• Original Article
    Sirolimus-based, calcineurin inhibitor- free regimen in kidney transplant patients: An open-label, randomized, controlled trial
    Background: We report a prospective, open-label, randomized study to evaluate the safety and efcacy of converting patients with stable renal function from Tacrolimus (Tac)-based regimen to a Sirolimus (SRL)-based regimen after kidney transplantation. Methods: Fifty eight low risk renal allograft recipients who were eligible to the study, 6 months posttransplant and receiving Tac, were randomly assigned to continue Tac (n=29) or convert to SRL (n=29). We evaluated the 3-year outcomes including patient and graft survival, graft function and safety profle. Results: 3-year patient and graft survival in SRL and Tac groups was 93.1% vs. 100% (P=0.04), and 89.7% vs. 100% (P=0.04), respectively. However, the SRL group had signifcantly better renal function, from the second year post-transplant until the last follow-up. Four (13.8%) patients in the SRL group and 3 (10.3%) in the Tac group (P=0.5) developed biopsy proven acute rejection. Mean urinary protein excretion increased signifcantly after SRL conversion. Diastolic blood pressure was signifcantly lower in patients who eliminated tacrolimus (80.4 vs. 75.6 mmHg) (P = 0.03). Mean hemoglobin concentrations decreased after SRL conversion and remained signifcantly lower from 12 months to 36 months (P=0.01). The mean serum cholesterol and triglyceride levels increased signifcantly in the SRL group, (P < 0.05). Conclusions: our experience demonstrates that conversion to sirolimus from calcineurin inhibitors (CNI)-based therapy may result in better renal function and blood pressure control in renal transplant recipients without an increased risk of acute rejection. However, these benefts have not resulted in a growing advantage in graft or patient survival. Key words: Kidney transplant- Sirolimus- outcome
  • Original Article
    Prevalence of Fibularis Tertius Muscle in South-eastren Indian Population: a Surface Anatomical Study
    Background: Fibularis tertius (FT) is a variant muscle of the anterior compartment of leg which involves in dorsiflexion and evertion of the foot. Literature shows that the reported prevalence of FT ranges from 49-100%. This study investigates the prevalence of FT in South-eastren population of India using surface anatomy techniques in living subjects and comparing it with the studies available in the literature. Material and methods: Study included the evaluation of 195 subjects from Year 1 & 2 medical students (102 females and 93 males) which correspond to 390 feet in total. The average age of the sample was 17.9 years, with lower and upper limits of 17 and 20 years, respectively. The presence of FT was identifed with a standard palpation technique that determines the presence of muscle on the basis of the progression tests called F1, F2, and F3. Results: The total FT prevalence was found to be 52% of the sample. On the right foot, FT was found to be 26.5% in males and 24.4% in females and on the left foot, it was 26.5% in males and 25.5% in females. FT palpation criterion showed 0 (zero) cases for F1, 31 cases for F2 and 172 cases for F3. Conclusion: This surface anatomical study reports for the frst time the FT prevalence in South-eastren population of India. Further studies on prevalence of FT are needed to understand its role in biomechanics and reconstructive surgeries of the ankle and foot. Keywords: Fibularis Tertirus muscle, Prevalence, South-eastern India, Surface anatomy
  • Original Article
    Factors Affecting Survival in Small Cell Lung Cancer
    Objective: Small cell lung cancer (SCLC) constitutes about 15-25 % of lung cancers with high mortality rate. Herein we observed the effect of parameters at the time of diagnosis to survival of cases with SCLC. Methods: We evaluated 65 patients who were followed up in our oncology department retrospectively. Results: Tumor location and stage at the time of diagnosis, smoking history, accompanying comorbidities, ECOG PS, laboratory parameters and treatments applied in pursuit were evaluated. 3-month survival rate of patients was 75.9%, 50.2% for 6-month, 21.4% for 1 year, and 5.5% for 2 years during follow up. ECOG PS and stage were found statistically signifcant risk factors in model created to determine overall survival. Conclusion: Performance score at the time of diagnosis, stage and presence of liver metastasis are identifed as prognostic factors for SCLC and of these factors are quite valuable to predict the clinical outcome. Key words: SCLC; prognostic factors; survival
  • Original Article
    Prevalence of oral lipomas in an Indian population: An institutional retrospective study of 10 years and analysis of 37 published cases from 1976 – 2015 reported in Indian patients.
    Background: Lipomas are benign mesenchymal tumors of soft tissue that can be found anywhere in the body: However their presence in oral cavity is very rare (4.4%). Histopathologically lipomas are classifed as simple lipomas and different variants. The present study describes the prevalence of oral lipomas with relation to patient’s age, their site of occurrence and histological pattern in Indian population. Methods: All cases of oral lipomas reported in the department of oral pathology and microbiology, N.I.M.S dental college Jaipur (India) from 2005 to 2017 for age, gender, site of occurrence, histopathological pattern and treatment mode were reviewed. The published case reports of oral lipomas reported in Indian patients from 1976 – 2017 also reviewed through pubmed by using MeSH word; oral lipoma and combined the data with the data of present study to analyze the prevalence and histopathological characteristic of oral lipomas in Indian population. Results: Total of 23 (14 males and 9 females) cases included in the study. The mean age was 34.3 years (range 17 – 71). The specifc sites involved were buccal mucosa (n = 9) Tongue (n = 5) buccal vestibule (n = 2) Lip (n -= 3) Floor of mouth (n = 1), palate (n = 2) and retro molar pad (n = 1). Histopathological examination revealed 11 cases were diagnosed as simple lipoma, 6 cases were fbrolipoma, 2 cases were angiolipoma, 1 case each of osteolipoma, myxolioma, angiomyxolipoma and hibernoma. All cases treated with surgical excision only one case showed radiographical sign. This data was combined with the data of published cases (pubmed) of oral lipoma in Indian population. Conclusion: Oral lipomas are rare neoplasms of oral cavity; only 49 published cases have been found from 1976 – 2017 in Indian population. Oral lipoma should be considered as a differential diagnosis of oral soft tissue swelling. Surgical excision is the treatment of choice for all such tumors. Keywords: Oral lipoma, Intra oral lipoma, Indian population, Prevalence, Adipocytes, Histopathological pattern
  • Review Article
    Renal dysfunction in cirrhosis
    Kidney dysfunction is a common and potentially life-threating event in patients with cirrhosis, and underlying mechanisms for renal dysfunction are quite variable. Acute kidney injury (AKI) is relatively frequent encountered in approximately 20% of hospitalized patients with cirrhosis. Nevertheless, chronic kidney disease (CKD) occurs in almost 1% of all patients with cirrhosis. In this review various renal problems encountered in cirrhotic patients are discussed and strategies to prevent renal dysfunction are suggested. Key words: Liver cirrhosis, acute kidney injury, chronic kidney failure
  • Case Report
    A rare presentation of Adenoid cystic carcinoma of parotid gland as metastatic Endobronchial growth during Bronchoscopy with multiple ‘Bilateral Cannon ball’ lung metastasis in chest radiograph
    Adenoid cystic carcinoma are relatively less common type of salivary gland tumour including parotid gland, and is the only histological type having propensity to spread distantly by lympho-hematogenous and other ‘classical perineural’ spread. Adenoid cystic carcinoma as a primary salivary gland tumor arising in bronchus is known entity although is exceptionally rare. In this case report, 43 year male with past history of adenoid cystic carcinoma of left parotid gland which was operated 4 years back and received post-operative radiotherapy presented with shortness of breath clinically. We observed ‘cannon ball opacities bilaterally’ over chest radiograph and Endobronchial growth during bronchoscopy. Histopathology confirmed as a metastatic lung cancer. We recommend bronchoscopy of all the cases with bilateral cannon ball metastasis as it will help in diagnosis endobronchial growth. Keywords: Bronchoscopy; Adenoid cystic carcinoma parotid; Cannon ball metastasis; Chest radiography, Metastasis
  • Case Report
    Eruptive Xanthomas In A Patient With Metabolic Syndrome
    Eruptive xanthomas are characterized by large numbers of yellow papules, typically 1-4 m in size, sometimes with an erythematous halo, sometimes pruritic, of sudden onset and generally observed on the extensor surfaces of the extremities. These are seen in less than 0.1% of diabetic patients. Diabetes mellitus is the most common secondary cause of type 5 hyperlipoproteinemia, a form of chylomcronemia. Eruptive xanthomas generally emerge at triglyceride levels above 2000 mg/dL proceeding with chylomicronemia. This case report of a 36-year-old woman diagnosed with eruptive xanthoma on the basis of clinical and histopathological fndings is presented in order to emphasize that these are an important fnding of diseases associated with metabolic syndrome, such as diabetes mellitus and hypertriglyceridemia. Keywords: Eruptive xanthoma, diabetes mellitus, hypertriglyceridemia, metabolic syndrome
  • Case Report
    Sitting Buddha position: Sacral agenesis case
    Sacral agenesis syndrome (Caudal regression syndrome) is a neural tube defect that is characterized by absence of the vertebral segment that constitutes the sacrum. It is very rarely seen and generally develops sporadically. Its etiology is influenced by maternal diabetes, genetic factors, teratogenic agents and vascular hypo-perfusion. It is important to make a diagnosis in the prenatal period. This paper presents a newborn diagnosed with sacral agenesis as a case and discusses this disease in the light of the latest literature information. Keywords: Sacral agenesis; Caudal regression syndrome; Newborn.

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