Background: Soft tissue vascular anomalies encompass a heterogeneous group of lesions ranging from benign vascular tumours to complex high-flow malformations. Accurate diagnosis is essential for appropriate management, and Magnetic Resonance Imaging (MRI) plays a pivotal role in classification. Objective: To assess the diagnostic utility of conventional MRI and dynamic MRI- TWIST sequence in classifying soft tissue vascular anomalies. Methods: This case series evaluates three patients using spin-echo sequences (T1/T2), contrast-enhanced TWIST imaging, and clinical correlation, with diagnostic classification referenced to Park et al. Results: Case-wise analysis distinguished between hemangioma, combined venolymphatic malformation and Arteriovenous Malformations (AVMs) based on the presence or absence of flow voids, nidus, enhancement patterns, and vascular architecture. Conclusion: The dynamic MRI sequence, particularly TWIST, is highly valuable in differentiating low-flow (e.g., venolymphatic malformation) from high-flow lesions (e.g., AVM), thereby guiding targeted therapy.
Introduction: Syphilis is a chronic systemic disease commonly acquired as a sexually transmitted infection and is caused by Treponema pallidum subsp. pallidum. It is one of the ancient diseases known for centuries now. The incidence and prevalence of syphilis worldwide observed a fall during the later part of the 19th century, with increased screening and adequate treatment of positive cases. The increased awareness of safe sexual practices helped reduce disease incidence and transmission. Since 2000, a resurgence has been observed in both developed and developing countries due to a change in sexual behaviour. Objective: To study the present clinico-epidemiological trend of syphilis among patients attending the STD clinic in a tertiary care centre in the Western part of Tamil Nadu. Methodology: A retrospective study of syphilis patients who participated in the Sexually Transmitted Diseases (STD) clinic at the department of Dermatology, Venereology and Leprosy at a tertiary care centre at Coimbatore, Tamil Nadu, for a 1-year duration (June 2022 – July 2023) was conducted. Of the 3119 clients, 170 serologically confirmed syphilis patients were included in our study whose records were analysed for the demographic distribution, clinical stage of syphilis, association with other Sexually Transmitted Infections (STIs) and sexual behaviour. The total number of positive cases was compared with the year-wise positive cases from 2019 to 2023 to study the trend of syphilis. Results: Of the 170 positive cases, males (71.2%) predominated over females (21.8%) and transgenders (7.1%). The most common age group was 21-30 years (52.7%), and presentation was the latent stage of syphilis (46.4%). Men having sex with men (MSM) (40.58%) was the most common high-risk behaviour, followed by heterosexuals (33.52%) and bisexuals (8.23%). Multiple STIs were found in 21.76% cases, of which 67.56% cases were positive for Human Immunodeficiency Virus (HIV) infection. Newly diagnosed HIV disease was found in 14 patients (8.23%), of whom 46.2% were MSM with multiple partners. Interestingly, 7.1% of patients reported usage of social media platforms and apps specially designed for partner selection. It was observed from this study that there is a statistically significant progressive rise in the incidence of syphilis from 1.08% in 2019 to 5.45% in 2023 (p=0.00001; p<.05 is significant). Conclusion: Syphilis, an age-old disease, is alarmingly rising in recent years. Early identification, treatment and preventing further spread depend on focusing on the changing trends of high-risk behaviour of patients and their psychosocial factors and on targeted interventions.
Background: Neonatal sepsis continues to be a leading cause of morbidity and mortality, particularly in preterm and low birth weight infants. The spectrum of organisms and their resistance patterns vary across centres, making local data essential to guide management. Aim: To describe the clinical profile, microbial pattern and outcomes of culture-positive neonatal sepsis in a tertiary NICU in Chennai. Methodology: This retrospective study included all neonates with positive blood cultures admitted to the NICU of Government RSRM Lying-In Hospital, Stanley Medical College, between January and December 2024. Demographic data, risk factors, clinical features, organism profile, antibiotic sensitivity, hospital stay and outcomes were analysed. Results: In this study 68 neonates were studied, of whom 57.4% were male. Nearly 80% were preterm and more than 80% had a birth weight below 2.5 kg. Late-onset sepsis was more frequent (61.8%) than early-onset sepsis (38.2%). Klebsiella pneumoniae (22.1%) and Acinetobacter baumannii (16.2%) were the most common Gram-negative isolates, while Enterococcus faecalis (16.2%) and Staphylococcus haemolyticus (13.2%) were the predominant Gram-positives. Gram-negatives showed high resistance to first-line agents; carbapenems and colistin were the most effective, whereas vancomycin and linezolid were reliable against Gram-positives. The mean hospital stay was 14.2 ± 6.5 days (EOS: 11.6 ± 5.2; LOS: 15.8 ± 7.4). Overall mortality was 16.2%, with higher fatality in multidrug-resistant Gram-negative and fungal infections. Conclusion: Culture-positive neonatal sepsis in our unit was closely linked to prematurity, low birth weight and invasive procedures. Gram-negative organisms predominated and contributed to most deaths, highlighting the need for updated local antibiograms, infection-control bundles and strict antibiotic stewardship to improve outcomes in this vulnerable population.
Chemotherapy remains the mainstay of cancer management but is frequently accompanied by diverse mucocutaneous adverse effects due to its action on rapidly proliferating cells. These toxicities can range from mild cosmetic issues to severe reactions necessitating dose modification or discontinuation. This prospective observational study conducted at the Department of Dermatology, Government Coimbatore Medical College, systematically evaluated the prevalence, pattern, timing, and drug associations of mucocutaneous adverse reactions among 30 adult patients undergoing single or combination chemotherapy regimens over one year. Nail changes (73.3%), hair changes (50%), mucosal changes (10%) and cutaneous changes (63.3%) were the most common adverse effects, with higher rates than comparable studies like Pavey et al. Specific skin changes noted were xerosis, hand and foot syndrome, cutaneous extravasation, facial hyperpigmentation and supravenous hyperpigmentation. Specific nail changes were onycholysis and melanonychia. Hair changes included anagen effluvium, and mucosal changes included mucosal pigmentation. Early-onset reactions within the first 2-4 cycles were frequent. Proactive counselling, dermatological management, and patient education were effective in minimising morbidity and ensuring uninterrupted therapy. The study highlights the critical role of dermatology-oncology collaboration in holistic cancer care.
Leiomyosarcoma of the inferior vena cava is a rare tumour arising from the smooth muscle fibres of the media with a mean size at diagnosis generally around 12cm (range 2-38cm). Leiomyosarcoma of the inferior vena cava is a rare clinical entity that has been described in fewer than 300 patients in the literature. Leiomyosarcoma is the most common primary tumour of the inferior vena cava and the second most frequent retroperitoneal neoplasm in adults. This study compares 3 cases of Leiomyosarcoma of the inferior vena cava discovered incidentally and with symptomatic late-stage disease.
Background: Work-Related Musculoskeletal Disorders (WRMSDs) refer to injuries affecting the muscles, nerves, tendons, joints, cartilage, and spinal discs that arise from or are worsened by job-related activities. These disorders can result from frequent, repetitive tasks or awkward postures, leading to discomfort both during work and at rest. Aim and objective: To estimate the prevalence pattern of work-related Musculoskeletal disorders among the staff nurses. To study the relation of self-reported musculoskeletal strain pattern with RULA- Rapid upper limb assessment score among staff nurses in Government Kilpauk Medical College. Methods: 110 staff nurses working in Kilpauk Medical College were enrolled. Musculoskeletal symptoms were assessed using the Nordic Standardised Musculoskeletal Questionnaire and RULA scale to assess ergonomic risk factors associated with musculoskeletal disorders. Results: Prevalence of musculoskeletal disorders is 56.4%. Musculoskeletal symptoms occurred most commonly in the lower back (68.2%), upper back (33.6%), neck (29.1%), shoulders (29%), ankles and feet (26.4%), and shoulder (23.6%). The 12-month and the last 7-day period of WMSDs in any region were 56.40% and 49.10% respectively. Comparing the working posture with the risk assessed by the RULA score shows that in the ICU, 9.1% are at negligible risk and 90.9% are at low risk. In the operating theatre, 75.0% are at low risk, and 25.0% are at medium risk. In outpatient services, 95.8% are at negligible risk, and 4.2% are at medium risk. In ward duty, 52.4% are at negligible risk, and 47.6% are at low risk. The p-value is 0.000, indicating statistical significance. Of which the Majority have a RULA score of 2 and 3 categories, indicating a low risk for injury and a need for ergonomic intervention. Conclusion: Work-related musculoskeletal disorders are common among nurses, and lower back pain is the most common symptom. It is advisable to implement educational programs focused on prevention and coping strategies for musculoskeletal disorders among nurses to lower the incidence of workplace hazards and enhance the quality of patient care. The RULA scale can be used for ergonomic screening, recommending workstation modifications, and testing the effectiveness of ergonomic interventions.
Hemophagocytic Lymphohistiocytosis (HLH) is an aggressive hematological disorder caused by an uncontrolled activation of Cytotoxic T-Cells (CTL), Natural Killer (NK) cells, and macrophages, leading to hyperinflammation and cytokine storm. It can be classified into either primary or secondary. Triggers like infections, malignancies, and autoimmune conditions can lead to secondary HLH. Viral infections (Epstein–Barr Virus (EBV), Cytomegalovirus (CMV), and parvovirus) are commonly known to cause HLH. Tropical infections like Typhoid are common in India but have infrequently been reported to cause HLH. HLH is a rare complication of typhoid fever. We report a case of an adolescent boy who presented with typhoid fever complicated by secondary HLH.
Background: Electrolyte imbalances are common in cirrhosis and may indicate disease progression. While magnesium has been explored as a marker of severity, limited studies evaluate the combined correlation of sodium, potassium, and magnesium with chronic liver disease severity. Aims: To estimate serum sodium, potassium, and magnesium levels in cirrhosis patients, and to assess their correlation with the severity of liver disease as measured by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores. Methods: This cross-sectional study enrolled 121 cirrhotic patients. Serum electrolyte levels were measured and correlated with MELD and CTP scores. Statistical tests were done using SPSS v26. Results: Magnesium levels declined significantly across worsening CTP classes (p = 0.012), and inversely correlated with MELD (r = -0.336, p < 0.001). However, sodium (p = 0.22) and potassium (p = 0.792) levels showed no significant variation across CTP classes. Magnesium also negatively correlated with bilirubin (r = -0.258, p = 0.004) and positively with albumin (r = 0.239, p = 0.008). Conclusion: Magnesium correlates significantly with cirrhosis severity, suggesting its utility as a prognostic marker. Sodium and potassium did not show a consistent association. Routine evaluation of magnesium may enhance the assessment of cirrhosis progression.
Wilson’s disease is an autosomal recessive disorder affecting copper metabolism. It is due to the mutation in ATP7B gene that codes for ATPase protein which facilitates the hepatic excretion of copper. Accumulation of copper affects tissues such as liver, brain, spleen, eyes and kidneys producing pathological changes resulting in clinical manifestations. Treatment with D-Penicillamine and Zinc brings out improvement.
Cutaneous involvement in anaplastic large cell lymphoma may be in the form of primary cutaneous disease (primary cutaneous anaplastic large cell lymphoma) or secondary to involvement by systemic disease (systemic anaplastic large cell lymphoma). This case report, an example of the latter, describes a solitary cutaneous lesion as the first evidence of disseminated neoplastic disease. The histology of the lesion was identical to its primary cutaneous counterpart.
This study was done to assess the efficacy of biologics in patients with various subtypes of Juvenile Idiopathic Arthritis (JIA). All JIA patients with active chronic polyarthritis, who were non responders to methotrexate, were included in this open-label, prospective, study. Systemic arthritis was treated with Tocilizumab and the other JIA subtypes were treated with Etanercept. JADAS-27, Leeds Enthesitis Index (LEI) and ACR Pedi-30 were used to assess improvement. We also assessed the tolerance to treatment of JIA with biologics. 54 patients were enrolled and followed up for a median of 14 months. In Oligoarticular and Polyarticular arthritis, JADAS-scores improved by > or =30% in 72% of patients after 3 months. There was a statistically significant improvement in JADAS 27 scores. In patients with oligoarthritis the mean JADAS 27 before treatment was 36± 2.5, which improved to 28.6±1.2 (p=0.008). in polyarticular JIA, the mean JADAS 27 before treatment was 40.2± 2.5, which improved to 31.6±1.2(p=0.001). In ERA Leeds Enthesitis index improved in 80% of patients and JADAS-27 score improved by > or =30% in 80% in 3 months. In Systemic Arthritis the primary end point was absence of fever and ACR Pedi-30 response at the end of 12 week of treatment achieved in 84% of patients. Tocilizumab and Etanercept were found efficacious in Systemic arthritis and in other JIA subsets respectively in methotrexate non-responders. Both tolicizumab and etanercept were well tolerated.
A 35-year-old female presented with progressive cholestatic jaundice and malaise with associated small joint arthralgia and subjective fever for three months duration. She initially underwent treatment with alternative medications after which her symptoms had progressively worsened. Imaging and biochemical evaluation were suggestive predominantly of hepatocellular jaundice with features of cholestasis. Etiological work-up was positive for anti-smooth muscle anti-body (ASMA) but anti-nuclear anti-body (ANA), anti liver-kidney microsomal antibody (Anti-LKM1), Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (p ANCA) were all negative. Hypergammaglobulinemia with IgG predominance was noted. Liver histology was suggestive of autoimmune hepatitis (AIH) with evidence of bile duct injury, hence a diagnosis of overlap syndrome, AIH-Cholestatic syndrome with toxic hepatitis was made. Treatment with steroids and avoidance of hepatotoxic agent brought about a rapid improvement in biochemical and clinical symptoms.
Myofibroblastoma of the breast is a rare benign mesenchymal tumor. The literature describes relatively few cases of this type of tumor. We report on a case of Myofibroblastoma in 56-year-old female from our institution. The purpose of this report is to describe the characteristics and differential diagnosis of this rare tumor.
Background: Plasmablastic lymphoma was initially described in HIV positive individuals, was included as a distinct entity in WHO lymphoma classification in 2008. Later it has been also described in other immune deficient individuals and also in immune-competent individuals. Methods: The clinical features, HIV status, treatment details and outcomes of patients diagnosed with plasmablastic lymphoma during the period of January 2012 to august 2016 where collected from the patient records and analyzed retrospectively. The survival analysis was done by Kaplan Meier analysis. Results: Median age of 12 patients included in the study was 39 years (Range 13 – 71 years). Males constituted 75% (n=9). HIV positivity was 75% (n=9). Stage 4 disease was present in 67% (n=8). Out of 12 patients, 5 did not receive any treatment, 1 received metronomic oral chemotherapy and 6 patients received chemotherapy on a curative intent. Infusional EPOCH chemotherapy, CHOPE, CHOP was given in 4, 1 and 1 patients respectively. Complete response and partial response was seen in 4 and 2 patients respectively. The median overall survival of the whole study group was 12.4 months with a median follow up period of 10.6 months. Conclusion: Plasmablastic lymphoma is relatively rare lymphoma, which commonly presents as stage 4 disease in immune-deficient individuals, tend to have a good survival when treated with aggressive chemotherapy regimens. Keywords: Plasmablastic lymphoma, HIV positive lymphoma, EPOCH chemotherapy.
Among all the adult malignancies renal cell carcinoma (RCC) accounts for approximately 3% and is a lethal tumour with aggressive behaviour. It has propensity to metastatic spread to any organ. It can present initially with metastasis in about 16% of cases. But it is rare for the tumour to present with metastasis without a primary renal lesion. We report such a case of metastatic renal cell carcinoma (mRCC) presenting as lymphadenopathy with no evidence of primary renal tumour.
Cardiac amyloidosis is an under diagnosed entity which is shown to have grave prognosis. Early detection allows for treatment modalities that can halt cardiac damage, improve cardiac function and reduce the risk for sudden cardiac death. We describe a patient who presented with dyspnea on exertion and had subtle findings by which cardiac amyloidosis was diagnosed who was subsequently initiated on early definitive treatment.
Fulminant hepatic failure is a form of severe liver injury . Viral hepatitis and toxins are the most common cause for fulminant hepatitis in a renal transplant recipient. This is a case report of a patient with invasive fungal infection presenting as fulminant hepatic failure. Key words: Fulminant hepatic failure, candidiasis, renal transplant recipient
Chorangiomaof placenta is rare tumor of placenta. It incidence is 0.5 -1% of all pregnancies. It usually presents as solitary nodule or less frequently as multiple nodules. Chorangiomasmore often associated with multiple gestations. Most frequently seen in multigravida and in 3 rd trimester and less frequently in 2 nd trimester. Maternal diabetes mellitus and hypertension are associated with this condition. Mostchorangiomasare small and possess no clinical significance. Chorangiomais a vascular tumor of placenta which is usually small in size and only found after careful examination of placenta. It is also called as haemangioma of placenta or vascular hamartoma of placenta. Case Summary: 27 Years old Antenatal mother G4P1L1A2/Previous LSCS done for fibroid complicating pregnancy/Gestational age 38weeks 3days.Now admitted for safe confinement. Emergency LSCS done. Specimen placenta sent for HPE examination. Received placenta with membranes and attached cord structure. Foetal surface of placenta is Glistening .Maternal surface of placenta shows multiple red to grey brown nodules. Cut surfacealso shows red to grey brown like blood clot.HPE shows features of chorangioma of placenta. Key Words: Chorangioma ,Pregnancy disorders Placental tumour, Vascular tumour.
Ibuprofen is one of the most commonly prescribed drugs used to reduce fever and relieve pain. In India non-steroidal anti-inflammatory drugs (NSAID) are freely available over-the-counter (OTC). OTC NSAIDs, including ibuprofen, are routinely administered to children or taken by teenagers for pain and fever. It is generally considered safe, and long term studies indicate a lack of serious adverse effects. We report here a two-and-a-half-year-old female child whodeveloped hematuria during treatment with ibuprofen and paracetamol combination.
OBJECTIVE Tuberculosis is emerging as a significant health problem in the elderly. The symptoms are often non-specific and may be attributed to changes related to age. This often leads to a delayed diagnosis and more advanced disease at presentation. The presence of other underlying diseases may also alter the clinical picture. The aim of the study was to assess clinical, radiological and laboratory manifestations of tuberculosis in elderly patients. METHODOLOGY This cross sectional study was conducted among inpatients in geriatric medicine department and thoracic medicine department in a tertiary care hospital based on their inclusion and exclusion criteria. This study included 60 elderly patients aged more than 60 years from either sex. Detailed history regarding demographic pattern, associated factors and clinical presentations were elicited. Clinical, radiological and various laboratory parameters were analysed and tabulated. RESULTS Among the study population , 80 percent were male and 20 percent were female. Tuberculosis was common among rural population (50 percent), when compared with urban and semiurban population in our study due to varied health seeking behaviour. In our study population, 56.6 percent males and 13.3 percent females were aged 60-69 years, which was higher when compared with other age groups 70-79, 80 years.Smoking (73.3 percent) and alcohol (70 percent) contributed major associated factors followed by malnutrition (40 percent) and diabetes mellitus (36.6 percent).Elderly patients presented more with constitutional symptoms rather than respiratory symptoms in our study population.70 percent of patients had pulmonary tuberculosis and 30 percent of patients had extrapulmonary involvement. CONCLUSION The presentation of tuberculosis in elderly patients differs from that of younger patients by the predominance of constitutional rather than respiratory symptoms. Hence a high index of suspicion is required to make a timely diagnosis of tuberculosis in elderly.
