Rashmi Kaul

Snakebite profile from a medical college in rural setting in the hills of Himachal Pradesh, India

Objective: The objective of the following study is to assess the clinical profiles and manifestations of snakebite patients in the rural hilly setting of Shivalik and the Lesser Himalayan region of Himachal Pradesh. Materials and Methods: A hospital record-based retrospective descriptive study was carried out that included details on demography, clinical profile, treatment and outcome among 200 patients over a period of 2 years. The data was analyzed using Chi-square test for comparison. Results: 142 (71%) patients were young (age group of 16-45 years) and the number of male patients was 118 (59%) and female patients were 82 (41%). All the cases recorded presented in the months of April to November. Not a single case was recorded from December to March. The most frequently bitten sites were the lower limbs particularly the feet. 86 (43%) of the patients presented without any features of envenomation. Neuroparalysis was the commonest presentation in 53 (46%) patients followed by hemotoxicity in 36 (31%) among symptomatic patients. Early morning neuroparalysis syndrome was the presentation in 26.4% patients. Allergic reactions in the form of early anaphylaxis were noted in 7% patients. Conclusion: Snake bite is a neglected tropical disease affecting poor villagers in rural areas. Future research focusing on understanding epidemiological determinants of snake bite is desired.

Seroprevalence of hepatitis B, hepatitis C, Human Immunodeficiency Virus surface, and syphilis among blood donors: A 6-year report from a sentinel site in Western Himalayas, India

1. Bala M, Toor A, Malhotra M, Kakran M, Muralidhar S, Ramesh V. Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera. Indian J Sex Transm Dis 2012;33:102‐6. 2. Archana BR, Prasad SR, Beena PM, Okade R. Making serological diagnosis of syphilis more accurate. Indian J Sex Transm Dis 2014;35:70‐1. 3. Angue Y, Yauieb A, Mola G, Duke T, Amoa AB. Syphilis serology testing: A comparative study of abbot determine, Rapid Plasma Reagin (RPR) card test and Venereal Disease Research Laboratory (VDRL) methods. P N G Med J 2005;48:168‐73. 4. Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995;8:1‐21. 5. Ahmed N, French P. Interpretation of syphilis serology. Br J Hosp Med (Lond) 2013;74:C104‐7.

Lymphangiomatosis: Two cases with unique presentations, salience of nomenclature, and diagnosis.

We are presenting two unique cases of lymphangiomatosis without visceral and bony involvement and critically discussing the nomenclature used in the extant literature. The first case was a 12-year-old boy with ill-defined mass on the right cheek extending into the ipsilateral orbit leading to conjunctival lesion. The second case was of a 14-week-old infant showing diffuse swelling on nape of the neck. In addition there were raised patches on dorsal aspects of bilateral hands and feet. The biopsies from all the lesions showed similar histopathological features consistent with lymphangiomatosis. We propose that the term lymphangiomatosis should be used only in cases with histological features of lymphangiomatosis. The term should not be used in cases of multiple lymphangiomas. We conclude that the lesions clinically diagnosed as lymphangioma may turn out to be lymphangiomatosis. Extensive lymphangiomatosis without visceral or bony involvement may lead to intrauterine death.

Game change in Indian Health Care System through reforms in medical education curriculum focusing on primary care- Recommendations of a joint working group

Despite the stated aim of Medical Council of India (body regulating medical education in India) to produce an Indian Medical Graduate with requisite knowledge, skills, attitudes, values and responsiveness, so that he or she may function appropriately and effectively as a doctor of first contact of the community while being globally relevant, it appears that we failed. The joint working group extensively consisting of medical teachers have come up with suggestions which may work as the game changer in Indian Health care system. The key is to dedicate medical education towards primary care.

Enterobius vermicularis infestation leading to meckel's diverticulitis in an adolescent boy: An extremely rare presentation

Enterobius vermicularis is an intestinal nematode commonly affecting children worldwide. Its transmission is by feco-oral route. Meckels diverticulitis due to E. vermicularis infestation is an extremely rare presentation. An 11-year-old boy presented with acute abdomen. During surgery inflamed Meckels diverticulum (M.D) was seen. Histopathology examination of specimen revealed E. vermicularis. Till date, only one case of E. vermicularis infestation of M.D is reported around five decades ago. This histopathological confirmation is extremely important as the required treatment (Mebendazole) of the infected case along with household contacts can prevent the spread of infection and may avoid surgery in known contacts.

Pediatric Lymphadenopathy: Cytological Diagnosis Over a Period of Two Years in a Rural Teaching Hospital

Background: Lymphadenopathy (LAP) is a common clinical presentation seen in pediatric patients attending the outpatient department. The etiology of LAP varies from a benign process to malignancy. Fine needle aspiration cytology (FNAC) is a very rapid and easy to perform diagnostic test. Majority of cases can be diagnosed and managed on FNAC without need of histopathology. The aim of this study was to evaluate the role of FNAC in diagnosis of superficial LAP in pediatric population. Methods: This retrospective study was carried out over a period of two years from January 2015 to December 2016 in the department of Pathology, Dr. RPGMC, Tanda, Himachal Pradesh, India. All cases of superficial LAP seen in pediatric population where FNAC was performed were included in the study. Results: A total of 357 lymph nodes were aspirated in pediatric population during the study period. Majority of cases (98%) were benign. The results were categorized into three broad categories as reactive lymphadenitis (296; 82%), granulomatous lymphadenitis (56; 16%) and malignancy (05; 02%). The five cases of malignancies identified in this population comprised of two cases each of Hodgkin’s Lymphoma (HL) and Non-Hodgkin’s Lymphoma (NHL). One case was diagnosed as metastasis from papillary carcinoma thyroid. Conclusion: FNAC should be considered as a first line investigation for evaluating the peripheral LAP in pediatric population. The main etiology of LAP is reactive lymphadenitis. Majority of these cases can be diagnosed and managed on FNAC alone. FNAC can play a key role in triage of appropriate cases, so that these patients may be further investigated to make a diagnosis or for referral to higher centers.

Unusual case of sciatic nerve and deep pelvic endometriosis with lumbosacral plexus spread presenting with muscular atrophy and foot drop

Endometriosis is an important disorder which affects women in the childbearing age group. In addition to the commonly observed intrapelvic sites, it can very rarely affect extrapelvic location such as the sciatic nerve. We describe an uncommon case of sciatic endometriosis leading to gross muscular atrophy and foot drop. The patient additionally had perineural extension of endometriosis along the ipsilateral lumbosacral trunk and coexisting intrapelvic endometrial implants in retrocervical area, uterosacral ligament, and urinary bladder wall.

Cholecystitis associated with heterotopic pancreas, pseudopyloric metaplasia, and adenomyomatous hyperplasia: A rare combination

Heterotopic pancreatic tissue in the gall bladder is an uncommon incidental finding in most cases. We hereby describe the case of a 45-year-old woman who presented with symptoms of acalculous cholecystitis. Pathological examination detected heterotopic pancreatic tissue, pseudopyloric metaplasia, and adenomyomatous hyperplasia in the gall bladder. This is a rare combination of three entities which is being reported for the first time. This case emphasizes that heterotopic pancreas might be the causative factor for cholecystitis.

Mesenteric Lymph Node Hamartoma (Castleman's Disease) in Association with Superior Mesenteric Arteriovenous Fistula.

We present a case of 21-year-old female patient with history of pain abdomen and abdominal distension. The patient also had oedema of the limbs, puffiness of the face, pallor and palpable mass in the abdomen. Ultrasonography of the abdomen and computed tomographic angiogram was done and it showed presence of vascular mass along with arteriovenous malformation in the mesentry of small gut between distal branches of superior mesenteric artery and vein. Surgical excision of the mass with ligation and division of the arteriovenous malformation was done through midline laparotomy. Histopathological examination was consistent with the diagnosis of Castlemans disease. The Patient recovered well and was discharged after seven days.

Eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome): a diagnostic rarity with an atypical presentation

We report a case of a 33-year-old woman who presented to us with symptoms of bronchial asthma and peripheral neuropathy. After investigations, the diagnosis of eosinophilic granulomatosis and polyangitis (Churg-Strauss syndrome) was made.