Kimura disease

Kimura disease is a rare inflammatory disorder of unknown cause, primarily seen in young Asian males. The disease is characterized by painless subcutaneous swelling, blood and tissue eosinophilia. We describe a 37year old Asian male with Kimura disease who presented with multiple subcutaneous swelling. The diagnosis was based on the characteristic histopathologic findings after surgical excision in conjunction with peripheral eosinophilia

Cytomorphological study of lymph node lesions: A study of 187 cases

Introduction: As components of peripheral or secondary lymphoid organs, lymph nodes are an important part of immune system. Their enlargement is noted in a wide spectrum of diseases, including infections and malignancy, they are a common finding in clinical practice. Therefore, peripheral lymphadenopathy is common in all age groups and management of cases depends on lymph node pathology, which can be studied by collecting material through fine-needle aspiration or excision biopsy. Objectives: The study was undertaken to assess the cytomorphological features and incidence of various lymph node diseases on fine-needle aspiration cytology (FNAC) and to analyze the utility and diagnostic importance of FNAC in lymph node diseases. Materials and Methods: In the study total of 187 patients were selected who had presented with lymph node enlargement at Department of Pathology in our Tertiary Care Centre. Results: Reactive lymphoid lesions comprised the majority (33.69%) followed by tubercular lymphadenitis, metastatic malignancies, acute suppurative lymphadenitis, and lymphomas, respectively. Conclusion: Reactive lymphoid and tubercular lesions were the most common among the lymph node swellings presentations. FNAC is a simple, safe, reliable, and inexpensive method in early detection of lymph node lesions, which has been proven once again in this study

Pharmacological Overview for Therapy of Gout and Hyperuricemia

Hyperuricemia & gout are disease conditions marked by over production and reduced excretion of uric acid. These conditions are linked with unhealthy lifestyle, Hypertension, Diabetes Mellitus, Metabolic syndrome, Cardiovascular & Chronic renal disease. Thus controlling & monitoring uric acid level becomes important. Development in the technology have led to greater insights into the pathophysiology of gout & hyperuricemia. Now we have a better understanding of involvement of interleukin 1β in inflammatory process of gout. Thus with better understanding newer therapeutic targets are being explored for treatment of gout & hyperuricemia. The armamentarium of drugs being used in therapy of acute gout here been expanded with recent addition by interleukin-1 inhibitors especially for refractory patients and patients with comorbidities.  As these new therapies are evolving we need to focus on improving the use of Allopurinol through patient education and training of physicians in order to minimize development of Allopurinol hypersensitivity syndrome (AHS). Further pretesting of Human leukocyte Antigen- B ( HLA-B*5801*) should be considered in Asian population. Febuxostat being critically new drug needs cautious approach, proper education of patients and Adverse Drug Reaction (ADR) reporting. With entry of Pegloticase there is a new class of drug added for treating hyperuricemia.&nbsp

Fine needle aspiration cytology in the diagnosis of Tuberculous lymphadenitis and utility of Ziehl Neelsen stain benefits and pitfalls

Introduction: In a developing country like India, tuberculous lymphadenitis is one of the most common presentations at OPDs. However, anti-tubercular treatment cannot be administered only on clinical suspicion. Cytomorphology with acid fast staining proves to be a valuable tool in diagnosing these cases along with culture. The study was undertaken to study the utility, limitations of fine needle aspiration cytology and various cytomorphological presentations in reference to Ziehl-Neelsen staining in tuberculous lymphadenitis and correlate the culture findings. Methods: The study was conducted for duration of two years with total of 170 cases at a tertiary care centre. The patients with clinically suspected lymphadenopathy were selected. Results: The incidence of tuberculous lymphadenitis was 68.8%. Overall AFB positivity was 64.1 %. Epithelioid cell granulomas with lymphocytes were the most common cytological picture and cases showing necrosis had highest AFB positivity. Maximum patients presented in second to fourth decade of life. Cervical region was the most common site of involvement with solitary lymphadenopathy as the most common presentation in contrast to matted lymph nodes as reported by others. Conclusion: Yet again Fine needle aspiration cytology is a safe, cheap and reliable procedure requiring minimal instrumentation and is highly sensitive to diagnose tuberculous lymphadenitis. The diagnostic index can be further increased by complementing cytomorphology with acid fast staining and culture techniques. However FNAC complimented with techniques like ELISA and PCR would give better dimensions to the current scenario of diagnosis and treatment modalities

Study of sideroblasts and iron stores in bone marrow aspirates using Perls′ stain

Introduction: A bone marrow examination is a critical part of the evaluation of patients with a variety of hematopoietic and nonhematopoietic diseases. A Perls′ or Prussian blue stain demonstrates hemosiderin in bone marrow macrophages and iron within sideroblasts. Examination of iron stain allows detection not only of an increased or decreased proportion of sideroblasts but also of abnormal sideroblasts. We undertook this study to evaluate the iron stores in bone marrow as judged by Perls′ stain. Materials and Methods: A Prospective analysis of 55 bone marrow aspirates in a tertiary care center. Results: Sideroblasts were present in all the cases. They were decreased in iron deficiency anemia (IDA), and few other chronic diseases whereas normal to increase in megaloblastic anemia. According to Gale′s method, cases of IDA had absent or decreased iron stores while those of megaloblastic anemia or normoblastic marrows showed normal to increased stores. Grading by the recent intensive method showed combined functional and iron stores deficiency. Conclusion: Perls′ stain on bone marrow aspirates is an important tool not only for assessing the iron stores, increased or decreased but also to study abnormal sideroblasts

The Art of Sim-Making: What to Learn from Film-Making

The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, Writing Powerful Narratives, depiction of emotional elements, specific industry-driven developments as well as the cultural considerations in both. For medical simulation and simulation-based education, the corresponding stages are as follows: DevelopmentPreproductionProductionPostproduction andDistribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt from the film-making process in cinematography and storytelling. Both film-making and sim-making can be seen from the artistic perspective as starting with a large piece of blank, white sheet of paper, which will need to be colored by the artists and personnel involved; in the former, to come up with the film and for the latter, to engage learners and ensure learning takes place, which is then translated into action for patients in the actual clinical care areas. Both entities have to go through a series of systematic stages. For film-making, the stages are as follows: Identification of problems and needs analysisSetting objectives, based on educational strategiesImplementation of the simulation activityDebriefing and evaluation, as well asFine-tuning for future use and archiving of scenarios/cases

The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper.

What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article\u27s publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a “new normal” are discussed in this article