Rashmi Mittal

How soon does cutaneous tuberculosis respond to treatment? Implications for a therapeutic test of diagnosis

Background  It is difficult to demonstrate Mycobacterium tuberculosis in smears or biopsies and to grow it in culture in cutaneous tuberculosis because most cases are paucibacillary. A therapeutic trial of antitubercular drugs is frequently used to confirm the diagnosis in difficult cases. Information is lacking on the response to antitubercular therapy in cutaneous tuberculosis; consequently there are no clear guidelines on when to expect a response and also when to abandon a therapeutic trial.

Phaeohyphomycosis caused by Exophiala spinifera in India.

The second case of phaeohyphomycosis due to Exophiala spinifera in India has been diagnosed 46 years after the initial case. The present case involved a 12-year-old female patient with no known immunocompromising conditions. She presented with multiple verrucous, well-defined plaques encompassing phaeohyphomycotic lesions of varying sizes on her face, chest, arms and thighs. Lymph node involvement in dissemination was confirmed by demonstrating pigmented fungal elements in histopathology of the left axillary node. The infection responded positively to prolonged administration of itraconazole. The original case involved a young boy and was similarly disseminated but was more severe, with bone involvement, and had a fatal outcome. It is likely that other such cases have occurred in the intervening time but have not been reported.

Neuroendocrine dysfunction in acute phase of moderate-to-severe traumatic brain injury: a prospective study.

Abstrcat Objectives: Most of the retrospective studies have demonstrated that traumatic brain injury mediated hypopituitarism could be more frequent than previously known. Therefore, this study has prospectively investigated pituitary function and their correlation with severity, pressure effect and Glasgow Outcome Scale in the acute phase of moderate-to-severe traumatic brain injury. Patients and methods: One hundred consecutive moderate-to-severe traumatic brain injury patients from August 2012 to November 2013 formed the study group. Apart from clinical assessment, non-contrast computed tomography of the head was performed on all patients on admission. The hormonal analysis (fT3, fT4, TSH, GH, Cortisol, Prolactin) was performed within 24 hours of traumatic brain injury and was repeated on the 7th day amongst the patients who survived. Results: Growth hormone was the most common hormone to decrease. Cortisol was the most common hormone to increase. Risk of pituitary insufficiency was increased in patients with severe traumatic brain injury, patients with increased intracranial pressure and who had low Glasgow Outcome Scale. Conclusion: Neuroendocrine dysfunction occurs often in the acute phase of moderate-to-severe traumatic brain injury, more commonly in patients with severe traumatic brain injury, patients with pressure effects and low Glasgow Outcome Scale. Hormonal analysis should be considered in patients with moderate-to-severe traumatic brain injury, so that appropriate hormonal replacement can be done to optimize the clinical outcome.

What is the appropriate duration of a therapeutic trial in cutaneous tuberculosis? Further observations.

BACKGROUND Laboratory tests for the diagnosis of cutaneous tuberculosis lack adequate sensitivity and specificity and a trial of therapy is often used as a diagnostic test in difficult cases. However, the duration for which the trial should be undertaken is not clearly defined. Our previous study indicated that one month of therapy was adequate to detect a clinical response to treatment. However, about half the patients first reported after one month of treatment, some much later. METHOD We therefore analysed the treatment records of 107 patients who received four-drug, short course, antitubercular therapy for a diagnosis of cutaneous tuberculosis in our hospital and who were asked to return for follow-up at biweekly intervals in the first month of treatment. RESULT Twenty-one patients did not return for any follow-up visit, nine patients did not respond to treatment and treatment was stopped in one patient. Of the remaining 76 patients, 72 patients were recorded to have distinct clinical improvement within five weeks of starting treatment while only four patients showed improvement after 60-123 (8-17 weeks) days of therapy. CONCLUSION These findings indicate that five weeks appears to be an adequate duration of a therapeutic trial in patients suspected to have cutaneous tuberculosis, with the exception of tuberculids and patients showing minimal clinical activity before treatment. Patients who have not responded by this time are unlikely to do so with further treatment and should have their diagnosis reviewed.

How useful is the Mantoux test in the diagnosis of doubtful cases of cutaneous tuberculosis

Background  Diagnostic tests are critical to management when the clinical picture is unclear. We analyzed the records of patients in whom the initial diagnosis of cutaneous tuberculosis was doubtful to evaluate the utility of the Mantoux test in this setting.

Occipital Post-Traumatic Intradiploic Arachnoid Cyst Converted to Pseudomeningocele after Re-Trauma: A Rare Complication of Rare Pathology

Background: Growing skull fracture (GSF)/pseudomeningocele is a rare complication of head injury in children. Post-traumatic intradiploic arachnoid cyst (PTIAC) is a variant but it is extremely rare. PTIACs are usually asymptomatic or with mild symptoms like headache. The rupture of PTIAC due to re-trauma leading to pseudomeningocele formation has not been seen or reported before. Patient and Method: We present a case of occipital PTIAC where pseudomeningocele developed after re-trauma, and discuss the pathogenesis and management. Result: En masse removal of the ruptured PTIAC was performed along with dural-defect repair. The post-operative recovery was good. Conclusion: PTIAC is an extremely rare occurrence as a variant of GSF. It is usually asymptomatic, but it may rupture with trivial trauma due to a thinned-out outer table and then converts into pseudomengocele. En masse excision with dural-defect repair gives good results in cases of ruptured PTIAC due to re-trauma.

Management of a post-radiotherapy xerostomic patient--a case report.

OBJECTIVE The objective of the study was to fabricate complete denture with palatal reservoir filled with artificial saliva for a post radiotherapy edentulous patient. BACKGROUND Xerostomia is a subjective complaint rather than a disease. It is caused by irradiation, medication, Sjogrens syndrome & neurological factors such as stress. Radiotherapeutic treatment of head and neck cancer patients often causes long term dysfunction involving their salivary function, swallowing capabilities & taste. All three of these domains are affected by radiation- induced damage to the salivary glands. This in turn results in poor retention of complete denture, frequent trauma to alveolar ridge & other oral infections. All these events drastically affects quality of life of ageing patients. MATERIAL AND METHOD A complete denture in heat cure acrylic resin was fabricated in which a palatal reservoir was made on the palatal side. RESULTS Problems arising due to xerostomia were reduced to a great extent. CONCLUSION Prosthodontic management of Xerostomic patient include several techniques. This paper presents a case report of post radiotherapy edentulous patient in which complete denture with palatal reservoir filled with artificial saliva was fabricated.

Pseudo primary abscess of the cavum septum pellucidum due to pus entrapment: A rare case report

The cavum septum pellucidum (CSP) is defined as a crevice-like space of variable width between the left and right transparent septum. In this report, a rare case of pseudo primary abscess formed in the CSP due to ventriculitis is presented.

Spinal intramedullary glioependymal cyst presented with paraplegia in an adult

We report a case of intramedullary glioependymal cyst at the level of D11‑D12 vertebra in 38 year old male patient, who presented to our hospital with progressive spastic paraplegia. The preoperative magnetic resonance image spine revealed a well‑defined intramedullary cystic lesion at D11‑D12 level, which was hypointense on T1W1, hyperintense on T2W1 and showing ring type enhancement on post contrast images. The patient underwent D11‑D12 laminectomy, durotomy, dorsal midline myelotomy with fenestration and decompression of intramedullary cystic lesion. Biopsy was taken from the cyst wall. The histopathological study of specimen was suggestive of glio‑ependymal cyst. Postoperatively patient improved neurologically but there was residual paraparesis at the time of discharge. To the best of our knowledge, only 20 cases have been reported so far. Considering this rarity and reviewing the literature, we present a case of spinal cord glioependymal cyst along with radiological, surgical, pathological and immunohistochemistry findings.

Spontaneous resolution of ruptured dissecting anterior inferior cerebellar artery aneurysm: A rare case report

Dissecting anterior inferior cerebellar artery (AICA) aneurysms are extremely rare, and only nine cases are reported till date. We are reporting a case of ruptured dissecting distal AICA aneurysm with spontaneous resolution; first of its kind in the indexed literature.