International Journal of Research in Medical Sciences
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Refractory atopic dermatitis: successful remission with novel new generation emollient consisting of furfuryl palmitate as an adjunct
Get PDFAtopic dermatitis (AD) is a chronic inflammatory skin condition requiring personalized treatment approaches. Conventional therapies, including topical corticosteroids and immunosuppressants, often fail to provide long-term relief, leading to disease relapse and poor quality of life. Recent advancements in JAK inhibitors, along with novel skin barrier-enhancing strategies such as antioxidant-rich emollients, offer new therapeutic possibilities. A 14-year-old female with treatment-resistant AD and a 27-year-old female with AD triggered by topical steroid withdrawal both presented with severe, widespread lesions. Previous therapies, including systemic steroids, immunosuppressants, and other JAK inhibitors, failed to provide sustained improvement. Both patients were treated with Abrocitinib 200 mg OD alongside an antioxidant-rich emollient containing furfuryl palmitate, known for its skin barrier-restoring and anti-inflammatory properties. Within a week, both patients experienced complete itch resolution, followed by full skin clearance (IGA 0) over three months, highlighting the potential synergy between targeted JAK inhibition and antioxidant therapy. These cases underscore the effectiveness of Abrocitinib in severe AD and emphasize the crucial role of furfuryl palmitate-based emollients in accelerating skin recovery. By addressing both inflammation and oxidative stress, this combination therapy presents a promising approach for improving long-term treatment outcomes in refractory AD. Further research is warranted to explore its broader dermatological applications
A study on digital dermatoglyphics among indigenous Assamese populations of Assam
Get PDFBackground: Dermatoglyphic patterns are among the most distinctive and reliable features of the human body. Their uniqueness plays a vital role in forensic investigations, as no two individuals have identical fingerprints. These patterns also reflect racial, ethnic, and gender differences and can assist in diagnosing certain congenital disorders.
Methods: The present study was conducted on 222 students from indigenous Assamese populations, aged 18–22 years, to examine the frequency distribution of fingerprint patterns, identify the most and least prevalent types, and assess inter- and intra-population variations. Fingerprint impressions of both hands were collected and classified using Henry’s classification system. Additionally, pattern intensity index, Dankmeijer’s index, and Furuhata’s index were calculated.
Results: The results showed that loops were the most common pattern in both males (58.89%) and females (62.8%). In males, whorls (24.63%) were the second most common, while in females, composites (20.88%) ranked second. Arches were the least common in both sexes—2.41% in males and 7.19% in females. Significant sex-based differences were observed in the distribution of whorls and composites. Among the indices, the pattern intensity index (10.76) and Furuhata’s index (41.82) were higher in males, while Dankmeijer’s index was higher in females (78.84).
Conclusions: The study identifies loops as the most common fingerprint pattern and arches as the least common
Fibroadenoma with pseudo angiomatous stromal hyperplasia and hamartoma of the breast: a case report
Get PDFPseudo angiomatous stromal hyperplasia (PASH) is an uncommon benign proliferative lesion of the breast stroma, characterized histologically by interanastomosing slit-like spaces within a dense collagenous background, mimicking vascular channels but lacking true endothelial lining. It was first described in 1986 by Vuitch, Rosen, and Erlandson, who reported nine cases of breast masses simulating vascular tumors, composed of proliferative mammary stromal tissue. Although PASH is often an incidental microscopic finding in breast biopsies, it can occasionally present as a palpable mass, particularly in premenopausal women, likely influenced by hormonal factors such as estrogen and progesterone. Fibroadenomas and hamartomas are also common benign breast entities, each with distinct histopathological features. However, the coexistence of PASH, fibroadenoma, and hamartoma within a single lesion is exceedingly rare, and its presentation with bloody nipple discharge, a symptom more often associated with intraductal carcinoma or papilloma, makes diagnosis particularly challenging. Accurately distinguishing benign from malignant lesions requires a multimodal approach, integrating clinical examination, radiologic imaging and core needle biopsy. Lesions that are classified as B3 on histopathology-including cellular fibroadenomas, papillomas with atypia, or complex sclerosing lesions-typically mandate complete surgical excision to rule out associated malignancy. This case report underscores the diagnostic complexities associated with overlapping benign breast lesions and highlights the importance of comprehensive evaluation and interdisciplinary collaboration in guiding management. Further prospective studies are warranted to optimize early detection strategies and decision-making in cases involving lesions with uncertain or mixed histology. This case emphasizes the need for a multidisciplinary approach, combining clinical, radiological, and pathological evaluations to accurately diagnose complex presentations. Recognizing rare benign lesions can prevent overtreatment and alleviate patient anxiety
Modified case-based learning as supplement to bedside teaching-why, how and what next?
Get PDFBackground: Competency based medical education requires the teaching learning methods and assessment to conform to the framework of competencies. The pandemic disrupted medical education; but led to modifications and innovations in teaching methodologies. We adopted modified CBL for third year part 2 students, alongside bedside teaching to explore its efficacy in terms of improving clinical reasoning, group dynamics, summarizing, presentation and to highlight perceptions of students regarding CBL and its adoption as a regular teaching learning activity.
Methods: CBL sessions were taken every afternoon by faculty from department of medicine, trained by department of Health Professions Education; who used real life authentic cases. At the end of each posting, evaluation was planned based on Kirkpatrick hierarchy. Google form, focussed group discussions and content analysis, OSCE stations, bedside case presentation and MCQ based tests were used.
Results: Learning assessment tools showed that CBL enhanced learning. Feedback from students revealed that CBL encouraged discussions and critical thinking and through FGDs they suggested the need for advance topic information, more pre-reading time, blending CBLs with lectures when relevant and selecting specific topics to be taught through CBL.
Conclusions: Our study demonstrates that modifying CBL-based teaching and including it in clinical postings as a substitute/ supplement to bedside teaching during times when there is lack of clinical material is feasible and effective, as shown by the performance of students in the MCQs. It also appeals to the students and the clinical case scenarios mirror real-world situations, enhance learning and facilitate the clearing of concepts
Immunoprofiling in poorly differentiated non-small cell lung cancer, analysis of data in a tertiary care center
Get PDFBackground: Lung cancer is a leading cause of cancer-related deaths worldwide, including India, where it accounts for 5.9% of cancer cases and 8.1% of cancer-related mortality. Differentiating between major histologic subtypes of non-small cell lung carcinoma (NSCLC)-adenocarcinoma (ACA) and squamous cell carcinoma (SCC) is crucial due to significant differences in treatment response. Our study addresses the IHC profile of NSCLC in a tertiary care centre in South India. We have also deliberated whether a 2 panel IHC markers would be sufficient for the final diagnosis in a resource poor setting as compared to the traditional 4 IHC panel.
Methods: A hospital-based cross-sectional study (2018-2022) analysed 319 histologically confirmed poorly differentiated NSCLC cases. IHC markers (TTF-1, Napsin A, p63 and p40) were used for subtyping per WHO classification. Staining patterns were semi-quantitatively scored against controls. Sensitivity, specificity, PPV, NPV, and overall accuracy were calculated. Data analysis was performed using SPSS v23.
Results: Of the 319 cases, ACA was the most common (65.2%), followed by SCC (31.03%). Males accounted for 81.2% of cases, with the peak incidence in the 62-66 age group. For ACA, TTF-1 had higher sensitivity (97.17%) compared to Napsin A (83.49%), while Napsin A showed better specificity (96.04%). For SCC, p63 demonstrated higher sensitivity (93.07%) than p40 (78.22%), while p40 had better specificity (89.62%).
Conclusions: The study highlights the need for tailoring the IHC panel to suit the histopathological specimen in order to clinch the final diagnosis. In finance effectiveness, two marker panel can also be used
Determining factors the knowledge of the element of diabetic foot prevention of patients followed at the endocrinology unit of Joseph Raseta Befelatanana hospital
Get PDFBackground: Diabetic foot (DF) is a common and disabling complication of diabetes that requires effective prevention. Objectives of this study are to investigate the factors determining knowledge of preventive measures for diabetic feet.
Methods: We performed a analytical, single-center, cross-sectional study at the endocrinology unit of the Joseph Raseta Befelatanana university hospital between September 2023 and January 2024. One hundred patients were included. The ANOVA test was used for the comparison of means. Chi-square was used to measure the association between two qualitative variables. The significance level of p<0.05.
Results: The least known prevention elements by diabetics were: methods to remove horns (such as the use of sharp objects), those to remove nails as well as dangerous methods to warm the feet. The knowledge rates for these elements in the population were 7%, 47% and 45% respectively. Patients living in rural areas had less knowledge of podiatric prevention (p=0.03). Those with at least a "high school" level (95% CI=2.67 [1.14-6.21]; (p=0.02), diabetics with at least two dependent children (p=0.02), as well as those who followed regular treatment (p=0.03) had significantly better knowledge of these preventive measures for foot lesions.
Conclusions: This study encourages a strengthening of the education of diabetics in relation to these preventive measures for foot lesions. Especially in patients with these characteristics
Current perspectives on Farh's disease: a glimpse from the internal medicine unit
Get PDFBackground: Fahr's disease involves abnormal calcium deposits (calcium carbonate/phosphate) in the basal ganglia and other brain regions, primarily due to metabolic dysfunction, with rare autosomal dominant cases. These calcifications affect basal ganglia, thalamus, hippocampus, dentate nucleus, cerebral cortex, and subcortical white matter of the cerebellum. The aim of this study was to determine the prevalence of fahr's disease unrelated to secondary metabolic disorders (2017-2024).
Methods: We conducted a retrospective review of hospital records between 2017 and 2024 to identify patients with a clinical diagnosis of Fahr's disease or those presenting with neurological abnormalities such as seizures, altered mental status, involuntary movements, or intracranial calcifications detected during diagnostic evaluations. Inclusion criteria required cranial CT scans to systematically assess calcifications in predefined brain regions: basal ganglia, thalamus, hippocampus, dentate nucleus, cerebral cortex, or subcortical cerebellar white matter.
Results: Of 134 suspected Fahr’s disease cases, only 8 were confirmed on tomography, not clinically with a prevalence of 0.06%. None showed clinical basal ganglia involvement, but CT revealed calcifications: 2 in basal ganglia, thalamus, hippocampus, and cerebellum; 4 in basal ganglia, thalamus, and hippocampus; and 2 in basal ganglia and cerebral cortex.
Conclusions: In our setting, Fahr's disease is generally underdiagnosed and is typically found incidentally through cranial CT scans. Its prevalence could potentially be even higher. Since most of these patients are asymptomatic, comprehensive extension studies are often not conducted for their evaluation. As a result, the current prevalence remains extremely low compared to other studies (around 1%)
A clinicopathological study of gestational trophoblastic diseases in a tertiary healthcare centre
Get PDFBackground: Gestational trophoblastic diseases are marked by abnormal proliferation of various trophoblastic cells during placentation. It includes hydatidiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). GTNs are among the rare human tumours that can be cured even in the presence of widespread dissemination. Aims of present study was to assess histomorphological features of GTD along with its clinical correlation.
Methods: It was an observational cross-sectional study conducted in the Department of Pathology, at tertiary healthcare centre in South Gujarat over a period of 5 years from January 2019 to December 2023. Histological finding of all cases were recorded and clinical correlation done.
Results: Out of 50 analysed cases of GTDs, 47 cases (94%) were Hydatiform mole and 3 cases (6%) were choriocarcinoma. The incidence of gestational trophoblastic diseases is found to be 1 in 799 pregnancies. Age ranged from 18-35 years. The most commonly affected age group was 20-25 years with 29 cases (58%). Most cases were presented in the first trimester. Most common clinical presentation was bleeding per vagina in 34 cases (68%) followed by abdominal pain. The majority of GTD cases belonged to 50,000 to <1,00,000 mlU/ml beta-HCG level.
Conclusions: Hydatidiform mole is most prevalent gestational trophoblastic disease. Present study signifies the importance of routine histopathological examination of products of conception to rule out microscopic molar changes, since there is an higher incidence of molar pregnancies progressing to choriocarcinoma, a highly metastasizing neoplasm
Intestinal type sinonasal adenocarcinomas: a tale of two rare cases
Get PDFSinonasal adenocarcinoma is a rare malignancy arising from the glandular epithelium of the nasal cavity and paranasal sinuses, accounting for <1% all malignant sinonasal tumours. It commonly presents with symptoms such as nasal obstruction, epistaxis, and facial pain, often leading to late diagnosis. Here we are presenting cases of two young individuals with left nasal mass extending into cranial cavity and frontal sinuses. CT findings described them are infiltrative lesions with heterogenous contrast enhancement with involvement of cranium. Histopathology and PAS stain revealed atypical cells arranged in papillaroid to compact glandular growth pattern. At places, back-to-back arranged glands were also noted, composed of columnar cells having abundant eosinophilic cytoplasm and basally located nuclei with mild anisonucleosis. Relevant history was taken to exclude the possibility of colorectal metastasis; later CT abdomen was also done. Finally, IHC was performed on both cases which revealed positive staining for CK7, CDX2, SATB2 and negative staining for CK20, supporting the diagnosis. Thus, sinonasal adenocarcinoma should be considered in cases of persistent nasal symptoms. Early detection through imaging and histopathology aids in timely intervention
The role of gut microbiota in modulating immune responses: a systematic review on implications for autoimmune diseases
Get PDFThe gut microbiota plays a crucial role in immune regulation, influencing innate and adaptive immunity. Dysbiosis an imbalance in microbial composition has been linked to autoimmune diseases such as rheumatoid arthritis (RA), type 1 diabetes (T1D), multiple sclerosis (MS), inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE). This review analyses sixteen studies, highlighting common dysbiosis patterns, including decreased short-chain fatty acid (SCFA)-producing bacteria (Faecalibacterium prausnitzii, Bifidobacterium) and increased pro-inflammatory bacteria (Prevotella copri, Akkermansia muciniphila). These shifts contribute to autoimmunity via molecular mimicry, increased gut permeability and immune dysregulation. Microbiota-targeted therapies such as probiotics, prebiotics, dietary interventions and fecal microbiota transplantation (FMT) show promise in restoring microbial balance and modulating immune responses. Probiotics (Lactobacillus reuteri) reduce inflammation in RA and MS, while FMT partially restores microbial diversity in IBD and MS. Despite progress, causality remains unclear, necessitating longitudinal studies and personalized microbiome-based interventions. Understanding the gut microbiota-autoimmunity relationship could pave the way for microbiome-driven immunotherapies