An unusual presentation of metastatic bone disease in a subject with Paget's disease of bone

Solid organ malignancies involving breast, prostate, and lung frequently metastasize to the skeleton. However, the occurrence of Paget's disease and metastatic bone disease in the same patient is uncommon. We report a case of a 63-year-old man who presented with back pain and a lump in the right breast. He was earlier diagnosed to have Paget's disease of bone based on characteristic skeletal radiological features, 99mTc methylene diphosphonate bone scan and elevated alkaline phosphatase, and treated with bisphosphonates, and his disease was in remission. Further evaluation revealed an underlying skeletal metastatic disease secondary to a breast malignancy. He underwent radical mastectomy with axillary node clearance, radiotherapy, and chemotherapy. In addition, he also received parenteral bisphosphonates for his skeletal metastatic bone disease

Early Detection and Aggressive Management Is a Key to Success in Management of Childhood Constipation: Aggressive Management of Childhood Constipation

Introduction: Functional constipation is an emerging problem in childhood of Indian subcontinent. If diagnosed early and managed aggressively along with lifestyle modification the success rate of disease treatment improves.Objectives:• To assess whether the pain abdomen is the early feature of constipation• To determine the relationship between good follow ups and the outcome• To determine the minimum duration of laxative therapy in management of constipation Materials and Methods: A retrospective analytical study of 150 children with constipation. Various parameters were considered namely demographic details, eating habits, clinical examination, abdominal radiographs and abdominal ultrasonography. Patients were divided into two groups based on the symptoms at the presentation. The first comparison was between constipation group vs pain abdomen group. Second comparison was between the patients with good follow-ups and bad follow-ups. The finally the duration of laxative therapy was assessed. Data was entered into Microsoft Excel and analysed using SPSS version 25. The categorical variables are presented using frequency and percentages. Chi square tests were used for statistical analysis. p<0.05 is considered as significant value for interpretation of results. Results: All the 150 patients were treated for constipation 70% showed improvement. Eighty percent of pain abdomen group patients also showed improvement in their symptoms suggesting that they might be the subset of larger constipation group. 97.1% patient with good follow-up followed the dietary advice. The study reveals that there is an association between following dietary advice and final improvement. 70.5% who followed dietary advice had good outcome irrespective of the use of regular laxatives. Most of the patients (78 %) showed the improvement with 3- 6 months of laxative therapy. Conclusion: Pain abdomen with stool stasis must be considered as early feature of constipation. Patients with better follow and good dietary habits have significant improvement. Aggressive therapy with two laxatives for 3-6 months can increase the success

COVID‐19 and preeclampsia: the unique and the mutually nonexclusive clinical manifestations

Preeclampsia (PE) is a serious, unpredictable hypertensive disorder of pregnancy present in around 8–10% of all pregnancies resulting in high rate of maternal and fetal morbidity and mortality. With the pathophysiology partially known, delivery is the only cure for PE. The disease sets due to multiple pathologic processes involving endothelial cell activation, inflammation, multiorgan damage and syncytiotrophoblast stress. Though the primary target organ is lungs in COVID-19, other systemic manifestations which include endothelial dysfunction, dysregulated angiogenesis, thrombosis, liver injury, thrombocytopenia, hypertension and kidney damage overlap with PE. COVID-19 patients show a higher incidence of PE as compared to their noninfected counterparts and vice versa. Similar pathophysiology and clinical features make differential diagnosis challenging. For effective and specific management, it is important to differentiate actual PE from COVID-19 with PE like features. There are contradictory reports about the accuracy of diagnostic tools in distinguishing PE from severe COVID-19 with PE like features. With the available data, it can only be stated that PE is a common adverse pregnancy event, which may be exacerbated by, or may exacerbate, COVID-19. Future research should focus on cohesive understanding of the pathophysiology of the clinical manifestations, and preventive strategies during pregnancy

Idiopathic Calcinosis Cutis of Nasal Dorsum

A 23-year-old lady presented with a slowly progressing firm mass on the nasal dorsum since 8 months. Her biochemical, haematological and collagen vascular disease screening tests were normal. Radiographs of the nasal bones showed a subcutaneous calcifying lesion with no evidence of nasal bone erosion. A diagnosis of idiopathic calcinosis cutis (ICC) was made. The mass was excised and soft tissue defect was augmented with silicone prosthesis. The histopathology with the haematoxylin and eosin staining and von Kossa stain confirmed the diagnosis of calcinosis cutis. This is an unusual presentation of ICC involving the nasal dorsum requiring surgery and nasal dorsal augmentation with silicone prosthesis