A Rare Case of Large Hydatidiform Mole Mimicking a Term Pregnancy

Molar pregnancy is a type of abnormal pregnancy that usually presents with amenorrhea, vaginal bleeding and elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 46-year-old P2L2 lady who presented with a term size uterus and elevated serum ß-hCG level (> 15,00,000 per deciliter, anemia (hemoglobin: 8.1 g/dL), difficulty in breathing and minimal vaginal bleeding. During the course of her evaluation, she had profuse vaginal bleeding, she underwent suction and evacuation, but bleeding was not controlled despite measures to control it. She was given uterotonics and antifibrinolytic agents and uterine artery ligation. But was proceeded with emergency hysterectomy for uncontrolled hemorrhage. The content of suction and evacuation was vesicles with blood clots and histopathology was reported as complete hydatidiform mole. The patient received a total of 4 units of packed red blood cells. She was discharged from hospital on 5th postoperative day and was followed up serial serum ß-hCG level. Therefore, complete mole can present with enlarged uterus, vaginal bleeding and anemia. It is also important to note that intractable bleeding following suction and evacuation not being controlled with uterotonics and antifibrinolytic agents and uterine artery ligation may require hysterectomy to save the patient's life.

Effect of a dietary supplement on the reduction of lymphedema-progression in mouse tail-cut model

OBJECTIVE

The aim of our study was to evaluate in vivo, in a mouse tail model of lymphedema, the effects of a dietary supplement, Garlive®, based on hydroxytyrosol from olive leaves, spermidine from rice seeds, hesperidin from citrus fruits and vitamin A. Hydroxytyrosol has anti-inflammatory, antioxidant and antimicrobial activities and inhibits leukotriene B4 generation; spermidine is able to inhibit the production of pro-inflammatory cytokines and mediators; hesperidin inhibits the secretion of pro-inflammatory cytokines: IFN-γ, IL-2, IL-4, IL-10; vitamin A deficiency was shown to induce inflammation and aggravate existing inflammatory states, whereas supplementation with vitamin A could ameliorate inflammation.

MATERIALS AND METHODS

The active compounds were included in tablets: 250 mg of olive leaf extract titrated in 10% hydroxytyrosol, 200 mg of citrus fruits extract titrated in 60% hesperidin, 10 mg of rice (Oryza sativa) seeds extract titrated in 1% spermidine and 0.8 mg of vitamin A. Mice of an inbred group were randomly selected and divided in the control group and drug-treated group. The wound necessary for lymphedema generation was made on the tail of each mice 1 cm below the base of the trunk.

RESULTS

After surgical intervention, there was a gradual increase in the circumference of both ends of the wound. The control group showed higher increase of tail volume than the drug-treated group. The differences in tail swelling between the control group and the drug-treated group were significantly different. The peak of swelling was anticipated to the 6th day in the drug-treated group, whereas in the control group the peak was reached later on.

CONCLUSIONS

The tested drug prevented the induction of swelling from day 5th of wound creation and decreased the duration of swelling, favoring the wound healing.

Observations on presumptive lumpy skin disease in native cattle and Asian water buffaloes around the tiger reserves of the central Indian highlands

CASE HISTORY

Between August and October 2020, following the monsoon, signs of lumpy skin disease (LSD) were recorded and described in 154 oxen, 34 cows, 13 calves (Bos indicus) and two Asian water buffalo (Bubalus bubalis) cows belonging to smallholder farmers in 32 villages located around the Kanha and Bandhavgarh tiger reserves in the state of Madhya Pradesh, central India. Affected animals were subjected to a full clinical examination and detailed findings were recorded in a clinical register. A semi-structured questionnaire was attached to the existing clinical register format to gather information on the clinical disease history and animal husbandry practices relevant to the spread of LSD virus.

CLINICAL FINDINGS

The affected animals were between 4 months and 14 years of age (mean 6.4 (SD 2.5) years). Persistent high temperature, depression, anorexia, and characteristic round nodules (lumps) on the skin were reported. The nodules were 2-5 cm in diameter and spread over the face, ears, neck, back, perineum, scrotum, legs, tail, udder, and nasal and oral mucosa. Secondary complications of myiasis (n = 39), mastitis (n = 16) and ulcerative lesions on legs were noticed. Death was reported for one animal (0.5%). The affected animals' recovery times were variable (mean 18.4 (SD 2.7) days). There was a significant positive correlation between delay in initiating treatment and the duration of sickness. Reduction in milk yield of 30-55% was reported in Bos indicus cows.

DIAGNOSIS

Clinical findings and treatment responses consistent with lumpy skin disease and its sequelae.

CLINICAL RELEVANCE

The presumptive LSD outbreak caused serious economic loss to the animal keepers. LSD is a new disease for India and in the absence of active immunisation, efficient vector control, animal movement control and stall-feeding practice, it will inevitably become endemic in the country. The severe impacts resulting from the introduction of a new disease to a previously unaffected country highlight the need for iterative improvements in global transboundary disease surveillance. The value of clinical examination and recording of findings is demonstrated in the context of smallholder farming systems with limited access to laboratory diagnosis, which are common around the world. The description of an LSD outbreak in naïve populations of cattle and buffalo illustrates the need for increased awareness of the associated clinical signs and maintenance of high levels of biosecurity in hitherto disease-free countries.

Serum Concentration of Myelin Basic Protein as a Prognostic Marker in Mild-to-moderate Head Injury Patients: A Prospective Study in a Tertiary Care Center

Objective To estimate the level of myelin basic protein (MBP) and look for its validity in outcome prediction among mild-to-moderate head injury patients.

Materials and Methods It was a prospective study done at the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University from Jan 2018 to July 2019. All patients who presented to us within 48 hours of injury with mild-to-moderate head injury with apparently normal CT brain were include in the study. The serum sample were collected on the day of admission and 48 hours later, and patients were treated with standard protocols and observed 6 months postdischarge.

Results Of the 32 patients enrolled, we observed mean MBP level was higher for severity of brain damage, but not associated with age, mode of injury, and radiological diagnosis. Mean MBP levels were not statistically associated with Glasgow coma scale (GCS) score at admission but was correlated to outcome with p < 0.05, with sensitivity of 50% and specificity 72%, that is, patients with good outcome have lower mean MBP levels.

Conclusion MBP as per our analysis can be used as a prognostic marker in patients with head injury. It is not the absolute value rather a trend showing rise in serum MBP levels, which carries a significant value in outcome prediction.

Effectiveness of Interventional Strategies in Modulating Knowledge and Attitude of Health Care Professionals for Promoting Organ Donation: A Study in Tertiary Care Public Hospital of North India

Objective:

To evaluate the impact of interventional “educational module” on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance.

Study Design:

Interventional and prospective.

Methods:

We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention.

Results:

A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the “concept of organ donation,” while nurses were more familiar with “procedures and protocols.” Both had low knowledge about “clinical criteria for brain death” and “legal issues” preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause.

Conclusion:

Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

In ovo carbohydrate supplementation modulates growth and immunity-related genes in broiler chickens

A study was undertaken to investigate the role of in ovo administrated carbohydrates on the expression pattern of growth and immune-related genes. In ovo injections (n = 400) were carried out on the 14th day of incubation into the yolk sac/amnion of the broiler chicken embryos. Expression of growth-related genes: chicken growth hormone (cGH), insulin-like growth factor-I & II (IGF-I & II) and mucin were studied in hepatic and jejunum tissues of late-term embryo and early post-hatch chicks. Expression of candidate immune genes: Interleukin-2, 6, 10 and 12 (IL-2, IL-6, IL-10 and IL-12), Tumour necrosis factor-alpha (TNF-α) and Interferon gamma (IFN-γ) were studied in peripheral blood monocyte cells of in ovo-injected and control birds following antigenic stimulation with sheep RBC (SRBC) or mitogen concanavalin A (Con-A). Glucose injection significantly increased the expression of IGF-II gene during embryonic period and both cGH and IGF-II in early post-hatch period, while ribose-injected chicks had higher expression of IGF-II gene during embryonic stage. Enhanced mucin gene expression was also observed in fructose-injected chicks during embryonic age. Glucose-injected chicks had higher expression of IL-6 or IL-10, while those injected with fructose or ribose had higher expression of IL-2, IL-12 and IFN gamma. It is concluded that in ovo supplementation of carbohydrates might help in improving the growth of late-term embryos and chicks. In ovo glucose could modulate humoral-related immunity, while fructose or ribose might help in improving the cellular immunity in broiler chickens.

Efficacy of different methanolic plant extracts on anti-methanogenesis, rumen fermentation and gas production kinetics in vitro

The present study was carried out to evaluate the effect of methanolic extracts of three plants, mehandi (Lawsonia inermis), jaiphal (Myristica fragrans) and green chili (Capsicum annuum) on methanogenesis, rumen fermentation and fermentation kinetic parameters by in vitro gas production techniques. Single dose of each plant extract (1 ml / 30 ml buffered rumen fluid) and two sorghum fodder containing diets (high and low fiber diets) were used for evaluating the effect on methanogenesis and rumen fermentation pattern, while sequential incubations (0, 1, 2, 3, 6 9, 12, 24, 36, 48, 60, 72 and 96 h) were carried out for gas production kinetics. Results showed that methane production was reduced, ammonia nitrogen was increased significantly, while no significant effect was found on pH and protozoal population following addition of different plant extracts in both diets except mehandi. Green chili significantly reduced digestibility of dry matter, total fatty acid and acetate concentration at incubation with sorghum based high and low fiber diets. Among all treatments, green chili increased potential gas production, while jaiphal decreased the gas production rate constant significantly. The present results demonstrate that methanolic extracts of different plants are promising rumen modifying agents. They have the potential to modulate the methane production, potential gas production, gas production rate constant, dry matter digestibility and microbial biomass synthesis.

Should palpable DCIS be treated as IDC? A retrospective audit

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Background: Ductal carcinoma in situ (DCIS) identified by screening mammography accounts for 20% of breast cancer diagnoses, and microinvasion (DCIS-M) is found in 5%-10%. There are no defined treatment guidelines for palpable DCIS or DCIS-M. In the developing world wherein screening mammography is controversial due to a predominantly premenopausal population, most women with DCIS present with a palpable lump in the breast. The objective of this study was to evaluate whether disease in these patients with palpable DCIS have been treated differently from screen detected DCIS.

Methods: Annually we register 3,000 new cases of breast cancer of which DCIS constitute a small fraction. Over a period of 12 years (1998-2010) we registered 71 cases of DCIS for treatment. A retrospective analysis of these was performed.

Results: Of the 71 patients reviewed, 35 (49.2%) had foci of microinvasion. The median age of presentation was 49 years and mean tumor size was 2.3 cm; all presented with palpable breast lumps. Of the 36 women with DCIS alone Tsize was > 2 cm in 26 (72.2%), 14 (38.9%) had presence of comedo necrosis and 1 (2.7%) had positive lymph nodes on histopathology. Adjuvant chemotherapy was given to 4 (11.11%). Of the 35 women with DCIS-M Tsize was > 2 cm in 23 (66%), 10 (29%) had comedo necrosis (compared to 38.9% in pure DCIS p=0.45), 3 (8.5%) had positive lymph nodes, and 17 (48.6%) received chemotherapy. We compared this data to that of women treated for invasive ductal carcinoma with pTsize <2cm, at a median follow-up of 60 months, DFS for the women with DCIS was 82% (95% CI 0. 67- 0.98), for DCIS-M was 78% (95% CI 0. 59 -0.98), and that for IDC < 2cm was 83% (95% CI 0.70-0.95).

Conclusions: DCIS presenting in these palpable lesions poses a clinical dilemma for the use of adjuvant therapy. Over 49.2% of the palpable DCIS showed evidence of microinvasion. We thus need to consider the role of adjuvant chemotherapy when treating women with palpable DCIS.

Effect of zinc on antioxidant response in maize (Zea mays L.) leaves

Maize (Zea mays L. cv kanaujia) plants grown with Zn [10 (control), 0.1 (low) and 20 microM (high)], were investigated for concentration of antioxidants and activities of antioxidative enzymes in leaves. Young leaves of low Zn plants developed whitish-necrotic spots. Leaves of both low and high Zn plants showed decrease in chlorophyll concentration and accumulation of lipid peroxides, ascorbate and dehydroascorbate, associated with a decrease in the activity of ascorbate peroxidase and superoxide dismutase. Low and high Zn, however, showed diverse effect on glutathione reductase. While low Zn increased the activity of glutathione reductase, high Zn decreased its activity. Zinc effect on antioxidative constituents suggested Zn involvement in sustaining the antioxidative defense system in maize leaves.

A Drosophila IkappaB kinase complex required for Relish cleavage and antibacterial immunity

Here we report the identification of a Drosophila IkappaB kinase complex containing DmIKKbeta and DmIKKgamma, homologs of the human IKKbeta and IKKgamma proteins. We show that this complex is required for the signal-dependent cleavage of Relish, a member of the Rel family of transcriptional activator proteins, and for the activation of antibacterial immune response genes. In addition, we find that the activated DmIKK complex, as well as recombinant DmIKKbeta, can phosphorylate Relish in vitro. Thus, we propose that the Drosophila IkappaB kinase complex functions, at least in part, by inducing the proteolytic cleavage of Relish. The N terminus of Relish then translocates to the nucleus and activates the transcription of antibacterial immune response genes. Remarkably, this Drosophila IkappaB kinase complex is not required for the activation of the Rel proteins Dif and Dorsal through the Toll signaling pathway, which is essential for antifungal immunity and dorsoventral patterning during early development. Thus, a yet to be identified IkappaB kinase complex must be required for Rel protein activation via the Toll signaling pathway.

Parkinsonism due to predominant involvement of substantia nigra in Japanese encephalitis

OBJECTIVE

To study the clinical correlates of lesions seen predominantly in the substantia nigra in some patients with Japanese encephalitis (JE).

BACKGROUND

JE typically involves thalamus, brainstem, spinal cord, and cerebral cortex. Rarely, basal ganglia and cerebellum may be affected. Lesions are often widespread and discrete. Predominant involvement of substantia nigra in JE has not been previously reported.

METHODS

Of 52 patients with JE seen in an endemic zone, five were selected on the basis of isolated lesions in the substantia nigra on MRI; all were subjected to detailed clinical and laboratory evaluation.

RESULTS

Presenting symptoms were fever, alteration of consciousness, neck stiffness, and decreased body movements. Examination during acute illness revealed restricted eye movements, opsoclonus, upbeating nystagmus, and cogwheel rigidity. There was early and complete recovery of consciousness and eye signs. Parkinsonian features such as positive glabellar tap sign, masklike face, bradykinesia, tremors, and postural instability became apparent as these patients started walking. Reversible mutism was observed in three patients during the acute phase. Response to levodopa, amantadine, and trihexiphenedyl was partial. Three patients were followed for more than 1 year, during which time their parkinsonian features recovered completely. Substantial recovery was also observed in the two other patients 2 months after regaining consciousness.

CONCLUSIONS

Some patients with Japanese encephalitis may have lesions predominantly in the substantia nigra. After recovery from acute encephalitic illness, they manifest clinically with typical parkinsonian features. Although several viruses are known to cause parkinsonism, this is the first demonstration of a virus producing lesions predominantly in the substantia nigra and causing parkinsonism.

Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis

We describe 4 patients with acute disseminated encephalomyelitis (ADEM) who were treated with intravenous immunoglobulins (IVIg) after getting no immediate response from a 3-5 day course of high dose intravenous methylprednisolone. All had clinical features to suggest poor prognosis and MRI findings to indicate extensive white matter changes in the brain. Two patients who had spinal cord involvement as well, required ventilatory support during acute phase of the illness. All the 4 patients recovered dramatically. Recovery pattern suggested that IVIg might be useful in fulminant ADEM. Further trials are needed to look for the efficacy of IVIg alone and in combination with methylprednisolone in the treatment of ADEM.

Kluver Bucy syndrome in young children

For the first time, Kluver Bucy syndrome (KBS) is described in young children who had no environmental learning of sex. The syndrome has so far been noted only in adults after bilateral temporal lobe affection. A few of its components, especially the hypersexuality and hypermetamorphosis, are likely to manifest differently in very young children. Seven patients in the pre-pubertal age group, who developed KBS as a post-encephalitic sequelae, are described. The patients, 2.5-6 years old, suffered from acute herpes simplex encephalitis (HSE) at 10 months-5.5 years of age and developed KBS on regaining consciousness and ambulation. Altered emotional behaviour, changes in dietary habits, hyperorality and hypersexuality were present in all, while psychic blindness and hypermetamorphosis were noted in a few of the patients. All showed marked indifference and lack of emotional attachment towards their close relatives. Apathy and easy distractibility were rare. Bulimia and strong urge to put non-food items into the mouth were common. Hypersexuality manifested as frequent holding of genitals, intermittent pelvic thrusting movements and rubbing of genitals to the bed on lying prone. Due to lack of environmental learning of sex and also, due to emotional and physical dependence on parents, the manifestations in young children showed modification over those of adults.

Acute disseminated encephalomyelitis presenting as ataxic hemiparesis

A patient of acute disseminated encephalomyelitis (ADEM) with a rare clinical presentation is described. The temporal profile of the disease suggested parainfectious central demyelination. The magnetic resonance imaging (MRI) also showed large demyelinating lesions scattered bilaterally in the cerebral white matter, thalami and brain stem. However, clinically he had only right ataxic hemiparesis and dysphasia without any impairment of cognition or consciousness.

Selective involvement of basal ganglia and occipital cortex in a patient with acute endosulfan poisoning

We report a teenage girl with acute endosulfan poisoning who developed psychosis, generalized tonic-clonic seizures, myoclonic jerks, cortical blindness and limb rigidity. Serial magnetic resonance imaging (MRI) showed bilateral reversible lesions localized to caudate nucleus, putamen and occipital cortex; internal capsule and thalamus were spared. This selective involvement may have a bearing on mechanisms underlying endosulfan toxicity.

Copper effect on photosynthesis and transpiration in safflower

The young leaves of safflower plants subjected to deficient supply of copper (0.00063 mg Cu L-1) developed visible symptoms of Cu deficiency and showed a decrease in chlorophyll concentration, Hill activity, net photosynthesis and transpiration. On giving normal supply of Cu (0.063 mg Cu L-1), these changes were partially reversed.

Evaluation of the mutagenic potential of endosulfan using the Salmonella/mammalian microsome assay

The mutagenic potential of endosulfan, a polychlorinated insecticide, was assessed using the highly sensitive Salmonella tester strains TA97(a), TA98, TA100 and TA102. It exhibited a toxic effect at dose levels of 50 micrograms/plate and higher. Plate incorporation studies did not show mutagenic response with any of the tester strains used. A modification of the assay using a preincubation procedure showed mutagenic activity with and without metabolic activation with TA97(a) only. Increased toxicity was observed after addition of phenobarbital-induced S9 mix.

Studies on the genotoxicity of endosulfan, an organochlorine insecticide, in mammalian germ cells

The genotoxic potential of endosulfan was assessed in mouse germ cells by 2 in vivo tests: the dominant lethal and the sperm shape abnormality test. At higher doses, endosulfan induced dominant lethal mutations in one mating interval (36-42 days) post treatment. A statistically significant dose-dependent increase in sperm abnormalities was observed with endosulfan treatment. At high doses the sperm count decreased up to 39%. No change in sperm motility was observed at any dose level. On the basis of the present in vivo results, it appears that endosulfan has a damaging effect on spermatogonial cells as well as on sperm morphology.

Colour vision deficiency among two populations of Chamars, a scheduled caste population of Uttar Pradesh (India)

On n = 320 nonrelated Kureel Chamars (160 males, 160 females) from Lucknow and neighbouring villages and n = 314 nonrelated Jaiswar Chamars (160 males, 154 females) from Jaunpur the frequency of colourvision deficiency was examined. In the Kureel Chamars the frequency of deuteranopia comes to a total of 1.25% (males: 25%, females: 0.0%), in the Jaiswar Chamars to a total of 1.91% (males: 3.13%, females: 0.65%). Protanopes were only found in the Kureel Chamars (0.63%; males: 1.25%, females: 0.0%). These observations are discussed and compared with those obtained on other Indian populations.

A serological study among two endogamous groups of chamars

On a sample of n = 320 unrelated Kureel Chamars (Lucknow district) and n = 314 unrelated Jaiswar Chamars (Jaunpur district) ABO- and Rh(D)-typings have been carried out. The two Chamar groups occupy the lowest position in caste hierarchy. In this paper the question is examined, whether the geographical fission of the both Chamar groups, followed by isolation, has had genetical effects.

The a-b ridge count in the Gujar Pasis and Kureel Chamars of India

The palmar a-b ridge count has been examined in the Gujar Pasis and Kureel Chamars and compared to other Indian populations.