Comparison of diagnostic methods of malaria by peripheral smear, centrifuged buffy coat smear and rapid antigen detection test

Background: Malaria is common, life threatening infection in endemic area and presents diagnostic challenge to laboratories in most endemic areas. A rapid and accurate diagnosis is a pre requisite for effective treatment, especially for potentially fatal cases of falciparum infection.Methods: Total 200 patients presented with fever and chills, were taken for study and performances of peripheral blood and centrifuged buffy coat smear were compared against the result of rapid antigen detection test (standard method).Results: out of 200 cases, 55 were positive by rapid detection test.30 of P. vivax, 24 of P. falci and 1 was mixed infection. Peripheral smear had 85.5% sensitive and 100% specific compared to RDT which was 100 % sensitive and specific whereas centrifuged buffy coat was 92.7% sensitive and 99.3% specific.Conclusions: Easy, rapid, most sensitive and specific diagnostic method will help in early diagnosis and lead to decrease in morbidity and mortality

Study of blood indices and high performance liquid chromatography (HPLC) in differentiation of β-thalassemia trait and iron deficiency anaemia

Background: Iron deficiency anemia (IDA) and beta thalassaemia trait (BTT) are two of the most common causes of microcytic anemia.It is essential to differentiate between the two, so as to avoid unnecessary iron therapy which is contraindicated in beta thalassaemia .We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and -TT in the same patient groups .Methods: A total of 200 patients were evaluated. We calculated 6 discrimination indices in all patients with anemia or suspected beta thalassemia. None of the subjects had  combined  IDA and -TT. The patient groups were evaluated according to  the Mentzer, Shine and Lal, England and Fraser,Srivastava, Green and King, Ricerca.Results: According to percentage correctly diagnosed criteria, Ricerca  and Mentzer  index are considered as the two best discrimination indices in differentiation between β thalassemia trait  and iron deficiency anaemia .Youden’s index showed the following ranking with respect to the indices’ ability to distinguish between -TT and IDA, Ricerca index >  Mentzer index > Green and King index >  Srivastava index >  Shine and Lal index > England and Fraser index.Conclusions: Ricerca  and Mentzer  index are considered as the two best discrimination indices in differentiation between β thalassemia trait  and iron deficiency anaemia.Keywords: Iron deficiency anemia (IDA) and beta thalassaemia trait (-TT)

Study of haematological parameters in malaria

Background: Malaria   causing   plasmodia   are   parasites   of   blood   and   hence   induce haematological alterations. The haematological changes that have been reported to accompany malaria include anemia, thrombocytopenia and leucocytosis, leukopenia, mild   to   moderate   atypical   lymphocytosis, monocytosis,   eosinophilia   and neutrophilia.Methods: Total hundred smear positive malaria cases were taken and various hematological parameters and biochemical parameters were studied.Results: Out of 100 smear positive cases, P. vivax was positive in 55 cases while P. falciparum was positive in 45 cases. It was seen in 86.67% of falciparum Malaria patients and in 72.72% of vivax Malaria patients. Severe anemia was seen in 9% of patients. Normocytic normochromic blood picture was the most common type in anaemic patients (51.89%). Thrombocytopenia was seen in 71% of the patients. Mild thrombocytopenia was more common and present in 52% of patients while Severe thrombocytopenia was seen in 19% of cases. In falciparum malaria thrombocytopenia was present in 66.66% of the patients while it was present in 74.54% of the patients in vivax malaria. Total Leucocyte Count was normal in 72% of the patients.Conclusions: Various haematological findings can help in early diagnosis of malaria which is essential for timely and appropriate treatment which can limit the morbidity and prevent further complications

Spectrum of hemoglobinopathies by high performance liquid chromatography with special reference to role of HbA2 levels at tertiary care centre

Background: The inherited disorders of blood include hemoglobinopathies as one of the major public health problems in India. This study indicates type of hemoglobinopathies in a tertiary care hospital over period of 2 years and 3 months.Methods: total of 500 suspected cases of haemolytic anaemia were studied during the period of July 2013 to Oct 2015 based on Complete Blood Count, Red cell indices and Peripheral blood smear examination. Sickling test, test for Hb quantitation by using cation exchange HPLC was done in all cases.Results: Out of all 500 cases of anaemia, 313 cases (62.6%) were confirmed to nonhemolytic anaemia whereas 187 cases (37.4%) had shown abnormal haemoglobin pattern on electrophoresis. Out of these 187 cases, 87 (46.52%) were Males and 100 (53.48%) were females. Most common haemoglobinopathy observed was Sickle cell trait 94 (18.8%) followed by beta-Thalassaemia Trait 33 (17.64%), sickle cell-thalassemia trait 27 (14.43%), beta thalassemia major 18 (9.62%) and 1 case of HbE thalassemia trait. The onset of disease was most prominent in Neonatal to paediatric age group (0-10 years) followed by reproductive age group (21-30 years). Few cases in old age were detected.Conclusions: Study provides data on the spectrum & pattern of Hemoglobinopathies in a tertiary care centre and importance of HbA2 levels in diagnosis of hemoglobinopathies and cases falling in borderline HbA2 levels. Screening of all anaemic patients should be done for Hemoglobinopathies and proper Genetic counselling must be given to all cases to prevent incidence of cases in future generation

Mucinous adenocarcinoma of gall bladder: a case report

Gall bladder carcinoma is the fifth most common malignancy of gastrointestinal tract. Mucinous carcinoma of gall bladder is very rare variant of gall bladder carcinoma. Only 20 cases of mucinous carcinoma reported till now. We report one such case of 55yr old female patient presented to our hospital with complaining of pain in right hypochondriac region and vomiting since, one month. Radiological examination revealed neoplastic thickening of gall bladder neck with cholelithiasis. Cholecystectomy was performed and specimen showed glistening grey white infiltrative firm solid mass at the neck of gall bladder. On microscopic examination showed mucinous adenocarcinoma. Tumour comprised of cystically dilated mucin filled glands. Tumour was seen infiltrating into muscle layer

Death due to sickle cell anemia: autopsy diagnosis

Background: Sickle cell disease (SCD) is well known and is the commonest hereditary hematological disorder which is associated with increased mortality and morbidity.  They are group of inherited haemoglobinopathies caused by the occurrence of hemoglobin S (Hbs) in homozygous or heterozygous form or in combinations of Hbs with another hemoglobin such as Hbsc or beta thalassaemia (Hbs-thal). Sickle cell syndromes are remarkable for their clinical heterogenecity including their presentations as sudden and unexpected death due to sickle cell crises. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vasoocclusive crisis in sickle cell disease. Aim of the study was to create awareness among the physicians and relatives / public and to minimize future unexpected death from complications or crisis from SCD.Methods: This is a retrospective study of 10 cases carried in the department of pathology, in tertiary care hospital and covers a period from January 2009 to December 2016. These cases were brought dead to the casualty with a history of sudden death. After post mortem examination, the specimens were sent for histopathological examination.Results: The record of 10 cases was reviewed. Out of our ten cases 7 were male and 3 were females. The youngest person was 17-year female and oldest was 65 years male. In clinical history 3 cases had complains of chest pain (30%), 3 others had complained of breathlessness (30%), 2 had history of unconsciousness (20%), one case had complained of abdominal pain (10%) and one case had a history of fall and injury (10%). Microscopic examination of each organ was carried out.  Organs like lungs, liver, spleen, kidneys, heart and brain showed wide spread congested vessels which were stuffed with RBC.Conclusions: We present this study to emphasize that sickle cell crisis is one of the cause of sudden unexplained death and highlight the importance of considering sickle cell disease as a cause of death in cases with no apparent cause

Department of Pathology, Government Medical College and Cancer Hospital, Aurangabad, Maharashtra, India

Background: The intrauterine existence of fetus is dependent on one vital organ 'the placenta’. The placenta reflects the status of maternal hypertension as it is the mirror of maternal and fetal health. The hypertensive disorders complicate 5-10% of all pregnancies and form a dangerous triad with haemorrhage and infection that contributes greatly to maternal morbidity and mortality. The fetus is dependent on placenta for growth and development. Many disorders of pregnancy like hypertension are accompanied by gross and histological changes in placenta. Aim of the study was to study the various morphological lesions of placenta in pregnancy induced hypertension and compare them with normal pregnanciesMethods: Gross and microscopic examination was conducted on 70 placentas. These included 15 normal placentas and 55 placentas from pregnancy induced hypertension.Results: In PIH, on gross the placenta showed areas of infarction, perivillous fibrin deposition and basal decidual haematoma, while microscopically showed increased syncytial knotting, cytotrophoblasitc proliferation, basement membrane thickening, vasculosyncytial membrane deficiency, infarction and fibrinoid necrosis.Conclusions: Maternal disorders affect the placental histology and can be detected by morphological examination of such placentae. The placenta from hypertensive pregnant women show significant morphological changes as compared to control, which may alter the perinatal outcome

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Ancient schwannoma of the orbit

The ancient schwannoma is a rare variant of a neurilemoma with a course typical of a slow-growing benign neoplasm. Histologically, it can be confused with a malignant mesenchymal tumor because of increased cellularity, nuclear pleomorphism, and hyperchromatism. Despite the degree of nuclear atypia, mitotic figures are absent. We describe the clinical and histopathologic features of an ancient schwannoma of the orbit. A need for early removal of such tumors is recommended to prevent complications

Spectrum of hemoglobinopathies by high performance liquid chromatography with special reference to role of HbA2 levels at tertiary care centre

Background: The inherited disorders of blood include hemoglobinopathies as one of the major public health problems in India. This study indicates type of hemoglobinopathies in a tertiary care hospital over period of 2 years and 3 months.Methods: total of 500 suspected cases of haemolytic anaemia were studied during the period of July 2013 to Oct 2015 based on Complete Blood Count, Red cell indices and Peripheral blood smear examination. Sickling test, test for Hb quantitation by using cation exchange HPLC was done in all cases.Results: Out of all 500 cases of anaemia, 313 cases (62.6%) were confirmed to nonhemolytic anaemia whereas 187 cases (37.4%) had shown abnormal haemoglobin pattern on electrophoresis. Out of these 187 cases, 87 (46.52%) were Males and 100 (53.48%) were females. Most common haemoglobinopathy observed was Sickle cell trait 94 (18.8%) followed by beta-Thalassaemia Trait 33 (17.64%), sickle cell-thalassemia trait 27 (14.43%), beta thalassemia major 18 (9.62%) and 1 case of HbE thalassemia trait. The onset of disease was most prominent in Neonatal to paediatric age group (0-10 years) followed by reproductive age group (21-30 years). Few cases in old age were detected.Conclusions: Study provides data on the spectrum & pattern of Hemoglobinopathies in a tertiary care centre and importance of HbA2 levels in diagnosis of hemoglobinopathies and cases falling in borderline HbA2 levels. Screening of all anaemic patients should be done for Hemoglobinopathies and proper Genetic counselling must be given to all cases to prevent incidence of cases in future generation