Fifty-eight-year-old man presented with pyrexia for 2½ months duration, posing challenge in identifying the cause. The history of presenting illness (symptoms) and repeated clinical examinations were not supportive of any diagnostic clue. Routine workup for common causes of fever was not yielding any help in finding the cause. However, the perseverance to evaluate etiological factors of pyrexia of unknown origin with an appropriate set of investigations could yield the result to arrive at appropriate diagnosis.

Almost 56% of Indian adolescent girls aged 15–19 years suffer from anemia. Adolescent age is a period of many significant physiological changes that increase nutritional demand, and they remain at risk for nutritional deficiencies. Our aim is to assess the prevalence of Vitamin B12 deficiency among school-going adolescent girls aged 13–16 years of rural Mysore. This study was a cross-sectional study, conducted in two high schools in rural Mysuru. Adolescent girls aged 13–16 years were included. The chosen subjects underwent complete hemogram, peripheral smear examination, and vitamin B12 level estimation. Out of 98 subjects enrolled, 40.81% were found to be deficient in vitamin B12. Macrocytes and hyper-segmented neutrophils were found to have statistically significant ( P value < 0.001) relationship with vitamin B12 deficiency. The relationship between vitamin B12 deficiency with either type of diet and anemia was statically insignificant ( P > 0.05). The prevalence of vitamin B12 deficiency among rural adolescent girls in Mysuru is high. Other causes of nutritional anemia apart from iron deficiency, such as vitamin B12 deficiency, must be considered in the etiology of anemia and optimally treated. It is recommended to further strengthen the adolescent national health programs and food fortification programs.

Pulmonary Arteriovenous Malformations (AVMs) are abnormal connections between the pulmonary arteries and veins, leading to a direct shunting of blood without passing through the normal capillary bed.These AVMs can be associated with a rare genetic disorder called Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome.HHT is an autosomal dominant disorder characterized by the development of fragile telangiectasias in various organs, including the skin and mucous membranes.These telangiectasias are prone to bleeding, leading to recurrent nosebleeds and mucocutaneous bleeding.In patients with HHT, the most common site of AVMs is in the lungs.Pulmonary AVMs can cause significant health risks due to the right-to-left shunting of blood, leading to hypoxemia and possible complications like stroke, cerebral abscesses, and heart failure.

Background Febrile seizures (FSs) are the common presentations of seizures in childhood. Activation of cytokine network plays a significant role in the genesis of FSs. Interleukin (IL)-6 is often considered as key cytokine in the generation of FSs. Objectives To compare the serum IL-6 levels in children between simple febrile seizures (SFSs) and febrile controls (FCs). Materials and Methods This hospital-based prospective cross-sectional study was conducted in JSS Hospital, Mysuru, during a period of 21 months. A total of 83 children were included in the study. Out of which, 38 were cases of SFSs and 45 were FCs without seizures. Serum IL-6 levels were estimated in both SFS and FC groups. Results Serum IL-6 levels were increased among children with SFSs (mean = 608.15 pg/mL) when compared with FCs (mean = 342 pg/mL), but the results are not statistically significant (p = 0.165). In SFS and FC groups, percentage of subjects with IL-6 levels >50 pg/mL is 31.6 and 44.4%, respectively (p = 0.16). Conclusion Serum IL-6 levels are higher in children with SFSs compared with FCs. However, this difference did not reach statistical significance.

Hepatitis E virus (HEV) infection is a significant public health problem, which infects 20 million individuals every year. The clinical presentation of acute HEV infection is similar to hepatitis A virus (HAV) infection, and few affected children may progress to develop acute liver failure. Extrahepatic manifestations involving other systems have been reported with acute and chronic HEV genotype 3 infections both in adults and children. Herein we report acute kidney injury as a rare complication of acute hepatitis E in a child who recovered with a medical line of management.

Squamous cell carcinoma (SCC) in upper aerodigestive tract (UADT) is one of the predominant causes of mortality and morbidity in a developing nation like India. The major risk factors being tobacco usage and alcohol. Besides these there are certain viruses like high-risk Human Papilloma Virus (HPV) and Epstein Bar Virus (EBV). Which have a potential role in the etiology of SCC. More over these HPV positive tumors have better prognosis compared to HPV negative ones due their radiosensitivity. There are several methods employed in identification of these viruses of which IHC is cost effective, reliable with high sensitivity and specificity.In the present study, we identified 30 cases of SCC in UADT sent to Pathology department. Expression of p16 for HPV and LMP1 for EBV was performed on the tissue blocks manually.p16 was positive in around 17% (5/30 cases) whereas LMP1 showed 0% (0/30 cases) positivity. Majority of patients with p16 positivity in SCC of UADT are in the older age (above 50 years), showed moderately differentiated (Grade II) SCC, had nodal metastasis at the time of presentation. Some studies showed the association of HPV of SCC in UADT in younger population have better prognosis compared to HPV negative ones. In the current study HPV was identified (17%) in older population (above 55 years) and none of the cases showed positivity for LMP1(EBV).

S-100 immunohistochemical staining may detect nerve involvement in early stages of tuberculoid spectrum of leprosy. This study investigated the use of S-100 in early diagnosis of the tuberculoid and borderline tuberculoid leprosy and compared its sensitivity with hematoxylin and eosin (HE) stains in discerning the nerve involvement.To study the different histopathological patterns of nerve involvement in tuberculoid and borderline tuberculoid leprosy on S-100 immunostaining and also to compare the sensitivity of HE stain with S-100 immunostain in discerning the nerve involvement in these cases.This was a descriptive, prospective and retrospective analytical study, which included patients with tuberculoid spectrum of leprosy. Histopathological examination (HPE) and immunohistochemical (IHC) analysis were performed on all skin biopsies using HE stain and S-100 immunostain, respectively. Then the sensitivities of both the stains in discerning the nerve involvement were calculated and the data was analyzed using SPSS software version 22 by applying chi-square test.The study included a total of 58 patients [tuberculoid (n=28), borderline tuberculoid (n=30)]. The mean age was 43 yrs. The most common clinical manifestation was hypopigmented patches (n=40, 70%) with loss of sensation (n=39, 68.3%). HPE revealed 36 cases with well-defined granulomas, 22 cases with ill-defined granulomas and 41 cases with nerve destruction. IHC analysis showed four different patterns of nerve damage (fragmented, n=32; infiltrated and fragmented, n=14; infiltrated, n=10; intact, infiltrated and fragmented; n=1). The sensitivity and positive predictive value (PPV) of HE staining in delineating the nerve involvement were 68.96% and 100%, respectively. Whereas, the sensitivity and PPV of S-100 IHC were 100% each.Less number of cases.Use of S-100 IHC along with HPE aids in early, accurate and confirmatory diagnosis.

Hemophagocytic lymphohistiocytosis (HLH) is an uncommon life-threatening immune disorder that may be either primary or secondary to infection, malignancy, or rheumatological disease. In tropical countries like India, secondary HLH is more commonly seen. Both Dengue fever and scrub typhus, which result in more than half of all acute undifferentiated febrile illnesses in tropics, can occasionally result in HLH. Early diagnosis of HLH and institution of appropriate treatment can result in a good outcome. Although coinfections are common in tropical countries, HLH due to coinfections is rare. We are reporting a child diagnosed with HLH associated with coinfection with scrub typhus and Dengue fever that received early supportive treatment and recovered without needing chemotherapy.

AbstractCroup is an acute inflammatory condition affecting upper airways and commonly seen in children with younger age group. Croup is most commonly due to acute viral infection and rarely because of bacterial and atypical agents. Here, we report a 3-month-old child who presented to us with classic signs and symptoms of croup and was also positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Child's mother also tested positive for SARS-CoV-2. SARS-CoV-2 infection presenting with stridor and croup is very rare and probably represents a new manifestation which should be considered in a young infant presenting with croup.

Accreditation affirms provision of quality education, thus determines its graduate attributes. WFME, WHO and various bodies have been striving to ensure credibility of educational institutions through accreditation. NAAC is an Indian accrediting body providing framework for quality assurance to higher education institutions. Being an autonomous body under UGC, it sets a standard of excellence to which they are bound to adhere. This article provides details regarding an insight into NAAC, its vision, objectives, core values and the process of accreditation. The details regarding various criteria, components, allotment of weightage to each of them are detailed in the manuscript. The requirements and needs towards preparedness for this accreditation process are simplified to make the readers to understand easily thus providing a bird’s eye view of entire process.

Introduction: Dermatoses are common among schoolgoing children, more so in a tribal area and cause significant morbidity. Objective: The present study was conducted to study the point prevalence and pattern of dermatoses in Jenukuruba tribal children in Mysore district. Materials and Methods: A cross-sectional study was conducted on 4207 Jenukuruba tribal children in Mysore district. Diagnosis of various dermatoses was made on the basis of detailed clinical examination. Results: The point prevalence of dermatoses was 71.5%. Majority had single skin lesion. Nearly 43% had more than one skin lesion. Among skin infections and infestations, pyoderma (33.4%) and scabies (19.8%) were most prevalent. Among the noninfective conditions, xerosis (71.5%), pityriasis alba (16.7%), acne (8.6%), and hyperpigmentation (54.5%) were most prevalent. Conclusions: The point prevalence of dermatoses in tribal schoolchildren in Mysore district is very high. Health education of children and caregivers regarding the signs and symptoms of dermatoses is warranted for early detection, timely intervention, and prevention.

Background: Prostate cancer is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide.In view of the above, early diagnosis and effective treatment of the disease are immensely important.The increasing number of options for the treatment of prostate cancer has made the prognostic evaluation of the disease even more important.P53 is a tumor suppressor gene characterised by a highly proliferative pattern and an aggressive behaviour.The Objectives was to study the immunostaining patterns of p53 in prostate cancers and to compare the results with Gleason's score.Methods: Fifty cases of histopathologically proven prostate carcinomas diagnosed on needle biopsies and transurethral resection specimens was studied in JSS medical college and hospital, mysore for a period of 3 years and histopathological grade was assessed using Gleason grading system.Immunohistochemistry (IHC) for p53 was done on paraffin embedded wax sections.Result: p53 staining was positive in 47(94%) cases out of 50 cases, three (6%) cases were negative.Although there was an increase in positive p53 staining with increased Gleason's score, it was not statistically significant ('p' value = 0.068). Conclusion:p53 is a tumor suppressor gene, that express high proliferative pattern.It can be used as a prognostic factor.The immunoreactivity of p53 marker with increased tumor grade can benefit patients with appropriate targeted treatment and increase their survival period.

Background: One of the most common causes of carcinoma deaths among men is prostate cancer. In view of the above, early diagnosis and effective treatment of the disease are immensely important. The increasing number of options for the treatment of prostate cancer has made the prognostic evaluation of the disease even more important. Proliferation plays an important role in the clinical behaviour of prostate cancer. Ki-67 binding, is an objective measurement of cell proliferation which significantly aids in the management of the prostate patients. Gleason grading describes the aggressiveness of prostate cancer. The Objectives was to study the immunostaining patterns of Ki-67 in prostate cancers and to compare the results with Gleason's score. Methods: Fifty cases of histopathologically proven prostate carcinomas diagnosed on needle biopsies and transurethral resection specimens was studied in JSS medical college and hospital, mysore for a period of 3years and histopathological grade was assessed using Gleason grading system. Immunohistochemistry (IHC) for Ki-67 was done on paraffin embedded wax sections. Result: Ki-67 was positive in 49/50 cases (98%). The range of Ki-67 score was 0 to 94%. No statistically significant association was seen with Ki-67 and gleasons scores (P=0.277). Conclusion: Proliferation has been recognized as a distinct hallmark of cancer and acts as an important determinant of cancer outcome. As Ki-67 can be used to objectively measure this, it can be included in the pool of prognostic markers like tumor volume, histopathological grade and surgical margins.

Context: Although the incidence rate of colorectal cancer (CRC) in all Indian cancer registries is very close to the lowest rate in the world, westernization has shown an increasing trend in the recent years. Recurrence is reported in CRC because the slowly proliferating stem cells escape the chemotherapeutic regimen. Aim: To detect the presence of CD133 and CD44 in human CRC specimens and to correlate the level of marker expression with tumor staging. Materials and Methods: We included 26 colorectal carcinoma patients between 20 and 70 years of age. Histological and immunohistochemical analysis of CD133 and CD44 was done in sections of 5 μm prepared from paraffin-embedded blocks with most representative areas. Statistical Analysis: All analyses were performed using Microsoft Excel 2010 and SPSS version 22. Results: CD133 expression was seen exclusively on the cell membrane at the glandular luminal surface with dot-like cytoplasmic staining. In the normal mucosa, CD44 expression was seen in the superficial region of the cell, whereas in most of the carcinomas, the staining was localized in the basolateral region of the cell. Both CD133 and CD44 showed significant correlation with tumor stage. Conclusions: In the present study, CD133 and CD44 show significant correlation with tumor staging. Cancer stem cell markers have shown similar pattern of expression in the patients of Indian origin. Using combination of markers for staging is preferred as it increases the sensitivity and specificity.

OBJECTIVES:The aim is to identify the etiology of community acquired pneumonia in children with special reference to atypical bacteria and viruses. MATERIALS AND METHODS:A total of 94 pneumonia children were enrolled in the study. Sixty-seven did not have an etiological diagnosis by conventional culture. These children were subjected to immunofluorescence assay by Pneumoslide IgM. RESULTS:Ninety-four children were evaluated for etiology by conventional culture. Twenty-seven of them had the bacteriological diagnosis. Rest 67 were further analyzed for causative organism using Pneumoslide immunofluorescence test. Among this group, 38 (56.7%) had etiological diagnosis. Atypical bacteria were identified in 23 cases, most common being Mycoplasma pneumoniae and which was more common between 5 months and 2 years of age. Viruses were identified in 19 cases, and the most common virus was Respiratory syncytial virus. Mixed pathogens were identified in five children., M. pneumoniae was the common offending agent. CONCLUSIONS:Atypical bacteria and viruses play an important role as etiological agents in pneumonia in children. Pneumoslide IgM is useful for rapid detection of atypical bacteria and viruses.

Intramural calcification in intestinal atresia is a rare type of intra-abdominal calcification. The exact etiology of intramural calcification remains obscure. A 1-day-old newborn male baby presented with signs of intestinal obstruction and was diagnosed to have jejunal atresia. The newborn underwent laparotomy with resection of atretic and dilated part of the small bowel. Histology of atretic part of jejunum and adjacent area revealed intramural calcification with extensive foreign-body giant cell reaction. This appears to be the first time that intramural calcification has been documented in association with extensive foreign-body giant cell reaction in a case of jejunal atresia. It can be hypothesized that vascular insult is the initiating event. The further consequences could be multifactorial. This could be the reason for the variation in the site of calcific deposits. Intramural calcification with extensive foreign-body giant cell reaction is a rare phenomenon and calls for focused studies aiming at elucidating the exact etiopathogenesis of intramural calcification.

Carcinoid is a type of neuroendocrine tumor originating in the enterochromaffin or Kulchitsky cells, distributed throughout the body. Carcinoid tumors metastatic to the ovary are uncommon, most of which arise in the gastrointestinal tract. We report herein a case of young female presenting with bilateral ovarian metastatic neuroendocrine tumor with synchronous bone metastases.