Utricular and visual aspects of inner ear disorders

The research described in this thesis is about investigation of the two less well understood mechanisms of balance system, namely utricular function and interactions of visual and vestibular system. Utricules are part of otolith apparatus and sense linear acceleration including gravity and lateral head tilts. Recent advances in rotational technology allow robust methods of assessment of unilateral utricular function using centrifugation techniques. Unilateral centrifugation generates substantial linear acceleration and the utricular response can be measured via tilt perception using subjective visual vertical (chapter 2). Utricular function was studied in common vestibular disorders seen in clinics, like chronic vestibular neuritis, benign positional paroxysmal vertigo, unilateral Ménière’s disease, migraine and bilateral vestibular hypofunction. Bilateral vestibular hypofunction produced significantly low utricular gain (chapter 3). A detailed study of the utricular function of larger group of unilateral Ménière’s disease showed significantly greater utricular asymmetry and lower utricular gain than normal controls. Interestingly, hearing loss was a predictor of utricular asymmetry (chapter 4). There was poor correlation between subjective measures and audiovestibular function. The chronic course of Ménière’s disease is well known with slow decline over years and absence of correlation between symptoms and function may point to ‘burn out’ as long term phenomenon (chapter 5). An investigation into visual dependence and vertigo was performed to understand the effect of visual dependence on tilt perception in chronic vertigo. Individuals with vestibular symptoms can have increased visual dependency and migraineurs can have a non-adaptable increase in visual dependency (chapter 6). In summary, we found that the unilateral centrifugation is a safe and well tolerated technique and provides additional, potentially useful information about utricular function. In future, the study of utricular function during acute phases of vertigo will further help overall understanding of otolith pathophysiology and mechanisms used for compensation.Open Acces

A rare case of triplet heterotopic pregnancy with a live intrauterine and bilateral tubal ectopic

Heterotopic pregnancy (HP) is a condition characterized by the coexistence of an ectopic pregnancy (EP) with a viable intrauterine pregnancy (IUP). The occurrence of a triplet heterotopic pregnancy is an exceptionally rare medical condition. Hence, timely diagnosis and management are challenging, but essential to prevent mortality. Authors report the case of a young woman who presented with a heterotopic triplet pregnancy, after in-vitro fertilization (IVF), at 12 weeks of gestation. She had been misdiagnosed as a case of severe ovarian hyperstimulation syndrome but had a ruptured tubal ectopic on the right side and an unruptured ectopic on the left side. Both the ectopics were managed by performing an emergency laparotomy with bilateral salpingectomy. The live intrauterine pregnancy was continued till term with the delivery of a healthy baby. High clinical suspicion and timely treatment can preserve the intrauterine gestation thus, ensuring a successful outcome

P53 and Nuclear Unrest: Biological Driver’s Suggesting Poor Prognosis in Anaplastic Wilm’s Tumor

In the early era, survival from Wilm’s tumor (WT) was less than 10% compare to today's date which has a 90% chance of survival. Multimodal therapy, enhanced surgical techniques, effective chemotherapy regimens and radiation therapy in treatment protocols have revolutionized the survival rates. As the advancement continues, molecular basis and targeted therapies are being considered for risk stratification and better treatment. Particularly important is evaluation of molecular abnormalities that confer to poor prognosis, so that intensification of chemotherapy and radiotherapy can be done to achieve maximum remission. The aim of this article is to highlight the importance of p53 and a morphological spectrum that have been associated with prognosis in WT

Visual inspection with acetic acid for cervical cancer screening in a tertiary health care centre

Background: Cervical cancer is one of the most prevalent malignant neoplasms among women in developing countries. Invasive cervical cancer is preceded by a long premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancereous lesions before cancer develops. The objective of the study was to assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center , to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low resource ones.Methods: This was a prospective study of 1520 asymptomatic women, carried out in 2014-2015. The study was performed at a tertiary care center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy.Results: More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P =0.0001). There were 27 women with histologic cervical intraepithelial neoplasia grade 1 (CIN1); of these, 12 were detected by Pap and 15 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN2–3) was confirmed in a total of 11 cases; Pap detected 4 of the cases and VIA 9 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.5% for VIA and 6.2% for Pap (P = 0.5). Most importantly, while only 2.8% of patients with a positive VIA were lost to follow-up before colposcopy that was true for 26.5% of the women with a positive Pap smear (P < 0.0001).Conclusions: VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology based screening

Angiomatoid fibrous histiocytoma in an elderly male: An unusual presentation with review of literature

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor occurring mostly in children, adolescents, and young adults. Clinically and radiographically, it is difficult to differentiate AFH from hematoma, soft tissue hemangioma, and malignant fibrous histiocytoma. Here, we present the clinical, radiologic, and pathologic findings of a case of AFH due to its rarity in a 67-year-old man. The patient underwent wide surgical excision with a provisional diagnosis of sarcoma. On pathological examination, the lesion demonstrated solid-cystic nodules of histiocytes with blood-filled cysts, a dense hyaline fibrous pseudo capsule, and a very focal peripheral lymphoplasmacytic infiltrates. The tumor cells showed strong positivity for CD68, variable positivity for CD34, Desmin, EMA, negativity for CK and a low Ki67 index

Seroprevalence of antistreptolysin O antibodies in a tertiary health care centre in Haryana, India: a three year retrospective study

Background: Presence of antistreptolysin O antibodies in a patient’s sera may be an isolated evidence of recent infection by group A or less commonly, group C or G Streptococcus, especially in patients suspected of having a non suppurative sequel to this infection.Methods: A retrospective study was done on the sera samples received in the Department of Microbiology, PGIMS Rohtak, India for the detection of ASO, over a period of three years. The test was carried out by latex agglutination rapid test kit by Aspen.Results: A total of 4632 samples were received in the laboratory during the study period. Of these, 1058 (22.8%) were found to be positive for the presence of ASO having titre of >200 IU/mL.Conclusions: The prevalence of ASO was found to be highest in the age group 0-20. The presence of elevated streptococcal antibody titres in such a population reflects a high background prevalence of streptococcal infections. Thus, determination of ASO antibodies should be taken into consideration when evaluating the role of group A streptococcus in non-purulent complications of infections

Crimean-Congo haemorrhagic fever: an overview

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute, highly-contagious and life-threatening vector borne disease. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40%. CCHF virus isolation and/or disease has been reported from more than 30 countries in Africa, Asia, South eastern Europe and Middle east. Jan 2011 marks first ever reports of outbreak of CCHF in India, total 5 cases were detected of CCHF from Gujarat. CCHF has recently in news again, 6 human cases and 32 animal samples test positive for CCHF from Kariyana village of Amreli district (Gujarat state) July 2013. Crimean-Congo hemorrhagic fever virus (CCHFV), member of genus Nairovirus in the family Bunyaviridae. Numerous genera of ixodid ticks serve both as vector and reservoir for CCHFV. Human infections occurred through tick bites, direct contact with blood or tissue of infected livestock, or nosocomial infections. Human infections begin with nonspecific febrile symptoms, but progress to a serious hemorrhagic syndrome with a high case fatality ratio. The most definitive way of diagnosis is the demonstration of virus or viral genome in sera samples. Hospitalization in special care unit with constant effort to prevent haemorrhagic complication along with laboratory monitoring is cornerstone for treatment of CCHF. Till date there is no FDA approved drug or definitive treatment for CCHF, ribavirin is tried by many physician need to be evaluated further. Current article is an effort to update existing knowledge about CCHF by due focus on various aspects especially prevention of this zoonotic disease. Much of the real life queries about this disease are elaborated after extensive literature research.

Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma.Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes.Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant.Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups