A rare case of teenage adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is very rare, accounting for only 0.1% of all breast carcinomas. Their rarity has made them difficult to study systematically with the most published series consisting of few cases or case reports; although, this existing evidence does suggest a good prognosis. ACC usually affects women, more in the sixth decade of life. However, our case has an exceptionally early onset of cancer at 16 years, the youngest ever reported in literature. Good local control can be obtained with lumpectomy and radiation or simple mastectomy for nearly all tumors. A routine axillary lymph node dissection is not recommended. We gave adjuvant radiotherapy to this patient in view of close margins and presence of lymphovascular emboli. She tolerated well with minimal side effects. Chemotherapy and hormonal therapy have no established benefit

AN INTRIGUING CAUSE OF CHRONIC DIARRHEA – PROTEIN-LOSING ENTEROPATHY AS THE PRESENTING MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS

ABSTRACTSystemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease.  It presents with myriad of clinical manifestations affecting every other organ system in human body. The gastrointestinal system is one of the commonest affected and it involves any part of the GI tract with incidences ranging from 1.3% to 27.5%. Gastrointestinal manifestations as a presenting feature of SLE is unusual. Chronic diarrhea due to protein losing enteropathy as the presenting manifestation of SLE is very rare and a diagnosis of SLE should be kept in mind when other systemic manifestations are absent. Hence, we report a 29-year-old female with chronic diarrhea as the main manifestation of SLE.Â

PREVALENCE OF DIABETIC RETINOPATHY IN TYPE 2 DIABETES MELLITUS: AN OBSERVATIONAL STUDY IN SOUTHERN INDIA

  Objectives: In India, 69.1 million are diabetics as of 2015 compared to 18 million in 1995. Pan India prevalence study in diabetics carried out at 194 centers by All India Ophthalmological Society reported the prevalence of diabetic retinopathy (DR) among diabetics as 21.8%. DR is of two types, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). The severity of NPDR depends on microaneurysms, hemorrhages, cotton wool spots, and beading of veins and can progress to PDR. Inherit characteristic of PDR is neovascularization. The aim of this observational prevalence study is to study the prevalence of diabetic retinopathy in Type 2 diabetic patients attending diabetic clinic and to study the distribution of diabetic retinopathy with respect to age, sex, and duration of disease in a tertiary care hospital in southern India.Methods: This is a retrospective observational study. Age above 20 years and patients diagnosed with Type 2 diabetes mellitus (DM) and examined by the ophthalmologist were included and others excluded. Data documented were analyzed using statistical software SPSS version 16.Results: About 52.07% of patients with Type 2 DM for more than 10 years had diabetic retinopathy and 13.07 % of patients with Type 2 DM for more than 5 years have diabetic retinopathy.Conclusion: India being the diabetic capital of the world and DR being the most common cause for visual impairment and blindness and it becomes empirical to assess the factors for its rising prevalence, which will significantly contribute in reducing the progression of DR

BRONCHOCONSTRICTION SECONDARY TO USE OF TOPICAL TIMOLOL IN A NON-ASTHMATIC PATIENT

Ophthalmic application of a non-selective beta blocker like timolol maleate is known to produce bronchoconstriction in asthmatic individuals or patients with obstructive lung diseases. Timolol-induced bronchoconstriction in a previously healthy young adult without any pulmonary disease is rare. We report a case of a young adult who developed bronchoconstriction following ocular instillation of timolol maleate ophthalmic solution when he was treated for open-angle glaucoma

Renormalization group study of the Kondo problem at a junction of several Luttinger wires

We study a system consisting of a junction of N quantum wires, where the junction is characterized by a scalar S-matrix, and an impurity spin is coupled to the electrons close to the junction. The wires are modeled as weakly interacting Tomonaga-Luttinger liquids. We derive the renormalization group equations for the Kondo couplings of the spin to the electronic modes on different wires, and analyze the renormalization group flows and fixed points for different values of the initial Kondo couplings and of the junction S-matrix (such as the decoupled S-matrix and the Griffiths S-matrix). We generally find that the Kondo couplings flow towards large and antiferromagnetic values in one of two possible ways. For the Griffiths S-matrix, we study one of the strong coupling flows by a perturbative expansion in the inverse of the Kondo coupling; we find that at large distances, the system approaches the ferromagnetic fixed point of the decoupled S-matrix. For the decoupled S-matrix with antiferromagnetic Kondo couplings and weak inter-electron interactions, the flows are to one of two strong coupling fixed points in which all the channels are strongly coupled to each other through the impurity spin. But strong inter-electron interactions, with K_\rho < N/(N+2), stabilize a multi-channel fixed point in which the coupling between different channels goes to zero. We have also studied the temperature dependence of the conductance at the decoupled and Griffiths S-matrices.Comment: Revtex4, 16 pages including 6 figure

Spontaneous urinary bladder perforation as a cause of recurrent, progressive ascites with multiorgan dysfunction syndrome

Spontaneous rupture of the urinary bladder wall is a rare complication that may lead to intraperitoneal accumulation of urine and is mistaken for ascites from other causes. This often leads to repeated and inconclusive diagnostic tests. Here, we report the case of a 60-year-old female, with a past history of cervical cancer, who presented with recurrent episodes of pain abdomen and breathlessness over 1 year period. She was hospitalized multiple times and found to have ascites. Ultrasound and computed tomography scan of the abdomen along with an ascitic fluid analysis were done at each admission, which were inconclusive as to the cause of the ascites. A diagnostic laparoscopy to rule out peritoneal metastases showed perforation of the urinary bladder wall with intraperitoneal urine leakage. Bladder wall repair was done the following which the patient recovered uneventfully

Study of sleep problems and their association with scholastic performance in school going children

Background: Sleep is an integral part of any healthy individual and sleep problems can affect the intellectual abilities including theperformance at school. Objectives: We studied the sleep problems among school going children in the age group of 6-16 years and theassociation of the sleep problems with scholastic performance in them. Materials and Methods: The study was a cross-sectional studycarried out in students attending a private school. The children were given a questionnaire based on the “BEARS” screening tool forsleep problems in children to be filled by children and parents. Accordingly, the age and academic grades of students were recorded.The prevalence of sleep problems and their relation to school grades were studied. Results: Out of 229 students, 25.33% (58) studentswere found to have sleep problems after applying the “BEARS” criteria. Of these 58 children, 31 scored A grade, 25 scored B grade, and2 scored C grade. 23% (31 out of 135) of A graders were found to have sleeping problems, 28% (25 out of 89) of B graders, and 40%(2 out of 5) of C graders had sleeping problems. Conclusion: Sleep problems were common in school going children. It was observedthat as scholastic grades decreased, the prevalence of sleeping problems increased. Sleep problems might be one of the contributors forpoor scholastic achievements in children

Bacterial Endo-Symbiont Inhabiting Tridax procumbens L. and Their Antimicrobial Potential

Bacterial symbionts inhabiting Tridax procumbens L. were screened for antimicrobial potential with the aim to isolate potent bacteria bearing significant activity against test pathogens. The selected isolate was subjected to large scale fermentation to extract antimicrobial metabolite. The organic phase was reduced under vacuum pressure and crude ethyl acetate extract (10 mg/mL) was evaluated for antimicrobial activity against panel of test pathogens. The antibacterial activity was measured as a zone of inhibition and compared with standard antibiotics, gentamicin and tetracycline. Similarly, antifungal activity was compared with miconazole and bavistin. Significant activity was conferred against Shigella flexneri (MTCC 731) with 27±1.5 mm zone across the disc. Partially, purification of antimicrobial metabolite with TLC-bioautography and HPLC resulted in active fraction bearing activity at Rf 0.65 and eluting between 4 and 5 retention times. The obtained results are promising enough for future purification and characterization of antimicrobial metabolite. Thus, the study attributes to the growing knowledge on endophytes as one of the rich sources of antimicrobial potentials

Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome

Background & AimsFew treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). A phase 3, randomized, double-blind, placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin.MethodsThe trial included adults with IBS-D, mean abdominal pain and bloating scores of 3 or more, and loose stool, located at 270 centers in the United States and Europe from February 2012 through June 2014. Those responding to a 2-week course of open-label rifaximin 550 mg 3 times daily, who then relapsed during an observation phase (up to 18 weeks), were randomly assigned to groups given repeat treatments of rifaximin 550 mg or placebo 3 times daily for 2 weeks. The primary end point was percentage of responders after first repeat treatment, defined as a decrease in abdominal pain of ≥30% from baseline and a decrease in frequency of loose stools of ≥50% from baseline, for 2 or more weeks during a 4-week post-treatment period.ResultsOf 1074 patients (44.1%) who responded to open-label rifaximin, 382 (35.6%) did not relapse and 692 (64.4%) did; of these, 636 were randomly assigned to receive repeat treatment with rifaximin (n = 328) or placebo (n = 308). The percentage of responders was significantly greater with rifaximin than placebo (38.1% vs 31.5%; P = .03). The percentage of responders for abdominal pain (50.6% vs 42.2%; P = .018) was significantly greater with rifaximin than placebo, but not stool consistency (51.8% vs 50.0%; P = .42). Significant improvements were also noted for prevention of recurrence, durable response, and bowel movement urgency. Adverse event rates were low and similar between groups.ConclusionsIn a phase 3 study of patients with relapsing symptoms of IBS-D, repeat rifaximin treatment was efficacious and well tolerated. ClinicalTrials.gov ID: NCT01543178