Manphool Singhal

A Randomized Trial of Vitamin D Supplementation on Vascular Function in CKD

Vitamin D deficiency associates with mortality in patients with CKD, and vitamin D supplementation might mitigate cardiovascular disease risk in CKD. In this randomized, double-blind, placebo-controlled trial, we investigated the effect of cholecalciferol supplementation on vascular function in 120 patients of either sex, aged 18-70 years, with nondiabetic CKD stage 3-4 and vitamin D deficiency (serum 25-hydroxyvitamin D ≤20 ng/ml). We randomized patients using a 1:1 ratio to receive either two directly observed oral doses of cholecalciferol (300,000 IU) or matching placebo at baseline and 8 weeks. The primary outcome was change in endothelium-dependent brachial artery flow-mediated dilation at 16 weeks. Secondary outcome measures included changes in pulse wave velocity and circulating biomarkers. Cholecalciferol supplementation significantly increased endothelium-dependent brachial artery flow-mediated dilation at 16 weeks, whereas placebo did not (between-group difference in mean change: 5.49%; 95% confidence interval, 4.34% to 6.64%; P<0.001). Intervention also led to significant favorable changes in pulse wave velocity and circulating IL-6 levels. Thus, in nondiabetic patients with stage 3-4 CKD and vitamin D deficiency, vitamin D supplementation may improve vascular function. This study is registered with the Clinical Trials Registry of India (no.: CTRI/2013/05/003648).

Celiac disease and Budd Chiari syndrome: report of a case with review of literature.

We here report a case of celiac disease and Budd Chiari syndrome. This 19-year-old boy was diagnosed to have portal hypertension in another hospital when he had developed variceal bleeding. In our hospital, he was found to have occlusion of all three hepatic veins as the cause of portal hypertension. On a routine endoscopy, he was found to have scalloping of duodenal folds. Suspecting celiac disease, he was investigated further. He did have positive serology for celiac disease as well as suggestive histology. He was found to be deficient for protein C and protein S. He was managed conservatively and put on gluten-free diet, with which he showed clinical improvement. A review of literature showed that only 14 previous cases of this combination were recorded and except for one all were from North Africa or southern Europe.

Omental inflammatory myofibroblastic tumour mimicking peritoneal carcinomatosis

Abstract Inflammatory myofibroblastic tumour (IMFT) is a relatively uncommon neoplasm with unpredictable malignant potential known to occur anywhere in the body. IMFT involving the omentum is a very rare entity with less than 15 cases reported so far. We report a case of omental IMFT in a 15-year-old girl who presented with multiple peritoneal masses on imaging and the diagnosis was confirmed on histopathology. In addition to its uncommon location, its presentation as multiple masses is extremely uncommon. This uncommon presentation as multifocal masses needs to be distinguished from other causes of peritoneal carcinomatosis.

Percutaneous cyanoacrylate glue injection into the renal pseudoaneurysm to control intractable hematuria after percutaneous nephrolithotomy.

We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.

Kawasaki disease in infants below 6 months: a clinical conundrum?

Kawasaki disease (KD) is a medium vessel vasculitis of childhood. In infancy KD is often characterized by incomplete and atypical forms. There is paucity of literature on KD in children below 6 months and there are no data from any developing country. This study defines the profile of children with KD below 6 months at our centre.

Polymicrobial lung infection in postrenal transplant recipient diagnosed by fine-needle aspiration cytology.

Tuberculous and fungal infections are among the non‐neoplastic lesions of the lung, in which fine‐needle aspiration cytology (FNAC) has proven to be a useful technique in both immunocompromised and immunocompetent patients. The presence of polymicrobial infection in a renal transplant recipient is documented in the literature, but has rarely been diagnosed on cytology. We report a case of concomitant pulmonary cryptococcosis, aspergillosis, and tuberculosis in a renal transplant recipient diagnosed on FNAC.

Iatrogenic Life-Threatening Pseudoaneurysms of Extracranial Internal Carotid Artery After Fine-Needle Aspiration of Cervical Lymph Nodes: Report of Two Cases in Children

Two children younger than 10 sought care for large, tense pulsatile swelling in the neck after fine-needle aspiration of cervical lymph nodes that resulted in severe respiratory distress. Computed tomographic angiography confirmed the presence of large pseudoaneurysms that caused a mass effect, leading to compression of surrounding vessels and airway. Pseudoaneurysms were successfully treated by coil embolization in one patient and surgical ligation of the internal carotid artery in the other.

Role of multidetector abdominal CT in the evaluation of abnormalities in polyarteritis nodosa

AIM To identify arterial and end-organ abnormalities on abdominal computed tomography (CT) in patients with polyarteritis nodosa (PAN). MATERIALS AND METHODS A prospective study comprising 27 consecutive patients with PAN was conducted from 2007 to 2013. Departmental ethics committee approval was obtained. All patients underwent contrast-enhanced CT comprising an arterial and a portal venous phase. Images were assessed for arterial irregularity, aneurysms, stenosis, and occlusion. End-organ changes, including infarcts, haematoma, and bowel involvement, were also recorded. RESULTS A positive CT was recorded in 15 patients including eight females. The mean age was 32 years. The most common abnormalities were aneurysms seen in 12 patients. The renal artery was the most common site of aneurysms (n=9). The hepatic (n=3), superior mesenteric (n=3) and splenic arteries (n=1) were also involved. Contour irregularity was noted in four patients involving the hepatic, splenic, and superior mesenteric arteries. Stenosis/occlusion was also noted in seven patients. The most common end-organ abnormality was infarct (n=9), followed by bowel wall thickening (n=3), and perinephric haematoma (n=2). CONCLUSION A combination of arterial and end-organ abnormalities on abdominal CT enables an accurate diagnosis of PAN in occult cases and may obviate the need for angiography and, sometimes, biopsy.

Congenital atresia of portal vein with portocaval shunt associated with cardiac defects, skeletal deformities, and skin lesions in a boy

Congenital absence of portal vein is a rare anomaly that results from aberrant venous development in early embryonic life. The intestinal and splenic venous drainage bypass the liver and may drain directly into inferior vena cava or the left renal vein or the left hepatic vein. This rare anomaly is commonly associated with other congenital malformations and generally limited to females. We describe a rare case of aberrant portal vein development with congenital portocaval shunt (end-to-side) in a 3.5-year male child associated with cardiac defects (atrial and ventricular septal defects), skeletal deformities (flexion deformity and clinodactyly of digits and toes), and lichen planus with café au lait macules of skin.

Fibrosing mediastinitis due to Aspergillus with dominant cardiac involvement: report of two autopsy cases with review of literature

Fibrosing mediastinitis (FM) is a rare condition characterized by extensive proliferation of fibrous tissue in the mediastinum resulting in mass like lesion. Histoplasma and Mycobacterium tuberculosis are the common infective causes of fibrosing mediastinitis, but Aspergillus infection is an extremely rare cause. Fibrosing mediastinitis due to Aspergillus usually occurs following Aspergillus bronchopneumonia. Cardiac involvement due to Aspergillus-related fibrosing mediastinitis is extremely rare in immune-competent individuals and occurs following some intervention or as a part of disseminated systemic fungal infection. Here, we report two cases of Aspergillus FM with dominant cardiac involvement in immune-competent patients. Both cases presented with large mediastinal mass and large vegetation in the left atrium. Autopsy findings showed the granulomatous Aspergillus mediastinitis and extension into the heart with associated fibrosis. One case was proven to be due to Aspergillus flavus by fungal genomic sequencing. To the best of our knowledge, this is the first report of Aspergillus FM with pancarditis.