Pseudo-duplication of the Gallbladder

Phrygian cap and its rare relative, pseudo-duplication of the gallbladder, are two radiologic findings that may be revealed on ultrasound evaluation. Correct identification of Phrygian cap and pseudo-duplication should trigger a careful survey of the gallbladder in its entirety to rule out pathology. These anatomic variants may lead to partial under-distension of the gallbladder and can cause the gallbladder wall to appear falsely thickened. Asymptomatic patients with this finding may be safely discharged while symptomatic patients may require further surgical consultation

The effect of nutritional status on the response to highly active antiretroviral therapy in human immunodeficiency virus-infected children at regional antiretroviral therapy centre in Northern India

Background: Effect of highly active antiretroviral therapy (HAART) on growth in children is well established but influence of prior nutritional status on the response to HAART is not well known. Objective: To determine the influence of prior nutritional status on the response to HAART in terms of growth and CD4 counts. Methods: It was a retrospective record review based study conducted at a regional ART centre at a tertiary care, teaching hospital in Northern India. Human immunodeficiency virus (HIV) positive children who were naïve to antiretroviral therapy and were initiated on treatment from January 2006 to December 2007 were included in this study. Age, weight, height and CD4 cell counts were recorded at the initiation of HAART and after 24 months of therapy. Data was analyzed using paired t-tests within the groups, Chi-square tests, and one-way analysis of variance. Results: Seventy-nine HIV positive children were included in the study. At baseline, 29% of children were normal weight, 27% moderately underweight and 44% severely underweight with mean CD4 counts 243.30±178.50, 282.95±173.69 and 215.11±85.71 respectively. After 24 months of HAART, mean CD4 cell counts as well as weight for age z scores increased significantly in all 3 groups with mean CD4 counts being 913.61±401.46, 931.24±363.54 and 775.31±424.43 respectively in the groups. There were no significant differences in CD4 counts in the groups both pre and post ART. Conclusion: Underlying malnutrition does not adversely affect growth and immunologic response (increase in CD4 count) to HAART in HIV-infected children

Nora’s lesion: bizarre parosteal osteochondromatous proliferation in right foot: a case report

Nora’s lesion is a benign lesion involving mainly the proximal phalanges, metatarsals or metacarpals in the hands and feet. It may be easily confused with a malignant entity and was first identified and reported by Nora et al. in 1983. We present a case of a 12 years old female with complains of a swelling over the right foot noticed 4 months ago. Plain radiograph revealed heterotrophic calcification over the dorso-lateral aspect of the head of the first metatarsal. MRI scan of the foot was suggestive of a benign pathology with a differential of bizarre parosteal osteochondromatous proliferation (BPOP) or an osteochondroma. The patient was managed with excision biopsy and lesion was excised along with the pseudo-capsule and adjoining periosteum. Cortex appeared normal and wound was washed with hydrogen peroxide and incision closed. Histopathology report was suggestive of Nora’s lesion. One year follow up of the patient showed no recurrence. BPOP proliferation is a benign lesion however differentials need to be kept in mind and treatment with excision of the lesion along with the pseudo-capsule and periosteal tissue beneath the lesion has low rates of recurrence

Comparative study to assess the safety of misoprostol and dinoprostone for cervical ripening and induction of labour

Background: To compare safety of induction of labour with dinoprostone and misoprostol with respect to maternal complications like fever, diarrhoea, vomiting, hyperstimulation, tachysystole; and Neonatal outcomes like APGAR score of baby, meconium aspiration, birth asphyxia, hyperbilirubinemia and NICU admission.Methods: 200 Patients admitted to labour ward of Sree Gokulam Medical College and Research Foundation with an indication of induction of labour and unfavourable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone between December 2012 and May 2014.Results: There was no significant difference in maternal or neonatal complications between the two groups. Apgar at 1 minute was significantly higher for Misoprostol group while at 5 minutes Apgar was comparable between the two groups.Conclusions: Misoprostol is as safe as dinoprostone for the induction of labour