An unusual presentation of vulvar cavernous hemangioma in a 10-year-old premenarchal girl: a rare entity

Vascular tumors of the female genitalia are unusual. Hemangiomas are benign tumors of the blood vessels. Usually they are asymptomatic but may present as discomfort, pain and other symptoms. However, vulvar cavernous hemangioma can be seen in newborns and infants, but rarely occur in children and adult women. A 10-year old premenarchal girl presented with a painless swelling on her right labia majora since birth which was increasing gradually. On examination, a well-defined, soft, mobile and non-tender multicystic swelling was observed involving right labia majora and minora of approximately 5×6 cm in size. An ultrasound of the lesion showed a well-circumscribed, hypo echoic mass with multicystic lesion of size 40×14×44 mm arising from right labia majora with vascularity on color Doppler and venous flow on spectral pattern, suggestive of vascular malformation. Surgical excision of lesion was performed with the utmost care to preserve the surrounding healthy tissue and vulvar anatomy. Histopathological examination (HPE) report confirmed the diagnosis of a cavernous hemangioma with no evidence of malignancy. Vulvar cavernous hemangioma is an uncommon vascular tumor that can be rarely seen in pediatric patients. Imaging studies, such as ultrasound and magnetic resonance imaging (MRI), play a crucial role in confirming the diagnosis and guiding the management. Surgical excision with preservation of healthy tissue is the treatment of choice. Long-term follow-up is essential to monitor recurrence and patient's well-being

Emergence of resistance to linezolid in methicillin resistant Staphylococcus haemolyticus reported from the sub Himalayan region of India

The spread of resistance among coagulase negative Staphylococci against major drugs is alarming as it limits the treatment options for serious infections. Resistance to linezolid in these organisms is emerging and further compounded by being observed in multidrug resistant strains. It is the only antibiotic available as an oral formulation for resistant Staphylococcal infections and due to the presence of a novel structure and unique mechanism of action, it does not display cross resistance with other classes of antimicrobial agents. However, the widespread use of Linezolid has gradually turned the impending fear of emergence of resistance against this novel drug into a reality. Herein we report a case of sepsis due to methicillin resistant Staphylococcus haemolyticus in a 16-year-old male child found resistant to linezolid, rarely reported from Sub Himalayan region of Indian sub-continent

Uterine leiomyoma presenting with unusual pathological features: a series of two cases

Leiomyomas are benign and most common smooth muscle neoplasms that can occur in any organ, most commonly in uterus, small bowel and esophagus. Leiomyomas may have unusual presentations either in form of location or various secondary changes like hyaline, myxoid, red degeneration, chondroid metaplasia, sarcomatous change, etc. We present two unusual cases of leiomyomas, one involving an unusual location (giant cervical fibroid) and the other a uterine leiomyoma with rare pure chondroid metaplasia. Both these entities are rare and hold importance in the differential diagnosis because it is imperative to differentiate the giant cervical fibroid from any ovarian neoplasm or procidentia and chondroid metaplasia from any other mesenchymal/mixed uterine tumor. Moreover giant leiomyomas require expert hands during surgical removal

Minimum wages and their role in the process and incentives to bargain

The study is based on four sources of data: (a) a survey of over 11,500 non-public sector organisations, (b) quantitative analysis of over 25,000 enterprise agreements, (c) qualitative analysis of 91 strategically selected agreements; and (d) 20 workplace case studies. Key findings (indicative) Organisations commonly used a number of pay-setting arrangements for their employees, with individual arrangements (at 65 per cent of organisations) and award based arrangements (52 per cent) the most common. The quantitative analysis of enterprise agreements found that that there may be a positive association between wage increases in enterprise agreements and Annual Wage Review increases. This was particularly the case for industries with higher proportions of agreements paying low wage increases and with a large number of award-reliant employees. The qualitative analysis of agreements identified the importance of distinguishing between agreements that are ‘award-reliant’, ‘slightly above award’ (i.e. pay modest over-awards) and ‘over-award’ (i.e. pay substantial amounts more than the award).  External relativities (i.e. differences in pay for exemplar or reference classifications common across employers) were dispersed among all industries considered. Internal relativities within agreements were very similar to those in their related awards. The case studies found little direct impact of Annual Wage Review decisions on wage outcomes or pay-setting processes – they are best conceived as third order factors shaping both. Conclusion While the direct impact of Annual Wage Review decisions was perceived to be limited at the work sites studied, this is not the whole story. The analysis of agreements revealed that there may be positive significant associations between Annual Wage Review increases and agreement content. The workplace cases in general, and the relativities analysis in particular, revealed that awards profoundly shape wage outcomes and the wage determination process.  In particular, the agreement and case study findings highlighted the importance of not conceiving the different pay-setting arrangements in mutually exclusive terms. If the Annual Wage Review increases examined are conceived as being part of an ongoing evolution of the award system, then their impact is better understood as being very significant, primarily because such increases are an integral part of labour standard regime that conditions workplace behaviour and shapes wage outcomes. This appears to be especially the case in those parts of the labour market paying below median wages

Association of trisomy 21 with anorectal malformation: a cytogenetic study

Background: Anorectal malformations (ARM) are congenital malformations of digestive system resulting from the disturbed development of hindgut during embryogenesis. ARMs involve both sexes; can occur either isolated or in association with other congenital abnormalities and may be associated with chromosomal abnormalities. Association of trisomy 21 with anorectal malformation is well documented. Present study was conducted to assess prevalence of association of trisomy 21 in patients with anorectal malformation.Methods: Total 48 children with diagnosis of anorectal malformation, who were admitted in Department of Paediatric Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, were selected for the study. Blood samples were collected and their cytogenetic analysis was carried out in the Cytogenetics laboratory, Department of Anatomy, KGMU-U.P, Lucknow, India.Results: Among the 48 study subjects, karyogram could be successfully obtained for 45 cases (93.75%). Numerical anomalies were observed in 8.9% cases. Trisomy 21 was found in 6.7%. The prevalence of trisomy 21 was found to more in males (4.5%) as compared to females (2.2%). Prevalence was highest in birth order 3(20%), followed by birth order 2(7.14%) and lowest in birth order 1(3.85%). Trisomy in association with ARM; was observed in children born to females aged >30 years. It was found unrelated to the history of consanguinity.Conclusions: Prevalence of association of trisomy 21 with ARM was found to be 6.7%. This coexistence emphasizes the need for a thorough investigation of patients with ARM

Fixed drug eruptions: causing drugs, pattern of distribution and causality assessment in a leading tertiary care hospital

Background: It is bitter truth that there is no drug in this world which is without an adverse drug reaction (ADR). After the clinical trials when the drug comes in market or when it is taken by variety of population then actual reality of the drug comes out about its efficacy and adverse drug reactions. Fixed drug eruption is also one such type of ADR in which a specific type of lesions occurs over the skin after the drug is taken.Methods: We have conducted a clinical, observational study, in BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana, India over a period of eight months. In that period we have found 159 patients having adverse drug reactions. Patients of both genders, under all age group were included in the study.Results: Out of 159 adverse drug reactions reports 69 (43.39%) were cutaneous adverse drug reaction report, 45 (28.30%) cases were of fixed drug eruption (FDE). Out of these 45 cases seen, there were 4 males (8.88%) and 41 females (91.11%). Flouroquinolone antibiotics like ciprofloxacin, ofloxacin and norofloxacin were the most common drugs causing fixed drug eruption followed by nitroimadazole antibiotic like metronidazole, tinidazole and NSAIDS like diclofenac, paracetamol and meftal spas in our study. FDE are more common in upper limbs extremities followed by lower limb extremities than face and trunk. Causality assessment was done with the help of WHO UMC scale and we found that association was possible in all the cases.Conclusions: Fixed drug eruptions are one of the major types of adverse drug reactions and should be assessed and reported

Determining factors influencing cloud services adoption in India

This study identifies the factors influencing cloud services adoption in India using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Role of perceived risk as a moderator in adoption of cloud services, too, has been examined along with other moderators such as gender, age, experience and voluntariness of use as stated in UTAUT model. Following a descriptive research design, a survey was conducted and a structured questionnaire was administered randomly to a sample of 379 respondents in Dehradun region. Most of the relationships confirmed to UTAUT model. Performance expectancy and effort expectancy emerged as the two most significant factors influencing cloud services adoption. Perceived risk, too, played a significant moderating role in adoption of cloud services. Cloud based services are relatively new to consumers in India. The benefits of these cloud technology can only be reaped fully if more and more customers adopt it. Also, various types of risks, such as financial loss, data loss, privacy etc., are associated with using cloud services. Therefore, this study may have immediate implications for cloud service providers

Inflammation-induced Id2 promotes plasticity in regulatory T cells

T(H)17 cells originating from regulatory T (T-reg) cells upon loss of the T-reg-specific transcription factor Foxp3 accumulate in sites of inflammation and aggravate autoimmune diseases. Whether an active mechanism drives the generation of these pathogenic 'ex-Foxp3 T(H)17' cells, remains unclear. Here we show that pro-inflammatory cytokines enhance the expression of transcription regulator Id2, which mediates cellular plasticity of T-reg into 'ex-Foxp3' T(H)17 cells. Expression of Id2 in in vitro differentiated iT(reg) cells reduces the expression of Foxp3 by sequestration of the transcription activator E2A, leading to the induction of T(H)17-related cytokines. T-reg-specific ectopic expression of Id2 in mice significantly reduces the T-reg compartment and causes immune dysregulation. Cellular fate-mapping experiments reveal enhanced T-reg plasticity compared to wild-type, resulting in exacerbated experimental autoimmune encephalomyelitis pathogenesis or enhanced anti-tumor immunity. Our findings suggest that controlling Id2 expression may provide a novel approach for effective T-reg cell immunotherapies for both autoimmunity and cancer.11sciescopu

Changes in morphology of white blood cells on peripheral smear in COVID-19 infection

Background: COVID-19 is an infectious disease caused by a newly discovered coronavirus, and has spread around the world in a deadly pandemic. The first case of COVID-19 was reported from Wuhan, China in December 2019. This is also called as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of its homology with SARS virus. The most common hematological manifestation of coronavirus is lymphopenia which is due to depletion of lymphocytes by coronavirus infection. Other manifestations are neutrophilia and mild thrombocytopenia. Literature is full of quantitative hematological parameters but the researches on morphology of white blood cells is still ongoing. We at our institute done study on 60 confirmed positive cases of COVID-19, and analyzed those peripheral smears in terms of morphology of white blood cells.Methods: The study was done using peripheral smear staining with methylene blue stain and was screened for various changes in white blood cells in peripheral smear.Results: Changes in the white blood cells were examined in the peripheral smear and findings were made in the tabular form.Conclusions: To conclude that all these changes are due to the virus infecting them or are secondary to pathogenesis of COVID disease, needs to be evaluated by larger studies

Minocycline, levodopa and MnTMPyP induced changes in the mitochondrial proteome profile of MPTP and maneb and paraquat mice models of Parkinson's disease

AbstractMitochondrial dysfunction is the foremost perpetrator of the nigrostriatal dopaminergic neurodegeneration leading to Parkinson's disease (PD). However, the roles played by majority of the mitochondrial proteins in PD pathogenesis have not yet been deciphered. The present study investigated the effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and combined maneb and paraquat on the mitochondrial proteome of the nigrostriatal tissues in the presence or absence of minocycline, levodopa and manganese (III) tetrakis (1-methyl-4-pyridyl) porphyrin (MnTMPyP). The differentially expressed proteins were identified and proteome profiles were correlated with the pathological and biochemical anomalies induced by MPTP and maneb and paraquat. MPTP altered the expression of twelve while combined maneb and paraquat altered the expression of fourteen proteins. Minocycline, levodopa and MnTMPyP, respectively, restored the expression of three, seven and eight proteins in MPTP and seven, eight and eight proteins in maneb- and paraquat-treated groups. Although levodopa and MnTMPyP rescued from MPTP- and maneb- and paraquat-mediated increase in the microglial activation and decrease in manganese-superoxide dismutase expression and complex I activity, dopamine content and number of dopaminergic neurons, minocycline defended mainly against maneb- and paraquat-mediated alterations. The results demonstrate that MPTP and combined maneb and paraquat induce mitochondrial dysfunction and microglial activation and alter the expression of a bunch of mitochondrial proteins leading to the nigrostriatal dopaminergic neurodegeneration and minocycline, levodopa or MnTMPyP variably offset scores of such changes