, P Srinivas Reddy, Y Pooja Reddy, A Devendhar
July-September 2017, 6(3):163-165
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_28_17  
Adult intussusception is a rare disease without classical symptoms. A delay in diagnosis may result in a fatal progression to complete bowel obstruction, ischemia, necrosis, and perforation. The association of a tumor with intussusception in young adults is rare. We report a case concerning a young male without a family history of bowel cancer presenting with a proximal ascending colon intussusception secondary to colonic carcinoma. This case puts insights on how intussusception and possible colon carcinoma must be included in the differential diagnosis even in young adults who have a persistent abdominal complaint. A high index of suspicion and an early computed tomography scan were required to prevent delayed diagnosis and the development of complications.
  - 1,722 140
Lipoid proteinosis: A rare congenital genodermatosis
Mitali Madhumita Rath, Pranita Mohanty
July-September 2017, 6(3):166-168
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_23_17  
Lipoid proteinosis or Urbach–Wiethe disease is a very rare autosomal recessive disease. The term was first coined by Urbach. This disorder is characterized by intercellular deposition of periodic-acid Schiff-positive amorphous hyaline material in the skin, mucosa, and viscera. Fewer than 300 cases have been reported in the literature till date. Characteristic skin lesions include multiple brown atrophic scars over the face and distal extremities, beaded papules over the margins of the eyelids, and verrucous nodules over the friction bearing areas such as elbows, knees, and buttocks. The overall prognosis is good. There is no definitive treatment. We present a case of this rare disorder with relevant review of the literature.
  - 1,152 109
Cheilitis granulomatosa: Case series
Sudha Rani Chintagunta, Sri Nitya Sana, Kavitha Sarrikonda Bukka, Sunethri Padma
July-September 2017, 6(3):174-177
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_13_17  
Granulomatous cheilitis is an idiopathic inflammatory disorder characterized by persistent, asymptomatic, diffuse swelling of one or both lips. It is also considered as an oligosymptomatic or monosymptomatic form of Melkersson–Rosenthal syndrome. We herewith report five cases of granulomatous cheilitis of which three cases were females and two were males. The mean age was 41 years. The average duration of symptoms was 2.5 years (2–3 years). Four patients presented with asymptomatic persistent swelling of the upper lip and one patient with lower lip. Two cases showed associated fissuring and angular cheilitis. One case also showed involvement of the left cheek. All the patients showed moderate improvement with combination of minocycline and intralesional triamcinolone therapy.
  - 1,719 123
A case of subdural hematoma following lumbar puncture
Ramatharaknath Vemuri, D Seshadri Sekhar, Sambasivarao Chandu, Lalith Kolukonda
July-September 2017, 6(3):178-180
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_44_17  
Lumbar puncture (LP) is a frequent procedure done for administration of spinal anesthesia or for obtaining cerebrospinal fluid for analysis. The common complications of LP are pain at the local site and headache. Fortunately, the serious complications such as infections of central nervous system, brain stem herniation, and subdural hematoma are rare. We present a rare case of subdural hematoma following a LP.
  - 3,251 163
Pigmented intramucosal nevus of gingiva with a special insight on its pathophysiology: Report of a rare entity
Rithika Bashamalla, Guttikonda V Rao, Surekha Ramulu, Taneeru Sravya
July-September 2017, 6(3):181-184
DOI:10.4103/2277-8632.215529  
Oral melanotic nevi can be characterized as developmental malformations or melanocytic tumors. Nevi are benign in nature originating from proliferating malfunctioning melanoblasts of the neural crest cells either in the epithelium or in connective tissue. It is an infrequent oral lesion triggering focal pigmentation. Considerable debate exists in the literature with respect to their origin, development, maturation, and their association to oral melanocytes. Nevi present in the mucous membrane have been documented to ensure the risk of malignant transformation. Hence, it is appropriate to cautiously diagnose all pigmented lesions of the oral cavity. Here, we report a case of intramucosal nevus with unusually large size in maxillary anterior gingival mucosa.
  - 1,870 135
Carcinoma ex-pleomorphic adenoma of submandibular salivary gland: A case report and review of literature
Vadisha Srinivas Bhat, Kolathingal Biniyam, Ajaz Abdul Aziz, Sunil Kumar Yeshwanth
July-September 2017, 6(3):185-188
DOI:10.4103/2277-8632.215518  
Pleomorphic adenoma (PA) is the most common benign neoplasm affecting the major salivary glands. It is more common in parotid gland and sometimes occurs in submandibular and other minor salivary glands. Carcinoma ex-pleomorphic adenoma (CXPA) is the malignant transformation of a primary or recurrent PA. Here, we report a case of CXPA of submandibular salivary gland with metastasis in the cervical lymph nodes. He was treated with excision of the mass with radical neck dissection, followed by adjuvant radiotherapy.
  - 1,976 163
Mitral bones in mitral stenosis: A rare presentation
Onteddu Joji Reddy, Polysetty Obuleswar Prasad, Jamkhana Abdul Gafoor, Munirajulu Rajanikanth
July-September 2017, 6(3):189-191
DOI:10.4103/2277-8632.215526  
Pulmonary ossification is described as mature bone formation with or without marrow elements in alveolar or interstitial spaces. Pulmonary ossification is a rare late sequelae that is virtually pathognomonic of mitral stenosis. Mitral bone is nothing but pulmonary ossification that can be seen in cases of severe Mitral stenosis. In olden days, these pulmonary ossific nodules were not infrequent, but nowadays pulmonary ossific nodules in mitral stenosis (mitral Bones) are very rare to see in chest radiographs in view of early diagnosis of rheumatic heart disease and recent rapid developments in medical diagnosis and surgical treatments for mitral stenosis, such as mitral valvotomy and mitral valve replacement. We report here a case of mitral bones in mitral stenosis in a middle aged man who is suffering from chronic mitral stenosis since childhood.
  - 1,215 90
LETTER TO THE EDITOR
Central or atypical skull base osteomyelitis
Rupinderjeet Kaur, Paramdeep Singh
July-September 2017, 6(3):200-201
DOI:10.4103/2277-8632.215528  
  - 1,498 123
ORIGINAL ARTICLES
Cytomorphometric analysis of exfoliated buccal cells to evaluate the malignant changes in individuals with tobacco smoking and chewing habits
Bharani Syamala, Ravi T Chitturi, Poosarala Chandrasekhar, K Lalith Prakash Chandra, K Kiran Kumar, BV Ramana Reddy
July-September 2017, 6(3):143-148
DOI:10.4103/2277-8632.215530  
Background: Tobacco is one of the leading causes for potentially malignant disorders (PMDs) and oral squamous cell carcinoma (OSCC) which stands 6th among all malignancies in the world. To prevent the high mortality rates and improve the five-year survival rates of patients with OSCC, it is very important to diagnose PMDs early. Exfoliative cytology combined with quantitative analysis such as cytomorphometry can be an important tool for early detection and diagnosis of these lesions. Aim: The aim of this study was to evaluate the quantitative changes in cytological buccal smears of tobacco smokers and chewers with that of the normal healthy individuals to assess the malignant changes by using cytomorphometric parameters such as cell diameter (CD), nuclear diameter (ND), and nuclear–cytoplasmic ratio (N/C). Materials and Methods: The study was carried out among 120 individuals. Group I consisted of 40 tobacco smokers, group II consisted of 40 tobacco chewers, and group III consisted of 40 controls who did not have a habit of tobacco smoking and chewing with apparently healthy appearing mucosa. Smears were made for all individuals and stained with Papanicolou technique. CD, ND, and N/C were calculated using an image analysis software after selecting 200 cells from each smear. All the parameters were subjected to statistical analysis using one-way analysis of variance and Scheffes multiple post hoc procedure. Results: There was a statistically significant reduction in CD and increase in ND and N/C of tobacco chewers and smokers when compared to that of controls. Age and sex did not have any influence on any of the cytomorphometric parameters. Conclusion: The habit of tobacco smoking and chewing causes quantitative cellular and nuclear changes in the squames of buccal mucosal epithelial cells, which shows a cause–effect relationship between tobacco and quantitative changes in the cells. Therefore, exfoliative cytology with the application of quantitative techniques can be used as a valuable diagnostic tool for detecting PMDs and malignant lesions.
  - 1,862 240
Exploring the pattern of antibiotic prescription by dentists: A questionnaire-based study
T Harsha Vardhan, N Vijaya Lakhshmi, B Haritha
July-September 2017, 6(3):149-153
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_30_17  
Introduction: Antibiotic overuse and misuse among dentists was found to be substantial. Exploration of scientific literature revealed very limited studies in India assessing the antibiotic prescription pattern among dentists. Antibiotics are one among the most commonly prescribed drugs by dentists for prophylactic and therapeutic management of oro-dental infections. Increasing inappropriate use of antibiotics has helped the bacteria to armor themselves and develop “Antibiotic Resistance.” Antibiotic resistance is an emerging global menace haunting all fields of the medical fraternity. All dentists should have to take moral responsibility to minimize and wisely use antibiotics. Aim: To know the prescription pattern of antibiotics for various dental procedures by dental practitioners. Objective: For treating in a better way to prevent antibiotic resistance. Materials and Methods: A self-administered, 12-item close-ended questionnaire was used. Questionnaire consisted of questions pertaining to knowledge, attitude, and practice of dental health care professionals before prescribing antibiotics. Associations were found out via the Chi-square test with P value kept as P ≤ 0.05. Results: With a response rate of 69.76%, medical representatives, patients' preference, fear of losing patients, and fear of spread of infections can potentially “influence” a dentist's capability to prescribe antibiotics. Conclusion: The dental profession as a whole needs to acquire a deeper understanding of the global effects of superfluous antibiotic prescription. Antibiotics, when judiciously used, are precise life-saving drugs. Proper knowledge about the prescription of antibiotics is the need of the hour. As a nation, we must respond to this growing problem so that antibiotics misuse can be stopped.
  - 2,047 288
Prevalence of lower urinary tract symptoms in patients of benign prostatic hyperplasia attending Tertiary Care Hospital in the State of Andhra Pradesh
M Nagarathnam, S. A. A. Latheef
July-September 2017, 6(3):154-157
DOI:10.4103/2277-8632.215533  
Background: There are only few studies available on the prevalence of lower urinary tract symptoms (LUTS) evaluated by the international prostate symptom score tool (IPSS), and it has not been validated in the Indian population. Aim: The purpose of the present study was to determine the prevalence of lower urinary tract symptoms in patients of benign prostatic hyperplasia (BPH) and to validate the IPSS tool in our studied population. Materials and Methods: One hundred BPH aged >51 years attending the outpatient department of Urology were recruited for the study. LUTS were evaluated using the international IPSS. The IPSS was validated for reliability and reproducibility by Cronbach's alpha and intraclass correlation coefficient (ICC). Results: The coefficients of Cronbach's alpha and ICC were 0.80 and 0.86, respectively. The majority of patients had moderate symptoms (72%) followed by severe symptoms (17%). Severity of symptoms increased with age (P < 0.01). The total score was associated with age (P < 0.01). The majority of patients (12%) with the severity of symptoms had reported that symptoms bother them to some extent. Conclusion: The results of the study showed that IPSS could serve as a good instrument to assess LUTS in this population.
  - 2,543 259
The assessment of systemic inflammatory response in apparently healthy adult smokers in Nnewi, South East Nigeria
Nancy C Ibeh, John C Aneke, Chide E Okocha, Chidinma Mmaduka
July-September 2017, 6(3):158-162
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_125_16  
Background: Induction of systemic inflammation is thought to underlie major organ dysfunction in cigarette smokers. Objective: The objective of the study is to estimate the levels of inflammatory markers (the leukocyte count and C-reactive protein [CRP]) in adult smokers in Nnewi metropolis, South East Nigeria. Subjects and Methods: A total of 120 adults, comprising of 60 smokers and age-matched nonsmokers, respectively were recruited. Five millilitre of venous blood was collected from each participant, of which 2 ml was used for full blood count estimation, using the Sysmex NX® hematology analyzer, while 3 ml was dispensed into plain tube and serum was extracted for CRP measurement, using the ELISA technique. Statistical analysis was done using SPSS (version 20), the students t-test was used for the comparison of means, and level of statistical significance set at (P < 0.05). Results: The serum CRP level was significantly higher in smokers compared with controls (P < 0.001) and the neutrophil count, neutrophil/lymphocyte ratio (NLR), and CRP were significantly higher in study individuals with smoking history of >5 years, compared with those whose smoking history was <5 years (P = 0.001, 0.001, and <0.001, respectively). The white cell count, eosinophil count, and serum CRP levels were significantly higher in individuals who smoked >5 sticks of cigarettes in 1 month (P = 0.023, 0.004, and <0.001, respectively). Conclusion: Cigarette smoking is associated with a significant acute inflammatory response which becomes exaggerated with increasing duration and frequency of exposure.
  - 1,305 121
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