Publications by authors named "Nidhi Mahajan"

46 Publications

Association of Anti-tissue Transglutaminase Antibody Titers and Duodenal Biopsy Findings in Pediatric Patients of Celiac Disease.

Cureus 2021 Mar 3;13(3):e13679. Epub 2021 Mar 3.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, IND.

Aims & Objectives To ascertain the association of serum anti-tissue transglutaminase (anti-tTG) antibody titers with the severity of duodenal mucosal damage on histology andto predict a possible cut-off value of anti-tTG antibody titers for the diagnosis of Celiac disease. Marsh grading greater than two in conjunction with clinical assessment, which may help avert an invasive endoscopic procedure, especially in medically unfit children. Materials & Methods A retrospective study was designed wherein demographic and laboratory data of children aged less than 12 years with raised anti-tTG antibody titers with available histopathology of duodenal biopsies were extracted from the hospital medical records and reviewed. Results A total of 134 children were included in the study, which showed female preponderance. Histopathological changes, characteristic of Celiac disease, were observed in 116 cases; seven among the rest showed evidence of Giardiasis, and 13 could be considered potential Celiac. Of the 116 patients, 1.7% belonged to Marsh grade I, 5.2% grade II and 8.6%, 26.7%, and 57.7% to grade IIIA, IIIB, and IIIC, respectively. A significant association was found between anti-tTG antibody titers and Marsh grading. The cut-off value of anti-tTG antibody titer levels for diagnosing Celiac disease using receiver operating characteristics (ROC) curve in predicting Marsh greater than two at histology was observed to be 84.6 U/ml with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 91.7%, 68.4%, 94.2%, and 59%, respectively. Conclusion An anti-tTG antibody titer greater than 10 times the upper limit of normal (≥84 U/ml) is significantly associated with Marsh grade greater than two. Standard stool microscopy may be used as a simple tool in the workup of all children with raised anti-tTG antibody levels to rule out Giardiasis to avert unnecessary endoscopic evaluation for Celiac disease in such cases.
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http://dx.doi.org/10.7759/cureus.13679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012245PMC
March 2021

Kaposiform haemangioendothelioma of duodenum in a neonate.

BMJ Case Rep 2021 Feb 19;14(2). Epub 2021 Feb 19.

Department of Gastroenterology, GB Pant Hospital, New Delhi, India

Kaposiform haemangioendothelioma, an endothelial borderline tumour, is typically seen in childhood involving extremities. It has been closely associated with a consumptive coagulopathy state, Kasabach-Merritt phenomenon (KMP). Extracutaneous involvement is uncommon. Intestinal involvement is quite uncommon and can masquerade as an acute abdomen. A 24-day-old neonate presented with bilious vomiting and fever for 5 days. Sections from the resected gangrenous duodenum contained a submucosal tumour composed of infiltrating nodules of slit-like or crescentic CD34-positive spindled-to-flattened endothelial-lined vascular spaces along with zones of fibrosis. No nuclear pleomorphism or necrosis identified. The findings were classic example of kaposiform haemangioendothelioma with an absence of any deranged coagulation profile. The index case raises interest given its congenital incidental presentation at an uncommon site, like duodenum, and absence of coexistent KMP.
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http://dx.doi.org/10.1136/bcr-2020-239527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898843PMC
February 2021

Renal Pelvic Cholesteatoma: An Uncommon Finding in Children.

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):408-410. Epub 2020 Oct 27.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Renal cholesteatoma or keratinizing desquamative squamous metaplasia is infrequent in adults and rare in children. We report a case of renal cholesteatoma in a 4-year-old male child who was referred to us as a case of multiple renal calculi with hydronephrosis. We also discuss his management with a review of relevant literature.
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http://dx.doi.org/10.4103/jiaps.JIAPS_20_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815026PMC
October 2020

Massive Ovarian Edema: An Extremely Rare Cause of Ovarian Mass in a 7-Year-Old Girl.

J Indian Assoc Pediatr Surg 2020 Jul-Aug;25(4):256-257. Epub 2020 Jun 24.

Department of Radiology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_111_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478289PMC
June 2020

Electrocuted Hip: Late Consequences of Electrical Shock Injuries of Orthopaedic Relevance: A Case Report and Review of Literature.

JBJS Case Connect 2020 Jul-Sep;10(3):e1900632

1Department of Orthopaedic Surgery, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India 2Department of Radiodiagnosis, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India 3Department of Pathology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India 4Department of Orthopaedics, ESIC Medical College & Hospital, Faridabad, Haryana, India.

Case: A 43-year-old man suffered household electric shock from 220 V alternating current when he accidently touched a live wire with his left hand. Subsequently, he was diagnosed to have osteonecrosis of the left femoral head and underwent total hip arthroplasty.

Conclusion: We suggest that the electric current could have thrombosed the terminal subsynovial vessels of the femoral head, leading to osteonecrosis. To the best of authors' knowledge, only 2 cases of osteonecrosis of the hip after electric shock have been reported in the literature. A literature review of the delayed consequences of electric shock injuries pertaining to orthopaedics is also presented.
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http://dx.doi.org/10.2106/JBJS.CC.19.00632DOI Listing
September 2020

Counting Polar Symptoms: How to Represent Results?

Homeopathy 2021 Feb 10;110(1):27-35. Epub 2020 Aug 10.

Central Council for Research in Homeopathy, Delhi, India.

Background:  Polar symptoms (PS)-symptoms with opposite values-are frequently used in homeopathy, but have many misleading entries in the repertory. This is caused by using absolute occurrence of symptoms, causing the same medicine to appear in both (opposite) symptom rubrics, and by lack of comparison with other medicines. Some PS, like 'aversion/desire for sweets' have a frequency distribution that is not evenly distributed around the neutral value: a desire for sweets is much more common than aversion. A desire for sweets is an indication for a specific medicine only if this desire occurs more frequently in this specific medicine population than in the remainder of the population. We need to find the best way to represent this difference.

Methods:  A multi-centre, explorative, prospective, observational study was conducted by nine centres of the Central Council for Research in Homoeopathy. Two-hundred and sixteen patients were enrolled with chronic cough lasting more than 8 weeks, and received usual homeopathic care. During intake, 30 general PS, 27 polar cough symptoms and 3 non-polar cough symptoms were checked. Different ways of representing results were explored, including two quantities borrowed from mechanics: Centre of Mass (CoM) and Leverage.

Results:  At the fourth follow-up, three medicines with more than 10 cases with good results were identified: 20 , 19 and 13 . The mean value of the frequency distribution of some symptoms in the whole sample was considerably different from the neutral value. Comparing a medicine population with the remainder of the respective population can give results that differ from polarity analysis. For some symptoms, the 'distance' (Leverage) between the CoMs of the medicine population and the remainder of the population was clearer than the likelihood ratio (LR).

Conclusion:  If the LR value is not clear about the prognostic value in PS, notions from mechanics such as CoM and Leverage can clarify how to interpret a polar symptom.
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http://dx.doi.org/10.1055/s-0040-1713363DOI Listing
February 2021

Congenital Cervical Mass in a Neonate with Secondary Scalp Swelling.

J Indian Assoc Pediatr Surg 2020 May-Jun;25(3):187. Epub 2020 Apr 11.

Department of Otolaryngology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_185_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302466PMC
April 2020

Spindle cell lipoma, dorsum of hand in a 4 year old child: A rare entity.

Indian J Pathol Microbiol 2020 Apr-Jun;63(2):301-304

Department of Pathology, Chacha Nehru Bal Chikitsalya, New Delhi, India.

Lipogenic tumors are an uncommon entity in children. There are several variants of lipoma, of which spindle cell lipoma is an extremely rare and accounts for only 1.5% of all lipoma diagnosis. Spindle cell lipoma rarely involves distal extremities. We report a 4-year old boy with swelling over dorsum of hand operated for aesthetic purposes. The report also highlights the salient cytological features, which can help differentiate this entity from other closer mimics on aspiration cytology, guiding the surgeon for appropriate management.
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http://dx.doi.org/10.4103/IJPM.IJPM_475_19DOI Listing
January 2021

Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports.

Homeopathy 2020 11 25;109(4):191-197. Epub 2020 Mar 25.

Central Council for Research in Ayurvedic Sciences, New Delhi, India.

Objectives: The objective of this study was to establish the reliability and content validity of the "Modified Naranjo Criteria for Homeopathy-Causal Attribution Inventory" as a tool for attributing a causal relationship between the homeopathic intervention and outcome in clinical case reports.

Methods: Purposive sampling was adopted for the selection of information-rich case reports using pre-defined criteria. Eligible case reports had to fulfil a minimum of nine items of the CARE Clinical Case Reporting Guideline checklist and a minimum of three of the homeopathic HOM-CASE CARE extension items. The Modified Naranjo Criteria for Homeopathy Inventory consists of 10 domains. Inter-rater agreement in the scoring of these domains was determined by calculating the percentage agreement and kappa (κ) values. A κ greater than 0.4, indicating fair agreement between raters, in conjunction with the absence of concerns regarding the face validity, was taken to indicate the validity of a given domain. Each domain was assessed by four raters for the selected case reports.

Results: Sixty case reports met the inclusion criteria. Inter-rater agreement/concordance per domain was "perfect" for domains 1 (100%, κ = 1.00) and 2 (100%, κ = 1.00); "almost perfect" for domain 8 (97.5%, κ = 0.86); "substantial" for domains 3 (96.7%, κ = 0.80) and 5 (91.1%, κ = 0.70); "moderate" for domains 4 (83.3%, κ = 0.60), 7 (67.8%, κ = 0.46) and 9 (99.2%, κ = 0.50); and "fair" for domain 10 (56.1%, κ = 0.38). For domains 6A (46.7%, κ = 0.03) and 6B (50.3%, κ = 0.18), there was "slight agreement" only. Thus, the validity of the Modified Naranjo Criteria for Homeopathy tool was established for each of its domains, except for the two that pertain to direction of cure (domains 6A and 6B).

Conclusion: The MO: dified NAR: anjo C: riteria for H: omeopathy-Causal Attribution Inventory was identified as a valid tool for assessing the likelihood of a causal relationship between a homeopathic intervention and clinical outcome. Improved wordings for several criteria have been proposed for the assessment tool, under the new acronym "MONARCH". Further assessment of two MONARCH domains is required.
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http://dx.doi.org/10.1055/s-0040-1701251DOI Listing
November 2020

Lipofibromatosis: A Rare Diagnosis on Fine Needle Aspiration Cytology.

Turk Patoloji Derg 2020 ;1(1):268-274

Departments of Pathology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, DELHI, INDIA.

Lipofibromatosis is a recently recognized slow growing rare pediatric tumor. Paucity of its cytological description in the literature leads to its pre operative misdiagnosis and further incomplete management. A twelve-month-old female presented with a rapidly progressive mass in the right thigh and buttock region. On examination, the mass was huge and involved the medial, posterior and lateral aspects of the thigh. The cytological smears showed mature adipocytes with few spindled out cells. FNA was reported as a lipoma, corroborating with the radiological presumptive diagnosis. However, histopathological and immunohistochemical features favoured a diagnosis of Lipofibromatosis. The cytological smears were reviewed and a cyto-histo correlation was established. The diagnosis of Lipofibromatosis rests upon classical cytological features in a clinically and radiologically suggestive picture. An early and accurate diagnosis if established can help the surgeon plan excision with wider margins as incomplete excision is associated with a high rate of recurrence.
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http://dx.doi.org/10.5146/tjpath.2020.01479DOI Listing
December 2020

Cytological diagnosis in a clinically unsuspected case of disseminated BCGosis: A case report.

Diagn Cytopathol 2020 Apr 19;48(4):371-375. Epub 2019 Dec 19.

Department of Microbiology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Bacille Calmette-Guerin (BCG) vaccine is administered worldwide to neonates and considered safe. Serious complications like disseminated BCGosis are extremely rare occurrences (<1 per million vaccinations). A 6 months male was brought to paediatric outpatient department with fever and swelling over the dorsum of the left hand for 5 days. On examination, he was febrile and had hepatosplenomegaly. X-ray of the hand showed lytic lesions in the first and second metacarpals. Provisional clinical diagnosis included Langerhans cell histiocytosis, congenital syphilis, and haematological malignancy. Fine Needle Aspiration Cytology (FNAC) was done from the swelling and showed diffuse sheets of histiocytes with both intracellular and extracellular rod-shaped unstained structures along with inflammatory cells. These ghost images stained positive with ZN stain. A cytological diagnosis of atypical mycobacteria vs leprosy was made. Child was revisited and found to have an active BCG scar. Further investigations showed low serum IgM and positive AFB culture. These bacilli were confirmed by GenoType MTBDR plus test as Mycobacterium bovis. Despite Antitubercular therapy, the patient succumbed to death. This case highlights the variable clinical presentation of BCGosis. Its occurrence may unmask any underlying immunodeficiency. If unfamiliar with the above cytological features and in absence of routinely performed special stains, the cytopathologist may miss these notorious organisms and treat such cases like suppurative lesions. To conclude, an early and definitive diagnosis of BCGosis can be established on FNAC which would ensure timely management and better outcome in this highly lethal entity.
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http://dx.doi.org/10.1002/dc.24369DOI Listing
April 2020

Tongue Base Schwannoma.

Indian J Otolaryngol Head Neck Surg 2019 Oct 20;71(Suppl 1):70-73. Epub 2016 Dec 20.

Department of Otolaryngology and Head, Neck Surgery, BL Taneja Block, MAM College and Assoc. LN Hospital, New Delhi, India.

Intraoral schwannomas account for 1% of head and neck schwannoma, with tongue base schwannoma being reported rarely. In an English literature search from 1988 to 2014, not more than 38 cases of tongue base schwannoma have been reported. Large tongue base schwannomas pose a significant risk to airway, thereby calling for an early intervention. We report a rare case of tongue base schwannoma in a 25 year old female managed surgically by lateral pharyngotomy approach.
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http://dx.doi.org/10.1007/s12070-016-1036-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848714PMC
October 2019

Gastrointestinal Mucormycosis in a two-year-old child: A clinical and radiological enigma.

Med Mycol Case Rep 2019 Dec 1;26:5-9. Epub 2019 Aug 1.

Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.

Mucormycosis is a rare, fatal angioinvasive infection occurring in immunocompromised individuals. Gastrointestinal mucormycosis is rare variety with high mortality rate. We present a case of GI mucormycosis in a 2-year-old male child who presented with abdominal mass with no underlying risk factors. The aim of this case report is to emphasize on its etiopathogenesis and keeping mucormycosis high in the differential diagnosis in a child presenting with abdominal mass.
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http://dx.doi.org/10.1016/j.mmcr.2019.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811992PMC
December 2019

Lipofibromatosis: Clues to the cytological diagnosis of a rare tumour.

Cytopathology 2019 11 1;30(6):667-670. Epub 2019 Aug 1.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.1111/cyt.12749DOI Listing
November 2019

Perturbed Biochemical Pathways and Associated Oxidative Stress Lead to Vascular Dysfunctions in Diabetic Retinopathy.

Oxid Med Cell Longev 2019 6;2019:8458472. Epub 2019 Mar 6.

Panjab University, Department of Biochemistry, Basic Medical Science Block II, Chandigarh 160014, India.

Diabetic retinopathy (DR) is a vascular insult that accompanies the hyperglycemic state. Retinal vasculature holds a pivotal role in maintaining the integrity of the retina, and any alteration to retinal vasculature affects retinal functions. The blood retinal barrier, a prerequisite to vision acuity, is most susceptible to damage during the progression of DR. This is a consequence of impaired biochemical pathways such as the polyol, advanced end glycation products (AGE), hexosamine, protein kinase C (PKC), and tissue renin-angiotensin system (RAS) pathways. Moreover, the role of histone modification and altered miRNA expression is also emerging as a major contributor. Epigenetic changes create a link between altered protein function and redox status of retinal cells, creating a state of metabolic memory. Although various biochemical pathways underlie the etiology of DR, the major insult to the retina is due to oxidative stress, a unifying factor of altered biochemical pathways. This review primarily focuses on the critical biochemical pathways altered in DR leading to vascular dysfunctions and discusses antioxidants as plausible treatment strategies.
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http://dx.doi.org/10.1155/2019/8458472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431380PMC
July 2019

Hyponatremic-Hypertensive Syndrome in Ovarian Paraganglioma.

Indian Pediatr 2019 Jan;56(1):69-71

Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

Background: Hyponatremic-hypertensive syndrome (HHS) is characterized by combination of polyuria, polydipsia, hypertension, hyponatremia and hypokalemia in association with unilateral renal artery stenosis.

Case Characteristics: A 10-year- old girl presented with polyuria, polydipsia, hypertension, hyponatremia, hypokalemia and proteinuria. Ultrasonography with doppler study revealed bilateral normal renal arteries. Completed tomography of abdomen detected a left adnexal mass, which was later confirmed as ovarian paraganglioma on histopathology.

Outcome: After tumor excision, polyuria subsided and blood pressure normalized.

Message: Hyponatremic-Hypertensive Syndrome does not always result from unilateral renal artery stenosis. High index of clinical suspicion with appropriate imaging technique may clinch rare endocrine causes of hypertension, like paraganglioma.
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January 2019

Synovial Lipomatosis with Chondroblastoma in an 8-year-old Female: A Previously Unreported Entity.

J Orthop Case Rep 2019 ;9(4):22-25

Department of Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.

Introduction: Synovial lipomatosis is a rare disease entity and a very small number of cases have been reported so far. It is characterized by villous proliferation of the synovium with expansion by mature adipose tissue. The etiology is unclear, thought cases can be seen secondary to injury, inflammation, chronic degenerative changes and neoplasms. Etiopathogenesis is still unclear, however is seen secondary to injury, inflammation, chronic degenerative conditions and neoplasms.

Case Report: An 8-year-old female child presented with pain and swelling in the left knee. Radiological examination suggested of a lytic lesion in upper tibia along with reactive synovial thickening. The lytic lesion was excised and an incisional biopsy was taken from the hyperplastic synovium. Histopathological examination of the synovial tissue showed villi-like structures with mature adipose tissue expanding the synovial lining along with the presence of mild chronic inflammatory cell infiltrate. The lytic lesion showed a cartilaginous tumor comprising mineralized chicken wire matrix surrounding the chondroblasts. A final diagnosis of synovial lipomatosis with chondroblastoma was made on histopathological examination.

Conclusion: This may be the first case report in medical literature of synovial lipomatosis coexisting with chondroblastoma in an adolescent girl. It also highlights the need for its increased awareness among young radiologists and pathologists so that an early diagnosis directs correct management and prevents further joint morbidity.
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http://dx.doi.org/10.13107/jocr.2019.v09.i04.1462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210901PMC
January 2019

MicroRNA-34a Promotes Endothelial Dysfunction and Mitochondrial-mediated Apoptosis in Murine Models of Acute Lung Injury.

Am J Respir Cell Mol Biol 2019 04;60(4):465-477

1 Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Recent evidence has shown that microRNAs (miRs) are involved in endothelial dysfunction and vascular injury in lung-related diseases. However, the potential role of miR-34a in the regulation of pulmonary endothelial dysfunction, vascular injury, and endothelial cells (ECs) apoptosis in acute lung injury (ALI)/acute lung respiratory distress syndrome is largely unknown. Here, we show that miR-34a-5p was upregulated in whole lungs, isolated ECs from lungs, and ECs stimulated with various insults (LPS and hyperoxia). Overexpression of miR-34a-5p in ECs exacerbated endothelial dysfunction, inflammation, and vascular injury, whereas the suppression of miR-34a-5p expression in ECs and miR-34a-null mutant mice showed protection against LPS- and hyperoxia-induced ALI. Furthermore, we observed that miR-34a-mediated endothelial dysfunction is associated with decreased miR-34a direct-target protein, sirtuin-1, and increased p53 expression in whole lungs and ECs. Mechanistically, we show that miR-34a leads to translocation of p53 and Bax to the mitochondrial compartment with disruption of mitochondrial membrane potential to release cytochrome C into the cytosol, initiating a cascade of mitochondrial-mediated apoptosis in lungs. Collectively, these data show that downregulating miR-34a expression or modulating its target proteins may improve endothelial dysfunction and attenuate ALI.
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http://dx.doi.org/10.1165/rcmb.2018-0194OCDOI Listing
April 2019

Anterior segment optical coherence tomography of intraocular lens opacification.

Indian J Ophthalmol 2018 06;66(6):858-860

Department of Pathology, Maulana Azad Medical College, New Delhi, India.

Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.
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http://dx.doi.org/10.4103/ijo.IJO_1172_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989518PMC
June 2018

Aberrant Pancreatic Tissue in a Mediastinal Enteric Duplication Cyst: A Rarity with Review of Literature.

Case Rep Gastrointest Med 2017 26;2017:7294896. Epub 2017 Apr 26.

Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

Mediastinal enteric duplication cysts are a rare congenital malformation encountered mainly in neonates and infants. It is a distinct entity within the family of foregut duplication cysts. It can present with respiratory distress due to mass effect and hence surgical excision is the preferred treatment. Histologically, it is characterised by a double layered smooth muscle wall with intestinal lining epithelium. We report a case of mediastinal enteric duplication cyst with aberrant pancreatic tissue in a neonate due to its rarity and early presentation. A neonate presented with respiratory distress and a cystic mass in the right posterior mediastinum. The lesion was excised and on histopathological analysis the diagnosis of mediastinal enteric duplication cyst was made. Also, aberrant pancreatic tissue which has been reported rarely was noted in this case. We discuss this case and review similar cases reported in literature.
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http://dx.doi.org/10.1155/2017/7294896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424172PMC
April 2017

Xanthogranulomatous Pancreatitis -A Rare Case Defying Clinical, Radiological and Tumor Marker Diagnostics with a Review of Literature.

Turk Patoloji Derg 2019 ;35(2):144-150

Department of Pathology, GB Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, NEW DELHI, INDIA.

Xanthogranulomatous inflammation of the pancreas is an extremely rare entity mimicking pancreatic neoplasia. Elevation of tumor markers has seldom been reported in xanthogranulomatous inflammation of the pancreas, rendering the diagnosis difficult and highlighting the importance of a meticulous histopathological examination. A 58-year-old male presented with severe abdominal pain and anorexia for six months. A heterogeneously enhancing solid cystic mass was detected in the pancreatic head on contrast enhanced computed tomography. Endoscopic ultrasound guided aspiration yielded fluid showing elevated levels of CA19-9 (12000 IU/ml) and CEA (221ng/ml) with a concordant increase in the serum tumour marker levels (CA 19-9:407 IU/ml; CEA: 70 ng /ml). Clinical, radiological and biochemical evidence favouring malignancy prompted a Whipple's procedure. A thorough histopathological examination of the specimen failed to reveal malignancy. Sheets of macrophages (CD 68 +, HAM 56 +), chronic inflammatory cells, fibroblasts and proliferating capillaries replacing most of the pancreatic parenchyma were seen instead, nailing the diagnosis of xanthogranulomatous inflammation of the pancreas. To the best of our knowledge this is the first report of xanthogranulomatous inflammation of the pancreas without associated malignancy displaying an elevation of serum and fluid tumour markers. After seven months of follow up, the patient is asymptomatic and is doing well.
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http://dx.doi.org/10.5146/tjpath.2017.01385DOI Listing
September 2019

Primary leiomyosarcoma of femur.

J Clin Orthop Trauma 2016 Oct-Dec;7(Suppl 1):125-129. Epub 2016 Mar 3.

Director, Professor & Head, Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India.

Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged female with a primary leiomyosarcoma of the distal femur. The patient was treated by hip disarticulation. The patient continues to be disease-free at one-year follow-up.
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http://dx.doi.org/10.1016/j.jcot.2016.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5167449PMC
March 2016

Malignant Bilateral Basifrontal Solitary Fibrous Tumor. A Case Report.

Anal Quant Cytopathol Histpathol 2016 Apr;38(2):133-6

Background: Solitary fibrous tumors are rare benign mesenchymal neoplasms characterized by involvement of many sites all over the body with uncommon presentation within the cranium. Furthermore, malignant bilateral basifrontal solitary fibrous tumor is extremely rare. Although uncommon, this rare entity may be included in the differential diagnosis of frontal tumors in adults, to ensure complete surgical resection. The tumor falls under the spectrum of fibroblastic proliferation and shares close morphological overlap with meningiomas and hemangiopericytomas, posing a diagnostic challenge for the histopathologist.

Case: We report a case of a malignant solitary fibrous tumor in the bilateral basifrontal region in a 50-year-old woman who presented with intermittent headache and vomiting and was clinicoradiologically diagnosed with meningioma.

Conclusion: Clinicoradiological and pathological correlation is required for recognizing the aggressive behavior of this tumor and aiding the clinician for appropriate surgical management (complete surgical resection) and close sequential follow-up.
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April 2016

A rare cytological diagnosis of primary non-Hodgkin lymphoma of the parotid gland.

J Cytol 2016 Apr-Jun;33(2):108-10

Department of Pathology, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India.

Primary lymphoma of the parotid gland is relatively rare and constitutes about 4-5% of extranodal lymphomas. The majority of them is non-Hodgkin lymphoma (NHL) and is B cell in nature. We report a case of primary diffuse large B-cell lymphoma (DLBCL) of the parotid gland in an elderly male. The case was diagnosed on fine needle aspiration cytology (FNAC) of the right parotid gland as high grade B-cell NHL and confirmed on histopathology as DLBCL. In correlation with the clinicoradiological findings, the case was diagnosed as primary parotid DLBCL. The case highlights the role of FNAC as a timely and useful diagnostic tool.
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http://dx.doi.org/10.4103/0970-9371.182539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881403PMC
June 2016

T-cell lymphoma of the oral cavity: case report.

J Clin Diagn Res 2015 Mar 1;9(3):MD03-4. Epub 2015 Mar 1.

Assistant Professor, Department of Pathology, Maulana Azad Medical College , India .

Lymphomas are heterogenous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkin's lymphoma (HL) and non- Hodgkin's lymphoma (NHL). NHL can originate from B, T, or natural killer (NK) lymphocytes. Extra-nodal presentation of T-cell NHL is extremely rare, and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in an immune-competent patient. The patient was diagnosed to have T-cell NHL on the basis of biopsy and immunohistochemistry, and was referred to oncology department for chemotherapy for definite treatment.
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http://dx.doi.org/10.7860/JCDR/2015/11883.5690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413091PMC
March 2015

Application of film-casting technique to investigate drug-polymer miscibility in solid dispersion and hot-melt extrudate.

J Pharm Sci 2015 Jul 27;104(7):2142-52. Epub 2015 Apr 27.

College of Pharmacy and Health Sciences, St. John's University, Queens, New York, 11439.

Determination of drug-polymer miscibility is critical for successful development of solid dispersions. This report details a practical method to predict miscibility and physical stability of drug with various polymers in solid dispersion and, especially, in melt extrudates by applying a film-casting technique. Mixtures of itraconazole (ITZ) with hydroxypropylmethylcellulose phthalate (HPMCP), Kollidon(®) VA 64, Eudragit(®) E PO, and Soluplus(®) were film-casted, exposed to 40°C/75% RH for 1 month and then analyzed using differential scanning calorimetry (DSC), powder X-ray diffractometry, and polarized light microscopy (PLM). ITZ had the highest miscibility with HPMCP, being miscible at drug to polymer ratio of 6:4 (w/w). There was a downward trend of lower miscibility with Soluplus(®) (miscible at 3:7, w/w, and a few microcrystals present at 4:6, w/w), Kollidon(®) VA 64 (2:8, w/w) and Eudragit(®) E PO (<1:9, w/w). PLM was found more sensitive to detect drug crystallization than DSC and powder X-ray diffractometry. There was general correlation between results of film casting and hot-melt extrusion (HME) using a twin screw extruder. For ITZ-Soluplus(®) mixtures, HME at 4:6 (w/w) resulted in a single phase, whereas drug crystallization was observed at higher drug load. HME of ITZ-Kollidon(®) VA 64 mixtures also correlated well with the miscibility predicted by film casting.
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http://dx.doi.org/10.1002/jps.24446DOI Listing
July 2015

Solitary bone plasmacytoma: An interesting case report with unusual clinico-cytological features.

J Cytol 2014 Jul;31(3):158-60

Department of Pathology, Maulana Azad Medical College, New Delhi, India.

Solitary bone plasmacytoma (SBP) is a rare entity characterized by localized proliferation of monoclonal plasma cells primarily occurring in the axial skeleton without systemic involvement. Involvement of the distal extremity is unusual. In the absence of typical clinical presentation, diagnosis may not be suspected clinico-radiologically; hence, fine-needle aspiration cytology may help in early and definitive diagnosis, hastening meticulous diagnostic workup and appropriate management of these patients. Intracytoplasmic crystalline inclusions (CI) have been reported in multiple myeloma and lymphoproliferative disorders. The present case highlights unusual clinico-cytological features of SBP with primary involvement of humerus, progression to tibia, and presence of extracellular and intracytoplasmic CI in plasma cells, a morphologic finding not reported in SBP earlier.
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http://dx.doi.org/10.4103/0970-9371.145650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274528PMC
July 2014

Effect of carbamazepine on viscoelastic properties and hot melt extrudability of Soluplus ®.

Int J Pharm 2015 Jan 13;478(1):232-239. Epub 2014 Nov 13.

College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA. Electronic address:

The purpose of this study was to apply viscoelastic properties of polymer and drug-polymer mixtures to determine processing conditions for the preparation of amorphous solid dispersion by melt extrusion. A poorly water-soluble drug, carbamazepine (CBZ), was mixed with Soluplus(®) as the carrier. Torque analysis using a melt extruder was performed at 10, 20 and 30% w/w drug concentrations and the effect of barrel temperature was studied. Viscosity of the mixtures either at fixed temperatures with different angular frequencies or as a function of temperature with the same frequency was studied using a rheometer. The viscosity of Soluplus(®) and the torque exerted on the twin screws decreased with the increase in CBZ concentration. The viscosity versus temperature plots for different CBZ concentrations were parallel to each other, without the drug melting transition, indicating complete drug-polymer miscibility. Thus, the drug-polymer mixtures could be extruded at temperature as low as 140°C with 10% w/w drug load, 135°C with 20% w/w drug and 125°C with 30% w/w drug, which were, respectively, ∼ 50°C, 55°C and 65°C below the melting point of 191°C for CBZ. The differential scanning calorimetry (DSC) and powder X-ray diffraction (XRD) analyses of the binary mixtures extruded at 125-150°C showed absence of crystalline drug. A systematic study of miscibility and extrudability of drug-polymer mixtures by rheological and torque analysis as a function of temperature will help formulators select optimal melt extrusion processing conditions to develop solid dispersions.
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http://dx.doi.org/10.1016/j.ijpharm.2014.11.025DOI Listing
January 2015

Oxidative stress and its biomarkers in systemic lupus erythematosus.

J Biomed Sci 2014 Mar 17;21:23. Epub 2014 Mar 17.

Center for Translational Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease whose etiology remains largely unknown. The uncontrolled oxidative stress in SLE contributes to functional oxidative modifications of cellular protein, lipid and DNA and consequences of oxidative modification play a crucial role in immunomodulation and trigger autoimmunity. Measurements of oxidative modified protein, lipid and DNA in biological samples from SLE patients may assist in the elucidation of the pathophysiological mechanisms of the oxidative stress-related damage, the prediction of disease prognosis and the selection of adequate treatment in the early stage of disease. Application of these biomarkers in disease may indicate the early effectiveness of the therapy. This review is intended to provide an overview of various reactive oxygen species (ROS) formed during the state of disease and their biomarkers linking with disease. The first part of the review presents biochemistry and pathophysiology of ROS and antioxidant system in disease. The second part of the review discusses the recent development of oxidative stress biomarkers that relates pathogenesis in SLE patients and animal model. Finally, this review also describes the reported clinical trials of antioxidant in the disease that have evaluated the efficacy of antioxidant in the management of disease with ongoing conventional therapy.
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http://dx.doi.org/10.1186/1423-0127-21-23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995422PMC
March 2014