Clinical and biochemical profile of hyponatremia and the role of vaptans in comparison to other standard modalities of therapy

Background: This study, conducted from August 2014 to August 2015, investigated hyponatremia in 228 in-hospital patients, aiming to discern its clinical and biochemical features and compare the efficacy of vaptans against standard treatments. The null hypothesis assumed no significant disparity in outcomes, while the alternate hypothesis posited otherwise. Methods: Using an open-label, non-blinded, observational, prospective comparative design, we assessed 228 hyponatremia patients. We scrutinized their clinical and biochemical profiles and made comparisons between moderate and profound hyponatremia cases, along with different treatment approaches. Results: Our findings revealed that patients aged 61-80, primarily females, dominated the cohort. Moderate hyponatremia occurred in 56.6% of cases, with severe hyponatremia in 43.4%. Common symptoms included drowsiness, nausea, and vomiting. Euvolemic hyponatremia was predominantly due to SIADH, while heart failure led to most hypervolemic cases. Various treatments were employed, with fluid restriction and normal saline being common. Tolvaptan and 1.6% hypertonic saline significantly increased serum sodium levels at 24 and 48 hours. Hospital stay duration didn’t significantly differ, and no osmotic demyelination cases emerged. Mortality stood at 10.5%, notably higher in profound hyponatremia cases. Conclusions: This study provides insights into hyponatremia’s clinical and biochemical aspects and compares vaptans to standard treatments. Tolvaptan and hypertonic saline displayed promise in raising serum sodium levels. Nevertheless, further research is warranted to validate these findings and explore additional factors impacting hyponatremia treatment outcomes

PARVIMONAS MICRA AND FUSOBACTERIUM NUCLEATUM SEPTIC ARTHRITIS: A RARE ANAEROBIC DOUBLE TROUBLE

Septic arthritis is a condition initiated by pathogenic inoculation of joints either by direct or hematogenous route, necessitating immediate medical attention. Among aerobic bacteria, Staphylococcus aureus and Streptococcus spp. are commonly found in association with septic joints. Anaerobes are very rarely involved in the causation of septic arthritis with an estimated rate of <1%. We are presenting a case of septic arthritis of knee joint by Parvimonas micra and Fusobacterium nucleatum, both being constituents of microbial flora in the oral cavity and gastrointestinal tract. Gram stain and anaerobic culture incorporated along with the aerobic culture of synovial fluid have played an important role in the preliminary diagnosis of anaerobic septic arthritis in this case

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

A review of histopathological and immunohistochemical parameters in diagnosis of metastatic renal cell carcinoma with a case of gingival metastasis

The oral cavity constitutes a site of low prevalence for metastasis of malignant tumors. However, oral metastasis of a renal origin is relatively more common and represents 2% of all cancer deaths. Renal cancer may metastasize to any part of the body, with a 15% risk of metastasis to the head and neck regions, and pose one of the greatest diagnostic challenges in medical sciences. Approximately 25% of patients have a metastatic disease at initial assessment, which is often responsible for initiating the diagnosis in the first place. Here we present a review of literature of renal cell carcinoma along with a case of gingival metastasis

Evaluating Different Counter Stains in Fluorescent Staining Technique for Detecting Acid Fast Bacilli: Best Amongst The Better

Tuberculosis is a global emergency needing an early and accurate diagnosis for management and control. Smear microscopy is a rapid diagnostic method for detecting acid fast bacilli (AFB) and improvising this method would contribute in better detection rates. The present study compares the efficacy of various counter stains used in Auramine O staining method in examining sputum smears under fluorescence microscope. This was a prospective study conducted in the Department of Microbiology from January to March, 2017. 102 sputum specimens were collected during this period from patients clinically suspected with pulmonary tuberculosis. Five smears were prepared from each specimen, where each smear was stained with Auramine O staining technique using five different counter stains, 0.1% potassium permanganate, 0.1% methylene blue, 0.1% toluidine blue, 0.1% malachite green and undiluted blue ink. Among the 102 sputum specimens, 50(49.01%), 50(49.01%), 49(48.03%), 44(43.13%) and 48(47.05%) smears showed positive results using potassium permanganate, methylene blue, toluidine blue, malachite green and blue ink respectively. On comparing the degree of fluorescence exhibited by debris in these smears, using potassium permanganate, methylene blue, toluidine blue, malachite green and blue ink, fluorescence was observed in 22(21.6%), 11(10.8%), 46(45.1%), 0(0%) and 31(30.4%) smears respectively. When the counter stains were analyzed, there was a statistically significant difference for debris getting fluoresced (p<0.001). In conclusion, methylene blue as a counter stain has almost equivalent effect compared to routinely used potassium permanganate. It has shown to have the best sensitivity and specificity, reduced debris fluorescence and better contrast in appreciating AFB

Antimicrobial Susceptibility Profile of Clinical Isolates of Peptostreptococcus anaerobius

Gram-positive anaerobic cocci (GPAC) which are commonly known as Peptococci or Peptostreptococci belong to the genus Peptostreptococcus. Peptostreptococcus anaerobius is one of the most common GPAC known to be associated with infections of the abdominal cavity and the female genitourinary tract. The present study aims at determining the antimicrobial susceptibility profile of P. anaerobius isolates against various antimicrobials. This study was conducted over a period of three years from January 2015 to December 2017 in the Department of Microbiology of a tertiary care teaching hospital. Specimens like pus aspirates, soft tissue and body fluids were included in the study. P. anaerobius isolates were identified by standard methods and confirmed by automated mass spectrometry. Minimum inhibitory concentration was determined by the reference agar dilution method for different anti-anaerobic agents. A total of 30 P. anaerobius isolates were obtained from various infections with majority (n=21, 70%) of the isolates being recovered from infections of the anatomical sites below the waistline. All isolates showed excellent anti-anaerobic activity against metronidazole, penicillin G, cefoxitin and chloramphenicol. Clindamycin resistance was noted in 53.3% (n=16) of P. anaerobius isolates. None of the isolates were b-lactamase producers. Metronidazole which is considered as the empirical therapy of choice for anaerobic infections was found to have excellent activity. Significant resistance was noted towards clindamycin which is commonly used as an alternative to metronidazole in suspected anaerobic infections. Routine sensitivity testing of clinical isolates of anaerobes seems to be the need of the hour for effective patient management

Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, Udupi district, Karnataka

<b>Background:</b> India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics. <b>Objective:</b> To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital. <b>Study Design:</b> Record-based study conducted in a coastal district of Karnataka. Required data from all the laboratory confirmed cases from 2002 to 2008 were collected from Medical Records Department (MRD) and analyzed using SPSS 13.5 version. <b>Results:</b> Study included 466 patients. Majority were males, 301(64.6&#x0025;) and in the and in the age group of 15-44 years, 267 (57.5&#x0025;). Maximum number of cases were seen in 2007, 219 (47&#x0025;) and in the month of September, 89 (19.1&#x0025;). The most common presentation was fever 462 (99.1&#x0025;), followed by myalgia 301 (64.6&#x0025;), vomiting 222 (47.6&#x0025;), headache 222 (47.6&#x0025;) and abdominal pain 175 (37.6&#x0025;). The most common hemorrhagic manifestation was petechiae 84 (67.2&#x0025;). 391 (83.9&#x0025;) cases presented with dengue fever, 41 (8.8&#x0025;) dengue hemorrhagic fever, and 34 (7.3&#x0025;) with dengue shock syndrome. Out of 66 (14.1&#x0025;) patients who developed clinical complications, 22 (33.3&#x0025;) had ARDS and 20 (30.3&#x0025;) had pleural effusion. Deaths reported were 11(2.4&#x0025;). <b>Conclusion:</b> Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases

Aggressive fibromatosis of anterior maxilla

Aggressive fibromatosis is a comparitively rare tumor with unpredictable growth and varying local recurrence rates. It does not develop distant metastases but locally it shows an aggressive and infiltrative behavior. Clinically, aggressive fibromatosis manifests as a painless, firm, often rapidly enlarging mass, fixed to underlying bone or soft tissue. It is never encapsulated. Histologically, it is rich in collagen and fibroblastic cells that are devoid of hyperchromatic or atypical nuclei, but with more variable cellularity in different tumor sections