Hepatic haemangioma causing isolated right-sided pleural effusion and bilateral pedal oedema

Hepatic haemangioma (HH) is a common benign tumour of the liver and is usually asymptomatic. HH causing isolated right-sided pleural effusion and bilateral pedal oedema due to inferior vena cava (IVC) compression have never been reported in the literature. We report a 35-year-old male patient who presented with breathlessness and mass per abdomen. On examination, the patient was found to have right-sided pleural effusion, bilateral pedal oedema, hepatomegaly. Contrast-enhanced CT showed compression of the IVC by the HH. The patient was managed with right-sided intercostal drain insertion for pleural effusion and hepatic artery embolisation. The patient improved gradually with reduced pleural effusion and resolving pedal oedema.

Management of the Index COVID -19 Obstetric Patient at the University of Benin Teaching Hospital

Introduction: The novel coronavirus (COVID-19) was first identified in Wuhan City, Hubei province of China, November 2019. As at September 2020, over 28 million infections have been identified with almost a million deaths worldwide causing an alarming pandemic. Clinical presentations in pregnant patients with COVID-19 could be atypical with normal temperature (56%) and leukocytosis. This is further masked by the features of pregnancy. We present the management of a COVID-19 parturient in our obstetric unit. Case Report: A 32 year old unbooked G₃P₁⁺1 lady at 32 weeks who presented via referral from a private facility with a history of elevated blood pressure and ++ of protein in urine. Also, complaints of cough and difficulty with breathing. On examination she was noted to be anxious, afebrile, not pale, anicteric, acyanosed, not dehydrated. Had bilateral pedal oedema. Tachypnic with a respiratory rate of 28 cycles per min with basal crepitations. Pulse rate was 96bpm full and regular. Blood pressure was 180/100 mmHg. Heart sounds S₁S₂only.An impression of Chronic hypertension with superimposed pre-eclampsia at 32 wks GA in a primipara with one previous CS with pulmonary edema. Keep in view COVID-19. She was managed with oxygen, antihypertensives, steroids, while observing strict infection control protocol. She had an emergency caesarean section under subarachnoid block and was delivered of a live female neonate. A confirmatory positive result for covid-19 was obtained 24hrs later. Neonate was however negative. None of the staff became positive also. Conclusion: The management of suspected cases of COVID-19 infection should be same as cases already confirmed. As the epidemic persists, numbers will continue to rise andhence our index of suspicion should be heightened. Pregnant women will also present with symptoms masked by the features of a sick parturient. Full complement of PPE must be worn by all staff attending to both confirmed and suspicious cases of COVID-19 infection and strict adherence to stated protocols must be observed.

ROLE OF ILAJ-BIL-GHIZA (DIETOTHERAPY) AS A PREVENTIVE THERAPY IN PREGNANCY INDUCED HYPERTENSION (PIH): A REVIEW

The hypertension that is caused directly by gravid state is known as Pregnancy Induced Hypertension (PIH). It has an association with increased maternal morbidity and mortality. In classical Unani literature, hypertension is referred as Hejan of blood. Ibn-e-Sina (Avicenna) wrote in his book Al-Qanoon Fit Tib (Alcanon) that few times pregnant women may complain Warm-e-Qadam (Pedal Oedema). During labour, Tashannuj wa Tamaddud (Convulsions) may occur. Ilaj-bil-Ghiza (Dietotherapy) is a method of Unani treatment in which a specific diet is given for a specific disease. Dietary supplement of 400 IU Vitamin E and 1000 mg Vitamin C per day as antioxidant resulted in reducing oxidative stress, decreased endothelial activation and reduction in the risk of PIH by 61%. Specific diets mentioned in Unani medicine which contains Vitamin E and Vitamin C can be beneficial in PIH.

A Study of Clinicopathological Correlation in Patients with Lupus Nephritis in a Tertiary Centre in South India

BACKGROUND Lupus nephritis (LN) is very common and significantly affects the prognosis of patients with systemic lupus erythematosus (SLE). Although the diagnosis of LN is obvious sometimes from the simple lab tests, it is important to perform a renal biopsy. We wanted to study the correlation between the clinical, lab parameters and the histopathological grade of LN in a tertiary care centre in South India. METHODS A cross-sectional study was conducted among all patients with biopsy proven LN who underwent a renal biopsy from 19 / 09 / 2017 to 30 / 06 / 2019. Data of 51 patients were obtained. For all the study subjects, a history was obtained, clinical examination was done, and their lab parameters and the renal biopsy report were noted in the proforma. The histology was correlated with the laboratory and clinical data. RESULTS The majority of the patients were females. Maximum patients had class IV LN and class III had more males than any other class of LN. When clinical and laboratory parameters were correlated with histopathological findings, pedal oedema and facial puffiness were found to be correlated with the classes of lupus nephritis with statistical significance. Among investigations, haemoglobin, C3, activity score and 24 -hour urine protein had a statistically significant correlation with the various classes of lupus nephritis. CONCLUSIONS This study suggests some meaningful correlation between pedal oedema, facial puffiness, 24 hours urine protein, haemoglobin levels, C3 levels and activity score with lupus nephritis classes of ISN / RPS 2003 classification. KEY WORDS Lupus, Clinicopathological Correlation

Study of cardiac involvement in liver cirrhosis patients

Background: Cirrhosis liver is characterized by diffuse destruction and regeneration of hepatic parenchymal cells. Various studies have been carried out over the years to evaluate the cardiac and hemodynamic changes in cirrhosis of the liver.Methods: Study is conducted on 50 consecutive patients with cirrhosis liver admitted in various medical wards of the Mc Gann Hospital attached to Shimoga institute of medical sciences, Shimoga from January, 2020 to September 2020. Detailed history was taken and a through physical examination was done. Blood investigations are done. Echocardiography, Chest radiography done. All patients were subjected to USG abdomen to confirm the diagnosis of cirrhosis.Results: There were 35 males and 15 females. Average age is 54±6.6 years. Alcoholism (64%) and idiopathic (16%) are commonest associations. Commonest symptom is anaemia (88%) followed by pedal oedema (80%) followed by fatigue (66%), ascites (60%) and jaundice (60%). Pleural effusion seen in 38%, diastolic dysfunction 32%, pericardial effusion 16%, wall motion abnormality in 11%. Hypertension, arrhythmias and LVF is seen in 8%. Cardiomyopathy in 6%. ECG changes are Hemiblock in 4 (8%), QTc prolongation in 34%. LVH in 12%, Low voltage complex are seen in 24%. cardiomegaly seen in 20%.Conclusions: Study shows that, there was significant incidence of subclinical cardiac abnormalities observed in chronic liver disease patients which increase with duration of illness. Early detection of subclinical cardiac changes is important to reduce morbidity and mortality in chronic liver disease patients.

Filariasis presenting with bicytopenia, progressive splenomegaly and acute renal failure: An unusual case report

Extra-lymphatic manifestation of filariasis, especially as acute renal failure, is uncommon and may be clinically unsuspected. We document the case of a 60 year old elderly male who presented with bilateral pedal oedema, fatigue and abdominal distension. Investigations revealed severe anaemia, splenomegaly and acute renal failure. Bone marrow aspiration was performed to evaluate the clinical suspicion of malignancy. Out of eight smears examined, microfilaria ( Brugia malayi) were identified in two. This presentation was devoid of peripheral eosinophilia. The patient was commenced on a regimen of diethylcarbamazine, on which he made a good recovery. The incidence of extra-lymphatic filariasis is largely unknown and sparsely reported. Such a presentation should be kept in mind by both clinicians and pathologists as it is potentially treatable.

Vibrio fluvialis – Unusual Case of Cellulitis Leading to Sepsis

Vibrio fluvialis, an enteric, Gram negative bacterium commonly isolated from sewage/ sea water contaminated with human and animal’s faeces. Infections with this unusual organism can cause cholera like bloody diarrhoea and also wound infection. Vibrio fluvialis causing skin infection and sepsis is uncommon with very few cases reported worldwide. It is an emerging pathogen with distinct features as compares to the other species of Vibrio group of bacteria in terms of high virulence and adaptability in hostile environments. Here is a case report of skin and soft tissue infection by Vibrio fluvialis, in a patient suffering from severe pedal oedema due to nephrotic syndrome and right lower limb deep vein thrombosis . Case Report: A young male, farmer, presented with ascites, pedal oedema, puffy face due to nephrotic syndrome.He developed skin and soft tissue infection resulted from skin atrophy and ulcer due to pedal oedema as well as right limb deep vein thrombosis . He had high grade fever, leucocytosis, anaemia, hypoproteinaemia, right leg cellulites and features of sepsis requiring wound debridement. Immunodeficiency and corticosteroids associated immunosuppression were absent in this patient. He was diagnosed with nephrotic syndrome due to minimal change disease. Conclusion: Vibrio fluvialis infection can occur due to wound contaminated with sewage water leading to skin and soft tissue infection and life threatening sepsis.

Emergency LSCS in a Parturient with Pre-eclampsia and HELLP Syndrome with Altered Renal Functions Managed with Regional Anaesthesia

Haemolysis, Elevated Liver enzyme levels, and Low Platelet (HELLP) syndrome is characterised by haemolysis (abnormal peripheral blood smear, increased unconjugated bilirubin), elevated liver enzyme and decreased platelet count. It is an advanced stage of pre-eclampsia. Pre-eclampsia is defined as blood pressure >140/90 mmHg with proteinuria with or without pedal oedema. HELLP syndrome account for 24% of maternal mortality and 40% of perinatal mortality. Anaesthetic management of such parturient is also challenging. This report is about a 35-year-old female patient with HELLP syndrome and altered renal function requiring LSCS. She was managed with regional anaesthesia.

Clear Cell Sarcoma of Kidney in Adult with Extensive Invasion of Pelvic Veins: Dual Aberration

Clear Cell Sarcoma of Kidney (CCSK) is a highly malignant renal tumour. The mean age of diagnosis is between 12-36 months. Due to heterogeneous histological appearance and age group affection similar to wilms tumour, it often leads to misdiagnosis. It has a tendency to metastasise distantly to bone and its therapeutic response differs from other childhood kidney tumours. So use of Immunohistochemical (IHC) markers becomes essential in many cases in differentiating CCSK from other paediatric renal neoplasms. It is extremely rare in adults, till now only 26 adult cases have been reported in the medical literature. Here, the case of a 49-year-old male presenting with haematuria and pedal oedema is reported. On radiological examination, he had a large left renal mass with tumour extension to Left Renal Vein (LRV) and Inferior Vena Cava (IVC) as thrombi. Histology and Immunohistochemistry (IHC) study revealed CCSK ruling the other differentials. This case is presented for its rarity in adult patients, unusual clinical feature of widespread vascular invasion rather than bone metastasis, simulating Renal Cell Carcinoma (RCC) and aggressive clinical behaviour. The diagnostic challenges faced by pathologist and clinicians further necessitate the proper diagnosis of the tumour for better management of such cases.