A Case of Multiple Myeloma Presenting with Diabetes Insipidus

Multiple myeloma (MM) can present with involvement of the central nervous system in the form of nerve palsy, plasma cell masses or, rarely, with endocrinological effects due to involvement of the pituitary gland. Usually, in such cases, the disease has a rapid progression and poor prognosis. We report a 52-year-old man who was admitted to the Kolkata Medical College, Kolkata, India, in 2016 with a prolonged low-grade fever and hypernatremia. Shortly afterwards, the patient began to complain of increased urinary frequency and drowsiness. The hypernatremia was treated with intranasal desmopressin and free water replacement. Serum protein electrophoresis and an immunofixation study revealed an immunoglobulin G-κ monoclonal band. Magnetic resonance imaging of the pituitary gland revealed the absence of a posterior bright spot and spotty infiltration of the pituitary fossa. A bone marrow biopsy confirmed a diagnosis of cranial diabetes insipidus due to posterior pituitary MM infiltration.

Study of Retinal Nerve Fibre Layer Thickness and Visual Contrast Sensitivity in HIV Positive Individuals

INTRODUCTION

Measurement of Retinal Nerve Fibre Layer Thickness (RNFLT) by Optical Coherence Tomography (OCT) is a sensitive, non invasive and cheap method of detecting early retinal changes in a variety of diseases. In HIV infection, RNFLT is altered and this may have effect on other visual functions like Contrast Sensitivity (CS) and visual acuity. Such ocular pathology can affect the daily life and profession (especially driving) of HIV infected individuals. However, studies on this topic in HIV infected population are rare from India.

AIM

To study RNFLT, CS and their correlation in a sample of HIV positive Indian population.

MATERIALS AND METHODS

The present cross-sectional study was done in a tertiary care medical college hospital of Eastern India between May 2016 and September 2016. We did this study on HIV positive subjects with no clinically apparent ocular infection or other pathology. In this study, we have measured the RNFLT using the HRA-OCT Spectralis machine. The CS was tested using a smartphone version of the Pellie-Robson chart. CD4 count, visual acuity and colour vision were also tested. The data was analysed using SPSS version 20.0 for any correlation between these parameters. Pearson coefficient was used for continuous data and Spearman rank correlation was used for categorical data. A p-value <0.05 was considered significant.

RESULTS

We had 17 patients, that is 34 eyes. RNFLT loss was found in 21% of the eyes and borderline thinning was found in a further 26%. Predominantly, the temporal quadrant was involved. The mean of log CS was 1.33±0.38. Taking 1.5 as the cut-off value for normalcy, 47% of the eyes tested showed decreased CS. Log CS showed significant correlation with RNFLT of the temporal quadrant only (r=0.37; 95% C.I. 0.041 to 0.631; p=0.02). Temporal RNFLT also showed statistical correlation with the CD4 count. The low CS was also significantly correlated with low visual acuity (r=0.5).

CONCLUSION

In HIV infected persons, subtle ocular changes may occur and this may affect visual functions quite early. Hence, a comprehensive eye check-up should include parameters like CS and OCT.

Non-puerperal Acute Uterine Inversion

Non-puerperal acute inversion of uterus is a rare complication that occurs as a complication of intra uterine tumors, especially big sub mucous leiomyoma. It is so rare that many gynecologists may not encounter such a case in their life time professional carrier. This condition causes severe pain, vaginal bleeding and shock. Management consists of manual reposition through cervical ring or surgical corrective measures. We report a case of acute uterine inversion in a 42 years lady due to big sub mucous fibroid. This case was initially managed by vaginal myomectomy then uterus was repositioned by Haultain’s technique, which was abdominal hysterectomy. DOI: http://dx.doi.org/10.3126/njog.v9i1.11190 NJOG 2014 Jan-Jun; 2(1):58-60

Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome

Background/Context:

Antiplatelet drug resistance increases the risk of adverse events like stent thrombosis in acute coronary syndrome (ACS). Metabolic syndrome (MS) is a prothrombotic state and presence of MS further increases the risk of antiplatelet drug resistance.

Aims and Objectives:

We studied platelet aggregation characteristics in patients of ACS for aspirin or clopidogrel resistance. We studied the relation of drug resistance with blood markers like high sensitivity C-reactive protein (hsCRP). We also studied for any relation of drug resistance with presence of MS.

Materials and Methods:

We studied platelet aggregation characteristics by optical aggregometry using platelet-rich plasma (PRP) of patients. Collagen (2 μg/mL) and adenosine diphosphate (ADP; 10 μmol) were used. Greater than 50% aggregation in PRP of patients was taken as an evidence of drug resistance. Suitable blood tests were done including newer risk markers like hsCRP, apolipoprotein B, and fibrinogen.

Statistical test:

Statistical tests included Student's t-test and Kendall's rank correlation coefficient.

Results:

We had a total of 94 patients of ACS with 47 (50%) having MS. MS patients showed higher blood levels of hsCRP and fibrinogen. Twenty-eight (59.5%) patients with MS showed antiplatelet drug resistance compared to 12 patients without MS. Serum fibrinogen showed strongest correlation with drug resistance. HsCRP levels showed correlation with aspirin resistance (r = 0.53) only in the MS group.

Discussion and Conclusion:

We found significantly high prevalence of antiplatelet drug resistance. Aspirin and clopidogrel resistance was comparable. MS was a significant risk factor for drug resistance. The prothrombotic and proinflammatory markers showed strong correlation with drug resistance. A larger randomized trial is needed to better characterize this clinical problem.

Quercetin induces cytochrome-c release and ROS accumulation to promote apoptosis and arrest the cell cycle in G2/M, in cervical carcinoma: signal cascade and drug-DNA interaction

OBJECTIVES

Small aromatic compounds like flavonoids can intercalate with DNA molecules bringing about conformational changes leading to reduced replication and transcription. Here, we have examined one dietary flavonoid, quercetin (found in many fruit and vegetables), for possible anti-cancer effects, on HeLa cells originally derived from a case of human cervical cancer.

MATERIAL AND METHODS

By circular dichroism spectroscopy we tested whether quercetin effectively interacted with DNA to bring about conformational changes that would strongly inhibit proliferation and migration of the HeLa cells. Cytotoxic effects of quercetin on cancer/normal cells, if any, were determined by MTT assay and such depolarization of mitochondrial membrane potential, as a consequence of quercetin treatment, and accumulation of reactive oxygen species (ROS) also were studied, by FACS analysis and expression profiles of different anti- and pro-apoptotic genes and their products were determined.

RESULTS

Quercetin intercalated with calf thymus cell DNA and HeLa cell DNA and inhibition of anti-apoptotic AKT and Bcl-2 expression were observed. Levels of mitochondrial cytochrome-c were elevated and depolarization of mitochondrial membrane potential occurred with increase of ROS; upregulation of expression of p53 and caspase-3 activity were also noted. These alterations in signalling proteins and externalization of phosphotidyl serine residues were involved with initiation of apoptosis. Reduced AKT expression suggested reduction in cell proliferation and metastasis potential, with arrest of the cell cycle at G2/M.

CONCLUSION

Quercetin would have potential for use in cervical cancer chemotherapy.

The abuse of multiple gastrointestinal antibiotics: a case report

The abuse of non dependence producing substances has been rarely reported. However, this can be a significant social problem and it may complicate psychiatric disorders like the anxiety states. We are reporting here, a case of the prolonged abuse of multiple gastrointestinal antibiotics like metronidazole, mebendazole and albendazole. The patient had fortunately not developed any overt toxicity from the overuse of these drugs. He was diagnosed with the generalized anxiety disorder with the anankastic personality disorder. He responded favourably to paroxetine and is being maintained on psychotherapy. As far as we know, this is probably the first report of this kind of abuse from India.

Study of C reactive protein as a prognostic marker in malaria from Eastern India

Background:

C-reactive protein (CRP) is useful as marker of severity in malaria. African studies have shown that serum CRP levels correlate with parasite burden and complications in malaria, especially falciparum. However, there are very few data on CRP levels in Indian malaria patients.

Materials and Methods:

We assessed CRP levels in malaria patients at presentation and studied for any relation of CRP levels with subsequent prognosis. Statistical tests included student's t-test, Mann Whitney U test, and chi square test, all with 2-tailed analyzes.

Results:

Of 71 patients in our study, 42 (59.1%) were infected with P. falciparum. 23 (32.4%) patients needed admission and 10 (14.1%) died. Average CRP levels were quite high in malaria patients (31.29 ± 20.4 mg/L). There was no significant difference in CRP between vivax and falciparum cases. Admitted patients had significantly higher CRP levels compared to those treated on outdoor basis (47.11 ± 19.13 vs. 23.71 ± 16.35 mg/L; P < 0.0001). 8 patients were admitted with multiple complications. They had significantly high CRP level compared to those with 1 complication (P = 0.015). Also, patients who died had higher CRP levels compared to survivors (P = 0.000346). CRP levels at presentation showed positive correlation with duration of hospital stay (r = 0.59; P < 0.05). CRP levels >35 mg/L was highly sensitive in predicting mortality.

Conclusion:

Our study in Indian population corroborates the findings in African studies regarding prognostic role of CRP in malaria. CRP is an effective biomarker in assessing malaria severity and also for follow-up.

Generation and dose distribution measurement of flash x-ray in KALI-5000 system

Flash x-ray generation studies have been carried out in KALI-5000 Pulse power system. The intense relativistic electron beam has been bombarded on a tantalum target at anode to produce flash x-ray via bremsstrahlung conversion. The typical electron beam parameter was 360 kV, 18 kA, and 100 ns, with a few hundreds of A/cm(2) current density. The x-ray dose has been measured with calcium sulfate:dysposium (CaSO(4):Dy) thermoluminescent dosimeter and the axial dose distribution has been characterized. It has been observed that the on axis dose falls of with distance approximately 1/x(n), where n varies from 1.8 to 1.85. A maximum on axis dose of 46 mrad has been measured at 1 m distance from the source. A plastic scintillator with optical fiber coupled to a photomultiplier tube has been developed to measure the x-ray pulse width. The typical x-ray pulse width varied from 50 to 80 ns.

Characterization and analysis of a pulse power system based on Marx generator and Blumlein

A pulse power system (1 MV, 50 kA, and 100 ns) based on Marx generator and Blumlein pulse forming line has been studied for characterization of a general system. Total erected Marx inductance and series resistance are calculated from modular testing of Marx generator and testing of Marx generator with Blumlein. The complete pulse power system has been tested with the termination of a liquid resistor load for finding the Blumlein characteristic impedance. Equivalent electrical circuits during the charging and discharging of the Blumlein are constructed from the characterized parameters of the system. These equivalent circuits can be used in the analysis of prepulse voltage and droop in the flat top of the main pulse in the pulse power systems based on Marx generator and Blumlein.

A case of disseminated hydatidosis

A young lady initially found to have hydatid cysts in the lung only, subsequently within a very short period was found to develop cysts in the liver. Soon after, she developed cysts in the subcutaneous tissue over the anterolateral chest wall, which, on investigation, revealed hepatic cysts herniating through the chest wall defects caused by previous operations. The unique features of this case include the degree of dissemination, the multiplicity of sites and the peculiar nature of herniation of the hepatic cysts into the parietes.