Ochronosis of the Hip Joint: Differential Diagnosis of Inflammatory Arthropathy with Lytic Lesion

Alkaptonuria or ochronosis is a rare inborn disorder of metabolism which is characterized by deficiency of homogentisic acid oxidase. There is accumulation of homogentisic acid in the connective tissues causing brownish black pigmentation and skeletal damage. The most serious complication of this disease is crippling degenerative arthropathy which presents in late years of life. There is no definitive treatment for the condition. Symptomatic management is the main stay. Surgical management such as arthroplasty is done for severe cases of ochronosis. We report a case of ochronosis of the hip joint presenting with inflammation and lytic lesion which can create confusion and lead to error in diagnosis.     

A Case of Light Chain Deposition Disease (LCDD) in a Young Patient

Light chain disease is a variant of multiple myeloma in which the malignant population of marrow cells produces free monoclonal light chains but no heavy chain or complete immunoglobulin. The monoclonal light chains are small enough to be freely filtered by the kidneys and become Bence–Jones protein. Light chain disease comprises about 18% of multiple myeloma patients. Here we present a case report of a 38-year-old man who initially presented with complaints of pain in back and low grade fever off and on. He was found to have collapse of D9 and D12 vertebrae along with ascites and right pleural effusion and massive proteinuria. Multiple myeloma was considered as a differential diagnosis based on the investigations but eventually the patient was lost to follow up. This case is reported here as the light chain variant of multiple myeloma leading to deposition disease is less commonly reported and presents considerable difficulties in diagnosis.     

Study of mutations in p53 tumour suppressor gene in human sporadic breast cancers

Using Polymerase Chain Reaction followed by Single Strand Conformation Polymorphism analysis, we studied thirty seven cases of primary human breast cancer for the presence of mutations in exons 5 and 7 of p53 tumour suppressor gene. Only one of the thirty seven tumours tested (2.7%) showed the electrophoretic mobility shift indicative of a mutation in exon 5 of the p53gene, while no such mobility shift was noted in exon 7. Our finding is in contrast to the findings in previous studies, wherein the mutation frequency has been reported to be 13–30% by direct DNA analysis. This may be related to the ethnicity and local population prevalence rather than technique.     

Does distance matter? A study of married Indian women professionals staying away from families to pursue higher studies*

‘Return to school’ for enhancement of career is considered a means to career mobility. However, if ‘return to school’ is chosen after a certain stage it has its own costs and challenges. It becomes more complex, especially for women, if geographical distance from family becomes an additional variable to it. Present study, grounded in Indian context, examines married Indian women professionals, who opted for geographical separation from their families (including, in some cases, infants and small children) to pursue higher studies. The study explores what spurs well-qualified married women professionals to take a career break and join a rigorous educational programme which requires them to stay away from their families for a substantial time. Key themes that emerged from the study can be categorised as motives: dissatisfaction with work situation, need for skill enhancement, and an urge to develop one’s own identity; facilitators: support and encouragement from spouse and other family members and age; challenges faced: psychological turmoil, strain on relationships, and financial stress.     

Effect of the use of instructional anatomy videos on student performance

Medical schools have reduced the time allotted to anatomy instruction. Consequently, schools engage students in more independent settings using information and communication technologies (ICT). There has been limited research in the use of video aids, a type of ICT, to enhance anatomy examination performance. The objective of this study is to describe the design, usage, and effect on examination performance of eight locally developed instructional anatomy videos. First‐year UCSF medical students (n = 141) had access to the videos. They reported their video usage, reason for usage, and satisfaction. The prior year students (n = 141) served as a historical control group. Anatomy and radiology examination performance was compared between groups while controlling for prior performance. The students with and without access to the videos did not differ in examination performance. Sixty‐one (43%) students in the experimental group responded to the survey. Of these, 79% reported using at least one video, viewing an average of 4.75 of the eight videos. They watched 3.27 (SD = 1.57, range 1–5) of the five anatomy videos and 1.48 (SD = 1.35; range 0–3) of the three radiology videos. In a regression analysis controlling for age and MCAT scores, using the anatomy videos at least once improved anatomy examination performance by 3.4% (P‐value = 0.007). There was no relationship between radiology video usage and radiology exam score. Video resource availability did not enhance student performance in anatomy and radiology. However, when analyzing performance for those whom we knew level of video use, there was a statistically different and higher anatomy achievement. Anat Sci Ed, 2008. © 2008 American Association of Anatomists.     

Lung surfactant

Lung surfactant, a lipo-protein complex, is a highly surface-active material found in the fluid lining the air-liquid interface of the alveolar surface. Surfactant plays a dual function of preventing alveolar collapse during breathing cycle and protection of the lungs from injuries and infections caused by foreign bodies and pathogens. Varying degrees of structure-function abnormalities of surfactant have been associated with obstructive lung diseases, respiratory infections, respiratory distress syndromes, interstitial lung diseases, pulmonary alveolar proteinosis, cardiopulmonary bypass surgery and smoking. For some pulmonary conditions, especially respiratory distress syndrome, surfactant therapy is on the horizon.     

Correlation Between Proinflammatory Serum Markers: High Sensitivity C-Reactive Protein,Interleukin-6 with Disability Score in Acute Ischemic Stroke

Stroke being the third leading cause of death and foremost cause of disability, if potential diagnostic utility of blood borne protein biomarkers in predicting acute stroke is established, it would be a substantial adjunct to computerized tomography and magnetic resonance imaging which have their own limitations. This study was done to correlate serum Interleukin 6, high sensitivity C reactive protein at the time of admission with neurological worsening assessed by NIHSS at the time of admission and 7 days after admission. 46 Patients admitted in neurology department SAIMS, Indore with first ever ischemic stroke within 72 h of onset were included in the study. All patients with history of stroke of more than 72 h onset, Infection & peripartum stroke were excluded from the study. Disability scoring was done by NIHSS and their serum samples assayed for hsCRP, IL6 by commercially available quantitative sandwich enzyme-linked immunoadsorbent assay kits. Serum samples of 50 control cases which included healthy volunteers and staff from SAIMS were also analyzed for hsCRP, IL6 for comparative study. A significant correlation was observed between NIHSS scoring and serum hsCRP and IL6 at the time of admission. Patients with initial high serum IL6 and hsCRP also showed significant clinical deterioration as assessed by NIHSS scoring 7 days after admission. Elevated hsCRP and IL6 within 72 h of admission strongly correlated with functional disability in study population in India and may serve as useful adjunct to CT Scan in emergency setting.