Browsing by Author "Vijai Tilak"

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A case of Actinomycotic mycetoma involving the right foot
(Journal of Infection in Developing Countries, 2009) Ragini Tilak; Sanjay Singh; Atul Garg; Jaya Bassi; Vijai Tilak; Anil K. Gulati
A 45-year-old male presented with history of multiple swellings over the foot with sinuses discharging seropurulent pus. Actinomadura madurae was demonstrated and identified by microbiological culture from the pus obtained directly of the lesion. This case is reported to emphasize the importance of laboratory diagnosis in the management and assessment of the prognosis of such cases.
Case report: Histoplasmosis accompanying disseminated tuberculosis in an immunocompetent adolescent boy
(American Society of Tropical Medicine and Hygiene, 2020) Ashis Kumar Choudhury; Ankit Kumar Mishra; Deepak Kumar Gautam; Ragini Tilak; Vijai Tilak; Indrajeet Singh Gambhir; Sankha Shubhra Chakrabarti
The incidence of tuberculosis in India is quite high. In such a situation, empirical antitubercular therapy (ATT) is often resorted to, when some of the investigation findings are clearly diagnostic of tuberculosis. This may mean missing out on coinfections. Whereas this is particularly true for immunosuppressed patients, rarely even immunocompetent patients may present with such diagnostic dilemmas.Wepresent the case of an adolescent boy who had been previously asymptomatic and who presented with fever with lymphadenopathy, splenomegaly, and pancytopenia. Initially, ATT was administered based on the detection of acid-fast bacteria in lymph node, caseating granulomas with Langhans giant cells, and a positive cartridge-based nucleic acid amplification test specific for Mycobacterium tuberculosis. However, when the patient failed to respond fully to the treatment, additional investigation in the form of bone marrow fungal culture led to the diagnosis of histoplasmosis. © 2020 by The American Society of Tropical Medicine and Hygiene.
Cryptococcal meningitis with an antecedent cutaneous Cryptococcal lesion
(Dermatology Online Journal, 2009) Ragini Tilak; Pradyot Prakash; Chaitanya Nigam; Vijai Tilak; I.S. Gambhir; A.K. Gulati
Cutaneous cryptococcosis, caused by an encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. Here we report a case of primary cutaneous cryptococcosis with spread to central nervous system in an HIV seronegative young boy. In the present case, a 17-year-old boy who was suffering from a non-healing ulcer on his right great toe for 5 months, presented with the signs and symptoms of meningitis. Cryptococcus neoformans var. gattii was isolated from the CSF of the patient. Amphotericin B administration produced recovery from the meningitis as well as from the ulcer. This case study suggests that primary cutaneous cryptococcosis can be diagnosed provisionally by a simple Gram stained smear and India ink examination in order to avoid occurrence of disseminated cryptococcosis, including meningial involvement, which may have a fatal outcome. © 2009 Dermatology Online Journal.
Cutaneous zygomycosis: A possible postoperative complication in immunocompetent individuals
(2009) Ragini Tilak; Prabhat Raina; Sanjeev Kumar Gupta; Vijai Tilak; Pradyot Prakash; Anil Kumar Gulati
Fungi in the class of zygomycetes usually produce serious infections in diabetics and immunocompromised hosts. Cutaneous zygomycosis is a less common form, with an unpredictable extent of anatomical involvement and clinical course. Here, we report two cases of primary cutaneous zygomycosis as postoperative complications in otherwise healthy females. Zygomycosis was suspected and specimens from the surgical debridement were examined by microbiological and histopathological studies for confirming the clinical diagnosis. Rapid diagnosis, liposomal amphotericin B, and proper debridement of affected tissue are necessary to avoid a fatal outcome.
Evaluation of different serological techniques in laboratory diagnosis of brucellosis
(Evangel Publishing, 2008) Ragini Jain; Vijai Tilak
Diagnosis of brucellosis is vital for early institution of proper therapy as untreated cases may progress to chronic stage. Though the demonstration of the causative agent in blood is considered as the most conclusive test in the diagnosis of brucellosis, isolation of brucella organism by blood culture is relatively low. Hence a number of sensitive and rapid serological tests have been introduced for the diagnosis of brucellosis. In the present study, an attempt was made to compare the efficacies of existing serological tests such as agglutination reaction with newer rapid tests which help in the detection of either specific antigen or antibody. The study included specimens from 80 patients clinically suspected to be suffering from brucellosis and 20 apparently healthy controls. All serum samples were subjected for evidence of brucellosis by five serological tests viz, standard tube agglutination test, 2-mercaptoethanol test, modified antiglobulin test, counter immuno- electrophoresis and passive haemagglutination test for antibody detection and two serological tests viz, counter immuno-electrophoresis and latex agglutination test for antigen detection. Eighty blood samples were processed for microbiological evidence of brucellosis and yielded only 8 isolates of Brucella melitensis of biotype 1. By standard tube agglutination test, 25 sera showed titre of brucella agglutinins equal to more than the diagnostic titre (ie, more than or equal to 160 IU). Counter immuno-electrophoresis test and latex agglutination showed presence of antigen in 3 and 4 blood culture negative cases respectively.
Floatation of decalcified bone marrow core biopsy - A clue to marrow hypocellularity
(Journal of Clinical and Diagnostic Research, 2014) Vijai Tilak; Subhajit Das; Gyan Prakash Singh
Background: Examination of bone marrow plays a pivotal role in the practice of haematology. It can be evaluated by three ways - bone marrow aspiration smears (BMA), bone marrow touch imprints (BMI) and bone marrow biopsy (BMB). BMB sections are considered to be the gold standard for assessing overall marrow cellularity.; Aim and objective: To evaluate the correlation, if any, between bone marrow cellularity and floatation pattern of the core biopsy specimen, after proper decalcification.; Setting and design: This study was carried out in the Department of Pathology, Institute of Medical Sciences, Varanasi over a period of 26 months.; Materials and methods: Specimens of BMA, BMI and BMB were collected from 182 cases. The core biopsy specimens were fixed in 10% buffered formalin for 24 hours, and were decalcified in 5% formic acid for 12 hours. The properly decalcified core biopsy samples were then put into adequate-sized container filled with 10% buffered formalin, and floatation pattern was documented.; Statistical analysis: All the observations were evaluated using simple and basic statistical tools, i.e. sensitivity, specificity, positive predictive value. Chi square test was applied for obtaining statistical correlation i.e. P-value.; Results: Out of 182 core biopsy specimens, 32.4% (n=59) floated, while rests sank. Out of the 59 floating core biopsies, 57 were hypocellular. 7 core biopsies, among 123 specimens that sank, were hypocellular. The sensitivity and specificity of floatation pattern for hypocellular marrow were 89.2% and 99.1%, respectively. A strong correlation (p-value <0.001) between the floatation pattern and bone marrow cellularity was obtained.; Conclusion: Assessment of floatation pattern of properly decalcified marrow core specimen is reliable for assessing marrow hypocellularity. © 2014, Journal of Clinical and Diagnostic Research. All right reserved.
Hepatocellular carcinoma presenting as neutrophilic leukaemoid reaction - A rare entity
(Indian Medical Association, 2007) Vijai Tilak; R.A.I. Madhukar; V.P. Singh; Amit Kumar Rai; Rajiva Raman
Leukaemoid reaction is a rare, growth factor-driven, paraneoplastic manifestation of hepatocellular carcinoma. It may masquerade as the neutrophilic chronic myeloid leukaemia or as chronic neutrophilic leukaemia. A 52-year-old male presented with hepatosplenomegaly and severe leucocytosis. He had progressive leucocytosis, neutrophil alkaline phosphatase score elevated, liver function tests altered. FNAC from the mass in the liver revealed features of moderately differentiated hepatocellular carcinoma. The patient deteriorated within two weeks and died thereafter.
Idiopathic fatal pancytopenia: A case report
(Journal of Clinical and Diagnostic Research, 2016) Hema Goyal; Vijai Tilak
Pancytopenia is defined as decrease in red blood cells, white blood cells and platelets. Many disease processes involve the bone marrow primarily or secondarily resulting in pancytopenia. A 55-year-old male presented with generalized body weakness and few episodes of malena for last one year. Physical and systemic examination was unremarkable. CBC report revealed pancytopenia. Other haematological parameters were within normal limit. Stool for occult blood was positive. USG and CECT abdomen showed no abnormality. The patient was evaluated for any evidence of malignancy but no clue was found. Bone marrow examination was done as patient was having pancytopenia. Bone marrow smears, clot sections and bone marrow biopsy was normal. Immunohistochemistry and cytogenetics study was unremarkable. Patient was admitted in hospital for 1 month and his condition rapidly deteriorated. The cause of pancytopenia remained unexplained and therefore it was named as Idiopathic fatal pancytopenia. “Idiopathic Fatal Pancytopenia (IFP)” is an emerging new entity with a grave prognosis. We wish to sensitize the medical community and the scientists to this rapidly fatal condition. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Immunosuppressive therapy in aplastic anemia
(2012) Vineeta Gupta; Akash Kumar; Vijai Tilak; Isha Saini; Baldev Bhatia
Objective: To assess the response to antithymocyte globulin based immunosuppressive therapy (IST) in pediatric patients with idiopathic aplastic anemia. Methods: Thirty patients (19 boys and 11 girls) with aplastic anemia received antithymocyte globulin and cyclosporine. Twenty-two patients had severe and 8 had very severe aplastic anemia. Results: Mean age of the patients was 9.19 ± 2.56 y. Three patients died within 1 mo of therapy, two due to sepsis and one due to intracranial hemorrhage. Twenty-seven patients were analyzed for response to therapy. Eight patients (29.7%) responded at 3 mo: 3 complete response (CR) and 5 partial response (PR). Six mo after the therapy, overall response (OR) was seen in 9/27 (33.3%), with one more patient in no response group achieving partial response. At 1 year, patients in CR maintained their status and 1 patient in PR group relapsed. He again achieved partial response with repeat course of ATG. Responders had significantly shorter duration of illness and higher absolute neutrophil count as compared to non responders to IST. None of the patients developed acute leukemia in the follow up. Conclusions: The treatment of aplastic anemia in pediatric patients is a challenging task. One third of the patients achieved overall response which included both complete and partial response. © 2012 Dr. K C Chaudhuri Foundation.
Indian Society of Hematology and Blood Transfusion (ISHBT) Consensus Document on Hematological Practice During COVID-19 Pandemic
(Springer, 2021) Rakhee Kar; Tuphan Kanti Dolai; Prakash Singh Shekhawat; Pankaj Malhotra; Avinash Singh; Rahul Naithani; Prakas Kumar Mandal; Prasanth Ganesan; Prabhu Manivannan; Debdatta Basu; Alok Srivastava; Reena Das; Maitreyee Bhattacharya; Manoranjan Mahapatra; Rishi Dhawan; Arihant Jain; Chandni Bhandary; Hara Prasad Pati; Tathagata Chatterjee; Vijai Tilak; Sarmila Chandra; Shrimati Dharampal Shetty; Rabindra Kumar Jena
The SARS-CoV-2 (COVID-19) pandemic is a worldwide public health emergency with widespread impact on health care delivery. Unforeseen challenges have been noted during administration of usual haematology care in these unusual COVID-19 times. Medical services have been overstretched and frontline health workers have borne the brunt of COVID-19 pandemic. Movement restrictions during lockdown prevented large sections of population from accessing health care, blood banks from holding blood drives, and disrupted delivery of diagnostic hematology services. The disruption in hematology care due to COVID-19 pandemic in India has been disproportionately higher compared to other subspecialities as hematology practice in India remains restricted to major cities. In this review we chronicle the challenges encountered in caring for hematology patients during the COVID-19 pandemic in India and put forth recommendations for minimizing their impact on provision of hematology care with special emphasis on hematology practice in lower and middle income countries (LMICs). © 2021, Indian Society of Hematology and Blood Transfusion.
Lymphoma without lymphadenopathy
(Chinese Medical Association, 2015) Ashutosh Jain; Nilesh Kumar; Mahendra K Jangid; Indrajeet Singh Gambhir; Vijai Tilak
[No abstract available]
Mycotic keratitis in India: A five-year retrospective study
(Journal of Infection in Developing Countries, 2010) Ragini Tilak; Abhisek Singh; Om Prakash Singh Maurya; Abhishek Chandra; Vijai Tilak; Anil Kumar Gulati
Background: Mycotic keratitis is a fungal infection of the cornea. This infection is difficult to treat and it can lead to severe visual impairment or blindness. It is worldwide in distribution, but is more common in the tropics and subtropical regions. Trauma is the major predisposing factor, followed by ocular and systemic defects, prior application of corticosteroids, and prolonged use of antibiotic eye-drops. The objective of this study was to determine causative agents and to identify the predisposing factors of mycotic keratitis. Methodology: Corneal scrapings from 90 corneal ulcer patients with suspected fungal etiology were subjected to direct examination by 10% KOH mount, Gram stain and culture. Results: This study included 90 subjects with corneal ulcers, based on clinical suspicion, of whom 41 cases were diagnosed with mycotic keratitis in the laboratory. Among these 41 cases, culture showed fungal growth only in 36 cases whereas the remaining five cases were positive only by potassium hydroxide (KOH) preparation. Males were more commonly affected and were mostly in the age group of 31-40 years. Aspergillus flavus was the most common fungus isolated followed by fusarium solani. Conclusion: Rapid diagnosis and early institution of antifungal therapy is necessary to prevent ocular morbidity and blindness. Although culture helps in definite diagnosis and identification, direct microscopic detection of fungal structures in corneal scrapes or biopsies permits a rapid presumptive diagnosis. © 2010 Tilak et al.
Philadelphia chromosome- positive myelodysplastic syndrome with single lineage dysplasia
(Elsevier Inc., 2023) Ajeet Kumar; Vijai Tilak; Disha Arora; Marisha; Rahul; Deepak Gautam; Akhtar Ali
Myelodysplastic syndrome (MDS) is a group of acquired clonal disorders characterized by dysplastic and ineffective hematopoiesis in the bone marrow. Various specific karyotypic and molecular abnormalities associated with MDS further guide the prognosis. Although translocation t(9;22)(q34;q11) (Philadelphia positive [Ph+]) and corresponding BCR-ABL fusion transcript are classically defined to differentiate CML from non-CML myeloproliferative disorders, it is also associated with adult acute lymphoblastic leukemia (Ph+ ALL), acute myeloid Leukemia (Ph+ AML), myelodysplastic syndrome (Ph+ MDS). The occurrence of Ph+ MDS is very uncommon, and a review of literature has shown by far 40 cases so far in which the majority are seen on progression to Leukemia. Few had de novo presence of such chromosomal abnormality. Due to its rarity, this entity has not yet found its space in the current WHO classification. Also, the role of tyrosine kinase inhibitors in such a scenario is still debatable. We found two such cases of de novo Ph+ MDS diagnosed at institute of medical sciences, Banaras Hindu university and a brief literature review. © 2023
Platelet function disorder in women with heavy menstrual bleeding in Eastern Uttar Pradesh
(Regional Institute of Medical Sciences, 2021) Shuchi Jain; Nisha Rani Agrawal; Vijai Tilak; Ekhlak Mohammad; D. Dash; Madhu Jain
Background: Platelet function disorder (PFD) is turning out to be a major cause of heavy menstrual bleeding (HMB) in women. One should suspect for this entity and should look for it in all girls who have this issue since menarche to impart proper management. Objectives: This study was carried out to find the incidence of PFD in Patients with HMB referred to our tertiary care teaching hospital. Materials and Methods: Platelet aggregation in response to ristocetin-induced platelet aggregation (RIPA), Adrenaline, adenosine diphosphate, and Collagen was studied in 50 women with HMB and in the equal number of age-matched healthy women. Bleeding time and Platelet count were also measured. Results: Glanzmann’s thrombasthenia (GT) was detected in 5 and Bernard Soulier Syndrome (BSS) in 2 women with HMB. Macrothrombocytopenia was observed in BSS. RIPA was also significantly reduced in BSS but normal in GT. Coagulopathies should always be doubted in the presence of significant anemia. One should carry out the Platelet function studies when screening parameters like prothrombin time, partial thromboplastin time, von Willebrand factor, and factor VIII activity level are normal. Normal platelet count and morphology in addition suggest functional defects in platelets which can be detected by various aggregation studies, electron microscopy, flow cytometry, and thromboelastography. Conclusion: The clinicians treating women with HMB should be aware of PFD as an important etiology and the platelet function should be studied in all women with HMB in a phase-wise manner in order not to miss the diagnosis and also to make it more cost-effective. © 2021 Journal of Medical Society | Published by Wolters Kluwer-Medknow.
Prevalence of von Willebrand Disease in Patients with Heavy Menstrual Bleeding: An Indian Perspective
(Jaypee Brothers Medical Publishers (P) Ltd, 2021) Shuchi Jain; Nisha R. Agrawal; Vijai Tilak; Madhu Jain; Tej B. Singh; Krishna S. Piplani
Aim: The von Willebrand disease (vWD) is said to be the most common hemostatic disorder among the nonstructural causes of heavy menstrual bleeding (HMB). This study was carried out to find prevalence of vWD and its subtypes in patients with HMB referred to a tertiary healthcare center. Materials and methods: Two hundred patients with HMB and equal number of age-matched control were subjected to laboratory tests such as complete blood count, bleeding time, and clotting time. Prothrombin time (PT), activated partial thromboplastin time (APTT), and factor VIII (FVIII):C assay were done manually. von Willebrand factor (vWF:Ag) antigen assay and vWF:Ag collagen binding (CB) were done by enzyme-linked immunosorbent assay (ELISA). Platelet aggregation study with ristocetin was done to find the different subtypes of vWD. Results: vWD and its subtypes were diagnosed in 25 out of 200 women with HMB with a prevalence of 12.5%. Type III vWD was the commonest (15/25, 60%), followed by type II (7/25, 28%) and type I (3/25, 12%). Among the various subcategories of type II, type IIB was conspicuously absent and type IIN was the most frequent (5/7, 71%). Conclusion: vWD should always be considered as one of the possible bleeding disorders in patients with HMB particularly in those referred to a tertiary care center. It was detected in 12.5% of such women, and type III was the most frequent type encountered among its various subtypes. Clinical significance: Detection of vWD and its various subtypes at the earliest opportunity would help the treating physician to plan out a definite line of management and save many women from unwarranted hysterectomies and also improve their quality of life and reproductive potential. © The Author(s).
Primary amoebic meningoencephalitis due to naegleria fowleri
(Indian Medical Association, 2011) Ragini Jain; Vijai Tilak
Primary amoebic meningo-encephalitis is a fulminant, often rapidly fatal infection affecting individu als with a recent history of swimming in warm fresh water. A fatal case of primary amoebic meningo encephalitis due to Naegleria fowleri in a 35 years old male suffering from human immunodeficiency virus with pulmonary tuberculosis infection is reported. Naegleria fowleri was diagnosed by wet mount examination of cerebrospinal fluid and the diagnosis was confirmed by culture of the cerebrospinal fluid on non-nutrient agar layered with Escherichia coli. The patient was treated with amphotericin B and antituberculous treatment but the outcome was fatal. Primary amoebic meningo-encephalitis should be suspected in every case of pyogenic meningo-encephalitis in which no bacteria or fungus is found on cerebrospinal fluid examination.
Primary cerebral Nocardiosis in a renal transplant recipient: A case report
(2012) Ragini Tilak; Arvind Achra; Vijai Tilak
Nocardial brain abscess is a rare central nervous system infection. A 50 year old renal transplant recipient developed a nocardial cerebral abscess. It manifested clinically with pyrexia of unknown origin, recurrent episodes of convulsions and a right sided hemiparesis. The purulent material was drained and sent to the Microbiology Laboratory for culture and sensitivity studies. Direct microscopy and culture confirmed the diagnosis of nocardial infection.
Pulmonary fungal ball in non-immunocompromised patient: A case report
(2007) Ragini Jain; D. Agarwal; T.K. Lahiri; Vijai Tilak; A.K. Gulati
Fungal ball caused by Aspergillus species is an opportunistic infection. We describe a case report of a patient with culture positive Aspergillus fumigatus who presented with complaints of cough and expectoration with recurrent episodes of haemoptysis. Tuberculosis is the commonest cause of haemoptysis in India. However fungal ball is also one of the leading cause of haemoptysis. Hence laboratory evaluation of haemoptysis should not only include work up for tuberculosis but sample should also be submitted for mycological evaluation.
Pulmonary nocardiosis presenting as fungal ball--a rare entity.
(2008) Ragini Tilak; D. Agarwal; T.K. Lahiri; Vijai Tilak
Pulmonary intracavitary infection caused by Nocardia is an opportunistic infection and is believed to be a rare entity. We describe a case report of a patient with culture positive Nocardia asteroides who presented with complaints of cough and expectoration with episodes of haemoptysis and dyspnoea. The diagnosis of nocardiosis was made by microscopic examination of the surgically resected portion of the lung and confirmed on culture.
Rhino-orbital-cerebral zygomycosis in a young boy: Case report
(Journal of Clinical and Diagnostic Research, 2012) Ragini Tilak; Vikas Kumar; Vijai Tilak; Vivek Sharma
Rhino-orbital-cerebral Zygomycosis is a rare opportunistic infection of sinuses, orbit and brain which is caused by saprophytic fungi which belongs to the order of Mucorales. It is one of the fulminant and fatal mycotic infections known to human beings with a high mortality rate. An increased incidence of zygomycosis has been observed in immuno-compromised patients such as poorly controlled diabetes mellitus, blood dyscrasias, malnutrition, neutropenia, iron overload, organ transplant and immuno-suppressive therapy but they can also occur in normal hosts rarely. We report here a case of 21-year old diabetic young boy presented with a history of non-specific headache, pain abdomen, vomiting and progressive swelling of left eye and altered sensorium. On the basis of MRI findings and micro biological investigations, he was diagnosed as a case of rhino-orbital-cerebral zygomycosis. He was treated successfully with a combination of surgical debridement and systemic amphotericin B administration.