Subcutaneous emphysema is not an uncommon condition and occurs following a chest injury or surgical procedures. Spontaneous subcutaneous emphysema (SSE) is a rare entity, it usually present when broncho-alveolar walls are weakened by chronic lung pathology and precipitated by chronic cough. Most widely accepted mechanism is rupture of broncho-alveolar walls with escape of air into the subcutaneous plane. Usually, it will be associated with pneumothorax or pneumomediastinum. However, its occurrence without pneumothorax or pneumomediastinum has been reported in the literature. We report a case of 46 years male presented with a history of cough of 1-month duration with swelling over the face, neck and upper part of the chest. The diagnosis of SSE without pneumothorax secondary to pulmonary tuberculosis was made by examination, confirmed by chest X-ray and computed tomography imaging. The probable mechanism in our patient could be due to the existence of pleural adhesions surrounded the point of rupture.

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Context: Use of Co-60 source in place of Ir-192 in high dose rate brachytherapy unit (HDR unit) has come for discussion in recent publications. Co-60 based system has been advocated for centers which have fewer brachytherapy procedures as it has comparative economically and administrative advantage. This study has direct practical application for such institutions, which are at the cusp of moving from Ir-192 to Co-60 based brachytherapy. Aims: Conversion of Ir-192 HDR room to Co-60 HDR room and to analyze radiation safety around the room. Materials and Methods: Uniform thickness of 15 cm concrete was added to all walls (except one wall adjoining to linear accelerator bunker) to convert existing room forIr-192 HDR unit to suitable room for Co-60 HDR unit. Radiation survey around room was done. Actual and calculated wall thicknesses were compared. Results: Radiation survey data indicates that modified room is suitable for Co-60 HDR unit and all values are in full conformity to annual dose limits mentioned in Safety Code for Radiation Therapy Sources (SCRTS), Atomic Energy Regulatory Body (AERB; the regulatory body in India). Also, modified wall thicknesses are appropriate for annual design dose limits mentioned in Safety Report Series No. 47 of International Atomic Energy Agency (IAEA). However, console wall thickness (0.45 m) is less than the calculated thickness (0.53 m) for instantaneous dose rate (IDR) design dose limit (7.5 ΅Sv/h) as perabove safety report of IAEA. Conclusions: The modified wall thicknesses are appropriate for annual design dose limits. However, console wall thickness is less than the required thickness for IDR design dose limit. It has been suggested to add 2.64 cm steel on console wall. It has been found that design dose limits should be considered while making room layout plan and regulatory body should add these constraints inSCRTS.

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Background: Homocysteine has been shown to be a risk factor for cardiovascular disease and is a degradation product of sulfur containing amino acids. The aim of this post-hoc analysis was aimed at arriving at homocysteine levels among voluntarily consenting healthy adults in the context of other hematological parameters. Methods: The data for this post-hoc analysis were derived from an observational study carried out at a medical college in rural North-west India. Results: About 77.42% of those participants enrolled in this study having serum homocysteine level more than 30 μmol/L were seen to possess suboptimal serum Vitamin B ₁₂ (<200 pg/ml). On subjecting data to regression analysis, serum homocysteine was observed to possess an inverse correlation with serum level of Vitamin B _12, in general. Conclusions: Hyperhomocysteinemia observed in our study was sufficiently common and wholly ascribable to low Vitamin B ₁₂ concentration as we did not find any case of subnormal serum folic acid level.

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Aim: The study investigates the antihyperlipidemic effect of Hibiscus rosa-sinensis Linn. (Malvaceae) ethanolic extract fractions in triton and atherogenic diet-induced hyperlipidemic rats. Materials and Methods: Oral administrations of 500 mg/kg body weight of various fractions of selected plant were evaluated for possible antihyperlipidemic activity in triton and atherogenic diet-induced hyperlipidemic rats for duration of 48 h and 14 days respectively. In triton model, hyperlipidemia was induced by intra-peritoneal injection of a saline solution of triton 400 mg/kg in rats, whereas in diet induced model, rats were made hyperlipidemic by giving atherogenic diet for 20 days using oral route of administration. A comparative assessment was also made between the actions of selected drug with simvastatin, known antihyperlipidemic drug. Result and Discussion: The outcomes of this study were expressed as mean ± standard error and data were evaluated by using analysis of variance followed by Dunnett's t-test for multiple comparisons. Oral administration of 500 mg/kg body weight of ethanolic extract residual fraction of Hibiscus rosa-sinensis Linn. flowers exhibited a significant reduction (P < 0.01) in serum lipid parameters such as triglycerides, total cholesterol, low density lipoprotein (LDL), very LDL and increase in high density lipoprotein in hyperlipidemic rats when compared with hyperlipidemic control in both models. Conclusion: Our results demonstrated that ethanolic extract fraction of Hibiscus rosa-sinensis Linn. possessed significant antihyperlipidemic activity.

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Background: The choice of radiographic contrast media for use in patients at increased risk of contrast-induced nephropathy is of ongoing interest. Materials and Methods: The current study is a prospective, randomized in which comparison of nonionic, isoosmolal agent, iodixanol, versus the nonionic, low-osmolal agent, iohexol, on the renal effects was carried out. A total of 526 subjects with impaired baseline renal functionand diabetes mellitus underwent diagnostic and/or therapeutic coronary angiographic procedures. The coprimary end points were the peak increase in serum creatinine and the incidence of contrast-induced nephropathy, that is, ≥0.5 mg/dl in serum creatinine from baseline within 72 h of receiving contrast media. Results: Of the 129 patients, 97 received iodixanol and 97 received iohexol randomly. The median peak increase in serum creatinine in the iodixanol arm was 0.10 mg/dl; whereas in the Iohexol arm, the median peak increase was 0.09 mg/dl (P = 0.13). The overall contrast-induced nephropathy incidence was 10.5% in the iodixanol arm and 9.8% in the iohexol arm (P = 0.7). The volume of contrast media, volume of saline administered, frequency of coronary interventional procedures, and severity of baseline kidney disease and of diabetes mellitus were similar between treatments. Conclusions: In the present study, the overall rate of contrast-induced nephropathy in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures was 10.5%. There was no significant difference between iodixanol and iohexol in either peak increase in serum creatinine or risk of contrast-induced nephropathy.

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Porphyria cutanea tarda (PCT) is the most frequent type of porphyria worldwide and presents with skin symptoms only. Porphyrias are a group of eight panethnic inherited metabolic disorders of heme biosynthesis. Porphyria can affect peripheral, autonomic, and central nervous systems.In porphyria conditions there is accumulation of the hemeprecursor's 5-aminolaevulinic acid, porphobilinogen, and porphyrins; which are associated with characteristic clinical feature with acute neurovisceral attacks and skin lesions. Variegate porphyria, hereditary coproporphyria, and PCT share the same chronic cutaneous photosensitivity. Some drugs will also induce acute attack of porphyria. This report summarizes the management of PCT with a focus on the signs and symptoms and finding that might help and prevent unnecessary medications.

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Cutaneous metastasis from lung carcinoma is rare and has ominous prognosis. Due to the absence of any pathognomonic appearance, it is usually misdiagnosed as benign skin lesion. Clinically, lung carcinoma may present first time with cutaneous lesions alone whilst the primary lesion in lung remains quiescent. We present the case of 62-year-old male who presented with cutaneous nodules and on further investigations they turned out be cutaneous metastasis from squamous cell carcinoma of lung.

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Background: Many ocular conditions when detected at an early age such as basic school age through vision screening are amenable to interventional measures. Despite this, there are no eye screening programs for school children in Ghana. Objective: The study set out to determine the prevalence of ocular morbidity among basic school children in the Kwabre East District of Ghana. Methods: A descriptive, cross-sectional survey was carried out in March 2014. A multi-stage random sampling technique was used to select school children aged 6-16 years from five randomly selected schools in the district. Ocular history and basic ocular examinations were carried out on the children that were sampled. Results: A total of 456 children were examined; they comprised 170 (27.3%) males and 286 (62.7%) females with a mean age of 12.6 ± 2.25. 215 (47.1%) of the school children had various ocular morbidities. Refractive error was found to be the most predominant ocular morbidity among 120 (26.3%) school children, followed by allergic conjunctivitis 79 (17.3%). A total of 445 (97.6%) of the participants had a visual acuity (VA) of 6/5-6/12, 8 (1.8%) had a VA of < 6/12-6/36 and 3 (0.7%) had a VA of 6/60 - NPL in their right eye. Only 12.8% of the school children had knowledge about refractive errors. Conclusion: Uncorrected refractive error and allergic conjunctivitis were the leading ocular morbidities found among school children in this sample. A routine ocular health assessment among basic school children is recommended to prevent any visual impairment.

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Introduction: Staphylococcus aureus is a major cause of infection, and methicillin-resistant strains are increasingly being reported worldwide. This study was carried out to evaluate the antibiotic susceptibility pattern of methicillin-resistant strains of S. aureus, isolated from clinical specimens from a super specialty hospital in Delhi. Materials and Methods: The study comprised of 80 strains of S. aureus isolated from various clinical specimens. From these isolates, methicillin-resistant strains were screened, and their susceptibility pattern to vancomycin, teicoplanin, daptomycin, and linezolid was detected using standard microbiological techniques. Results: Of the 80 strains, 53 strains were found to be methicillin resistant while the rest of the 27 strains were methicillin-susceptible. Four among the 53 strains were linezolid resistant, and eight were vancomycin-intermediate. Of the 8 strains, two were teicoplanin intermediate, and one was teicoplanin resistant. All the 53 strains were sensitive to daptomycin. Conclusion: In the current study, daptomycin was found to be the only drug to which all the isolates were susceptible. However, daptomycin resistance has also been reported from elsewhere. Therefore, all the recommended measures to control the emergence and spread of these strains must be followed strictly in all health-care systems.

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The solid pseudopapillary tumor of the pancreas (SPPT) is an unusual low-grade malignant epithelial tumor affecting predominantly adolescent girls and young women, usually misdiagnosed as pancreatic pseudocyst. Although approximately 500 cases of SPTP have been described in the last 40 years, its pathogenesis remains uncertain. However, the clinical features of this neoplasm are very characteristic and SPPT must be suspected in any young woman with a cystic or partially cystic pancreatic mass. The most frequent symptom of SPPT is upper abdominal pain seen in nearly half the patients. The differential diagnosis of SPPT includes pseudocyst of pancreas, neuroendocrine tumor and ductal adenocarcinoma of pancreas. Diagnosis of SPPT is usually made only after operative biopsy. Surgical excision offers the best chance for cure and should always be attempted irrespective of the magnitude of resection involved. This case report highlights the importance of awareness of SPPT as a distinct class of pancreatic tumor in young females with excellent prognosis.

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Background: Limited community-based data are available on the serum zinc and copper levels and factors affecting their levels in the adult healthy population of rural and urban India. Hence, the present study is conducted to evaluate and compare the serum levels of zinc and copper with body mass indices (BMI) in rural and urban healthy adult population. Materials and Methods: Fifty subjects each from the rural and urban population in the age group of 20-40 years were recruited for the study. Subjects having past medical histories of major diseases and with acute infections were excluded. Their anthropometric measurements such as height, weight, hip, and waist circumference were measured, and the BMI calculated. Venous samples collected from them were used to determine the levels of zinc and copper. Results: Both the subject groups had optimum levels of zinc, but the urban subjects were deficient in copper. The levels of serum zinc were higher in the urban population while the levels of copper were higher in the rural population. In addition, the levels of serum zinc and copper were negatively correlated with each other but were not statistically significant. Considering each of the population individually, there was no gender wise difference between the serum zinc and copper levels and were almost the same. The BMI had a strong positive correlation with the serum zinc levels in the rural population (P = 0.026). However, it did not have any correlation with the copper levels. Conclusion: Our study brought out the association between serum zinc levels and BMI and the fact that serum zinc levels were higher in the urban population and copper levels in the rural population. Emphasis on the diet rich in these trace elements can help in maintaining adequate and balanced levels of zinc and copper.

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Secretory carcinoma is a rare type of breast carcinoma usually seen in the young females, and it is also called as "Juvenile carcinoma." We report here a case of secretory carcinoma in an elderly female with an unusual clinical presentation. She had a painful swelling in left breast of 6 cm × 5 cm size for the past 6 months. Skin over the swelling was inflamed and ulcerated. Mammogram findings favored a chronic infected hematoma/abscess. Fine needle aspirate (FNA) is a murky fluid admixed with blood and was reported as acute inflammatory lesion. 2 weeks later she developed nipple retraction and an increase in size of the swelling. Fine needle aspiration cytology (FNAC) was repeated again from firm areas and in multiple points of swelling. To our surprise, FNA smears revealed dysplastic ductal epithelial cells with minimal atypia. Modified radical mastectomy was planned. Histopathological examination confirmed the mass as secretory carcinoma, a rare variant of ductal carcinoma of the breast. Postoperative chemotherapy and radiotherapy was started. We report this case to emphasize that FNAC can be repeated in suspicious cases and should be correlated clinico-radiologically to give a preoperative diagnosis.

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