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   Table of Contents - Current issue
October-December 2020
Volume 9 | Issue 4
Page Nos. 209-279

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Association of chronic periodontitis and oral cancer: A review on pathogenetic mechanism and clinical implication Highly accessed article p. 209
RJ Krishnasree, P Jayanthi, PS Karthika, K Nandhakumar, R Rathy
The objective of this article is to review the available literature on the pathogenetic mechanisms involved in the association between oral cancer and periodontitis and its clinical implications. Periodontal diseases are characterized by chronic inflammation as a response to the host tissue invasion by multi-species microbial community. The activation of different inflammatory cascades by chronic periodontitis negatively affects the oral mucosa and has the potential to activate carcinogenesis. An electronic literature search was conducted in the MEDLINE and EMBASE databases. The search terms used were “CHRONIC PERIODONTITIS, ORAL CANCER, and PATHOGENESIS”. Original articles published between January 1990 and March 2018 was identified. Thirty-two potentially relevant articles were selected and included in the review after assessing the title and abstract. Several studies have shown that the inflammatory mediators produced in periodontal diseases may lead to angiogenesis and subsequently promote tumorogenesis. Periodontitis being a polymicrobial disease promotes carcinogenesis by evoking various inflammatory pathways. The rationale behind the association of oral cancer and periodontitis is that inflammation plays a key role in the pathogenesis of both conditions.
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Role of S100 immunostaining in demonstrating neural granulomas in paucibacillary leprosy p. 213
Debahuti Mohapatra, Debasmita Das, Kaushambi Chakraborty
Background: Challenges encountered in diagnosing paucibacillary leprosy are difficulty in visualizing the nerve twigs in H&E section due to small size or fragmentation and paucity of organisms in Wade-fite stain. Aims: This study aims to test the role of S100 immunostain in demonstration of neural granuloma, the hallmark in paucibacillary leprosy, compare morphology of S100 staining of nerves inside granuloma in different types of leprosy and distinguish this pattern from non-leprosy cutaneous granulomas. Methods: Sixty cases of diagnosed paucibacillary leprosy were studied in a span of one and half year (January 2018 to June 2019). Ten cases of non-lepromatous cutaneous granulomas and five cases of normal skin histology were also studied and included as control. H&E stain along with S100 immunostaining was done for all the cases. The H&E stained slides were used for studying the histopathological features and the S-100 was used for identifying the different dermal nerve patterns. Results: The most common pattern seen in case of borderline tuberculoid was fragmented and infiltrated whereas most common pattern seen in case of indeterminate was intact and infiltrated. Reduced, fragmented and infiltrated was most commonly seen in case of tuberculoid leprosy. Conclusion: Immunohistochemistry with S-100 has shown to be an effective adjuvant to histopathology in the diagnosis of different types of paucibacillary leprosy with bacterial index zero and to differentiate them from non-lepromatous granulomatous condition.
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To study diagnostic efficacy of ultrasound and magnetic resonance cholangiopancreatography in obstructive jaundice p. 217
Satyanarayana Goud, B Vijayalakshmi Devi, Pavan Kumar G. Kale, AY Lakshmi, V Venkata Rami Reddy
Background and Objective: Ultrasonography (??USG) and magnetic resonance cholangiopancreatography (??MRCP) are noninvasive modalities for evaluation of patients with obstructive jaundice. USG is widely available and less expensive compared to MRCP. But the value of USG is limited in obese patients and distal CBD evaluation due to poor window caused by bowel gas. With this knowledge, we planned to assess the diagnostic efficacy of USG and MRCP in detecting the level and cause of obstructive jaundice considering the gold standard being the final diagnosis made at surgery/Endoscopic retrograde cholangiopancreatography (ERCP). Settings and Design: Prospective observational study. Material and Methods: The study was conducted in the department of Radio Diagnosis, SVIMS, over a period of 18 ?months from March 2018–July 2019. This study includes thirty-seven consecutive patients who were referred to the department of Radiodiagnosis with the clinical suspicion of obstructive jaundice and elevated serum bilirubin levels. USG followed by MRCP were done in all the patients. Results: Of the thirty-seven patients with obstructive jaundice, twenty-nine patients had benign while eight patients had malignant etiology. For diagnosing the cause of obstructive jaundice, MRCP has a diagnostic accuracy of 97.2% and USG has a diagnostic accuracy of 86.4%. The sensitivity of MRCP is greater than USG in diagnosing the cause of obstructive jaundice. In diagnosing the level of obstruction, MRCP had an accuracy of 100%, while USG 81%. Conclusion: As MRCP has more diagnostic accuracy compared to ultrasound in detecting the level and cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size.
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A comparative study of immunofluorescence pattern and line immune assay profile in the detection of the antinuclear antibodies p. 222
SY Boorgula, G Jyothi Lakshmi
Background and Aims: To compare the efficacy of the Immunofluorescence and Line Immune Assay profile in the detection of ANA antibody. To ascertain an association between ANA patterns and the specific antibodies. To correlate the obtained ANA patterns with the Immunoassay. Settings and Design: This cross sectional study was done at a tertiary care center at Hyderabad Telangana. The samples were tested for ANA by Indirect Immunofluorescence (IIF) method and by Line immunoassay (LIA) methods. Materials and Methods: Serum samples of patients with a clinical suspicion of autoimmune disease were tested for ANA by indirect immunofluorescence (IIF) method and Line immunoassay (LIA) during January 2018-December 2018. Serum samples for indirect immunofluorescence were processed in 1:100 dilution using HEp–2010/liver/stomach/kidney biochip (EUROIMMUN AG). The serum samples were further processed for the line immunoassay in 1:100 dilution on nylon strips coated with purified and recombinant antigens as discrete lines with plastic backing coated with the antigens nRNP/Sm, Sm, SSA, Ro-52, SSB, PM-Scl, Scl-70, PCNA, Jo-1, CENP-B, dsDNA, nucleosomes, ribosomal protein-P, histones, anti-mitochondrial antibodies (AMA-M2) along with the control band. The analysis was done by the comparison of the intensity of reaction with the positive control line by image analysis. Results: Out of 236 samples tested, 77 were tested positive for Immunofluorescence and Line immuno assay, 115 were tested negative for Immunofluorescence and Immunoblot assay, only 1 was tested positive for Immunofluorescence and negative for Line immunoassay and 43 were tested positive for Line immunoassay and negative for Immunofluorescence. Conclusion: Detection of ANA by IIF method is a cost effective method. It may be used for the screening purposes for patients with or without clinical criterion for the autoimmune disease in daily clinical practice. The fluorescent pattern can also predict presence of certain specific antibodies in the sera. This may regulate one from requesting for line immunoassay, which is expensive. The Line Immuno assay may be reserved for those patients who need them for prognostic significance.
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Role of high-resolution sonography and doppler imaging in detecting nerve damage in leprosy patients p. 230
Joji Reddy Ontedddoo, N Bhavana, Gafoor J Abdul, B Suresh, M Padmalatha, D Harinath
Leprosy is the chronic infectious disease-causing peripheral nerve damage leading to functional impairment of limbs, ulcer formation, and deformities. Pathological findings of leprosy are nerve enlargement and inflammation, with the help of high-resolution sonography and color Doppler (CD) imaging to demonstrate nerve enlargement and inflammation. Aims: To assess the role of high-resolution sonography in detecting nerve damage in leprosy patients. Methods and Materials: The study group of 30 cases of leprosy performed on e Soate My lab 40 and evaluated bilateral US of the ulnar (UN), lateral popliteal (LP), and posterior tibial (PT) nerves compared this with the sonographic findings in 30 healthy controls. Results and Conclusions: The nerves were significantly thicker in the leprosy patients as compared with healthy controls (P < 0.001 for each nerve). Increased neural vascularity was present in 47 of 158 examined nerves (3%). A significant correlation observed between clinical parameters of the grade of thickening, sensory loss and muscle weakness, and US abnormalities of nerve echotexture, endoneurial flow, and cross-sectional area. Studies have reported that clinical examination of enlarged nerves in leprosy patients is subjective and inaccurate, whereas ultrasonography (USG) provides an objective measure of nerve damage.
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Spectrum of Turner's syndrome: Our experience p. 236
Padmaja Pendekanti, Radha Rani Palanki, P G. N Vijaya Durga, P Srinivasulu
Introduction: Turner's syndrome (TS) is the most common sex chromosome disorder in women, with an incidence of 1 in 2,500 female births. TS is characterized by distinctive features of short stature, streak gonads, increased risk of heart and renal defects and specific cognitive and psychosocial phenotype. Materials and Methods: We conducted a study in the department of endocrinology, GGH, Kurnool, for one year. 27 cases presented with short stature and primary amenorrhea, recurrent otitis media, were diagnosed as TS after detailed workup. We started growth hormone therapy for some patients with short stature. Gonadectomy was conducted for TS patients with Y component, and they were asked for regular follow-up. Results: Out of 27 cases, 12 were found to be turner mosaic, 15 were classical cases of TS. Conclusion: TS can be diagnosed with a high degree of clinical suspicion and confirmed by karyotyping. TS if identified earlier, growth can be achieved to the maximum potential. Early identification and proper management can improve the outcome and decrease the complications associated with TS.
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Correlation of diffusion weighted apparent diffusion coefficient values with immunochemical prognostic factors of breast carcinoma p. 241
Theja Settem, Vijayalakshmi Devi Bodagala, K Hari Kishore, Pavan Kumar G. Kale, AY Lakshmi, Mutheeshwaraiah Yootla, Narendra Hulikal, Rukmangada Nandyala
Context: Classic prognostic markers in breast cancer are tumor size and grade, lymph node status, molecular markers, including estrogen receptor (ER), progesterone receptor (PR), Ki-67 index, human growth factor receptor 2 (HER2) protein, and angiogenic molecular markers. Purpose of present study is to assess the utility of apparent diffusion coefficient (ADC) values in the prognosis of breast cancer by correlating them with molecular biomarkers. Aim: To correlate the ADC values of DWI of Breast cancer with immunochemical prognostic factors. Settings and Design: Retrospective observational study. Materials and Methods: Ours is a retrospective study of 30 female cases of histologically proven breast carcinoma who underwent magnetic resonance imaging (MRI) of breast in Tertiary healthcare centre, Andhra Pradesh. Molecular prognostic factors data were available for 20 cases which were further analyzed. Statistical Analysis Used: Correlation between the ADC value of the breast tumour and molecular prognostic markers was analyzed using Student's t test. Results: Mean ADC of Ki-67 index positive cancers (0.755 × 10 - 3 ± 0.158 × 10 - 3mm2/s) was significantly lower than Ki-67 index negative cancers (0.929 × 10-3 ± 0.117 × 10 - 3mm2/s) suggesting statistically significant correlation between ADC value and Ki67 index. There is no significant correlation between ADC value and ER, PR, and HER2 expression status. Conclusion: Our study showed statistically significant association between ADC values and Ki-67 index. Thus ADC values may be of use in providing prognostic information about disease.
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Twinning and birth defects: Rachipegal heteropagal twins and acardiac twins p. 245
Padmavathi Devi Chaganti, Maruthi Devi Karri, Sreedhar Bora, Pamidipalli Vamsi Vihar
Twin pregnancies are associated with multiple birth defects. The increase in twinning was attributed to fertility treatments. Twins were supposed to be associated with increased risk of congenital malformations. Among the twins, monozygotic twins were associated with more malformations then dizygotic twins. Heteropagus conjoined twins are asymmetrical conjoined twins where one twin is normal and the other is anatomically incomplete and grossly defective, attached externally, with or without internal connection. Heteropagal Conjoined twins were classified based on the site of their union, and when the fusion occurs at the level of the spine it is called Rachipagal heteropagal twin. One of the most important complication of Monochorionic placenta is Twin to twin transfusion syndrome. The major major defect is in recipient twin there was lack of well developed cardiac structure, and the blood supply was maintained through placental vascular anastomosis with normal twin. This sequence was described as the twin reversed arterial perfusion ,also known as Acardiac Twinning. Here we are going to present two rare cases of Rachipegal Heteropagal twin and Acardiac twin.
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Hemoperfusion in the management of acute poisoning p. 250
C Mahesh, N Nagalakshmi, Karanam Sivaparvathi, RD Nagaraj, N Praveen, N Raja Amarendra, B Maria, B Alekhya, Sivakumar Vishnubothla
The role of extracorporeal therapies for poisoning is expanding in the present days with technological advances and increased awareness among physicians attending critically ill patients both intensivists and nephrologists. In this regard we present our experience on hemoperfusion in poisonings over a period of 5 years. A total of 6 patients were treated with hemoperfusion during this period with majority of them were due to antiepileptic drugs (phenytoin, phenobarbitone, carbamazepine) followed by paraquat (a weedicide).The age range is from 19-59 years with a mean age of 31.3 years and male: female ratio of 1:1. Coming to the clinical presentation, 3 of them presented with unconsciousness, one with altered sensorium and two of them with vomiting associated with oliguria and breathlessness. Five of the six (83.3%) required ventilatory support during the hospital stay. The total number of hemoperfusion sessions required was 10, with an average of 1.6 sessions per patient. The average number of hemodialysis sessions required was 2.3 sessions per patient. Only one patient developed procedure related complication of thrombocytopenia related oral bleeding which subsided with supportive therapy and no further hemoperfusion. Four out of six patients (66.6 %) recovered while 33.4 % expired and both the patients who expired consumed paraquat poisoning. In conclusion hemoperfusion has a significant role in the management of certain poisonings which would reduce the morbidity and mortality associated with these poisonings.
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Pelger-Huet anomaly: A Rare case report p. 255
B Padmapriya, B Venkata Satya Kartheek, Sridhar Reddy Bodhireddy, Bhagyalakshmi Atla
Pelger-Huet anomaly (PHA) is a rare benign genetic disorder affecting terminal differentiation of granulocytes. Granulocytes have hyposegmented nuclei with normal cytoplasmic granularity and perform immune function. Knowledge about PHA is necessary to avoid misdiagnosis of hyposegmented granulocytes as increased band forms (bandemia) and to differentiate it from pseudo Pelger-Huet cells found in certain pathological conditions. Here, we report a case of PHA in neutrophils of a 46-year-old female found during routine peripheral smear examination. Further work up in family members revealed her siblings and her son were also having Pelger-Huet neutrophils in peripheral smear.
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The Tolosa-Hunt syndrome-Role of MR imaging p. 259
Anurudh Kishore Vatti, Swarnalatha Seelam, Naveen Basireddy, Vineela Rekha Vidavaluru
Tolosa–Hunt syndrome (THS) is a painful ophthalmoplegia due to nonspecific inflammation in the cavernous sinus (CS) and superior orbital fissure/orbital? apex. Diagnosis is based on clinical manifestations, magnetic resonance imaging (MRI) findings, rapid response to steroids, and exclusion of other causes of CS involvement. Our case report is regarding a 48-year-old female presenting with unilateral orbital pain, restricted ocular movements, and ptosis. The clinical presentation can be a pointer to several conditions of the CS and a correct diagnosis is a must to institute appropriate early management. This case is to emphasize the role of contrast-enhanced magnetic resonance imaging in the diagnosis of this condition and prompt clinical response to steroid therapy. This condition may be sight-threatening if untreated inflammation extends beyond CS to affect the optic nerve.
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Delayed and atypical presentation of Boerhaave's syndrome as epigastric mass p. 264
Mahavir Singh, Satish Dalal, Baleshwar Dhiman, Sethu Raman
Boerhaave's syndrome (BS), also known as “spontaneous rupture of the esophagus,” is an emergent condition requiring early diagnosis and management to prevent associated morbidity and mortality. Mortality ranges between 20% and 40% with timely treatment but this rises to virtually 100% if treatment is delayed by more than 48 h.[1] The classical clinical triad of vomiting, chest pain, and subcutaneous emphysema classically described symptoms for BS, which is actually uncommon accounting for the frequently delayed diagnosis.[2] This article describes a case of this syndrome in which the actual diagnosis was made 1 month after the esophageal perforation because of delayed atypical presentation with epigastrium mass and was successfully managed.
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Intramedullary cysticercosis p. 267
J Suneeth, Nimmagadda L Moorthy, Gollapudi P Rao, Doli M Chander, N Anil Kumar
Neurocysticercosis is one of the most common parasitic diseases of the central nervous system. However, spinal involvement is rare. Here, we report the case of a 28-year-old man with intramedullary cysticercosis in the cervical spinal cord. Magnetic resonance imaging of the cervical spine with contrast showed a well-defined, peripherally enhancing intramedullary cyst at C3 spinal cord level producing significant perilesional edema with expansion of the cord. Because the patient had progressive neurological deficits, surgery was performed. Pathological examination of the removed lesion proved it to be cysticercosis..
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A rare case report of scar ectopic pregnancy p. 270
Shobha Gumdal, Rama Devi Lakavath
Caesarean scar ectopic pregnancy is a rare form of ectopic pregnancy where gestational sac is implanted in the myometrium at the site of previous caesarean scar. Incidence of scar pregnancy is increasing due to the rise in caesarean section (CS) rate. A 26-year-old female [G1P1L0 with 3MA, prev. lower segment CS (LSCS)] came with acute abdomen and hypovolemic shock. Caesarean scar pregnancy was diagnosed. The patient was resuscitated and emergency laparotomy and resection of ectopic mass was done. In women with a history of caesarean scar pregnancy, early ultrasound should be performed in subsequent pregnancies in order to establish the location of implantation, and make early diagnosis so that conservative management is initiated to avoid severe maternal morbidity and spare fertility in patients with cesarean scar pregnancy.
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“Bubbly lung consolidation” - A highly specific imaging marker for pulmonary infarction p. 273
Srinivas Dandamudi, Raghuram Palaparti, P S S Chowdary, Purnachandra Rao Kondru, Sudarshan Palaparthi, Gopala Krishna Koduru, Somasekhar Ghanta, Boochi Babu Mannuva
A 23-year-old male with a history of smoking presented with dyspnea and pleuritic chest pain. His CXR showed pleural-based wedge-shaped opacity in the right lower zone. Non-contrast CT thorax showed central air lucencies without air bronchogram in the opacity (bubbly lung consolidation), suggestive of pulmonary infarction. CT pulmonary angiogram showed a large thrombus involving the right pulmonary artery. Pulmonary infarction affects only a minority of patients with pulmonary embolism. Recent literature suggests that younger individuals without major cardiovascular disease states present more commonly with pulmonary infarction contrary to the earlier studies. “Bubbly lung consolidation” is a highly specific imaging marker for pulmonary infarction and CT pulmonary angiogram has to be expedited to rule out pulmonary embolism. Our case report demonstrates this classical finding and highlights the importance of identifying various CT signs of pulmonary infarction.
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Outcome of heterotophic pregnancy p. 276
Myneni Pujita, B Kavitha, GC Prabhakar, T Usha Rani
Heterotophic pregnancy is defined as presence of combined intrauterine and ectopic pregnancy. We are reporting 3 cases of heterotophic pregnancy out of 54 ectopic pregnancy cases during a study period of two years (April 2013–March 2015) in Mamata General Hospital Telangana. All of the three heterotophic pregnancies are due to induction of ovulation and intrauterine insemination. Early diagnosis and management of ruptured ectopic pregnancy was done and intrauterine pregnancy was managed conservatively. Of the three, two pregnancies reached term gestation and had good perinatal outcome. The other case aborted spontaneously at 26 weeks of gestation. Interesting thing in our cases is continuation of intrauterine pregnancies with good perinatal outcome even after catastrophic rupture of ectopic pregnancies.
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