Prevalence of haemoglobinopathies in anemic females

Background: The β-thalassemias and various other hemoglobinopathies are a major health problem in India.  An accurate diagnosis of patients suffering from β-thalassemia syndrome and other hemoglobinopathies is important for prevention and management of major hemoglobin disorders. High-performance liquid chromatography (HPLC) is a highly sensitive and specific method for the accurate diagnosis of thalassemia and other hemoglobinopathies. Methods: Present study was conducted on 1400 females of reproductive age group for screening of hemoglobinopathies in a rural block of north India. Patients were evaluated for presence of anemia with detailed hematological workup. Anemia cases were further screened by HPLC system for presence of any hemoglobinopathy.Results: 855 subjects out of a total of 1400 were found to be anemic. 359 patients had normocytic normochromic anemia, 399 had microcytic hypochromic picture, 37 had macrocytic picture, while 60 patients had dimorphic anemia. 47 cases were detected positive for various types of hemoglobinopathies. 36 patients were positive for β-thalassemia trait/ heterozygous forming the major portion (76.5%), while one (2%) patient was β-thalassemia intermedia / homozygous and was non-transfusion dependent. 3 patients were positive for HbE heterozygous and hereditary persistence of fetal hemoglobin each, two for HbD Punjab, one each for HbS heterozygous and Hb Lepore.Conclusions: The detection of various hemoglobinopathies is the key to diagnosis and proper treatment of various types of anemia. Antenatal screening should be an integral part of workup in pregnant females to prevent morbidity related to hemoglobinopathies like thalassemias

Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India

: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections

Male breast carcinoma: study from a tertiary care centre in North India

Male breast cancer is a rare malignancy. In recent years a rise in the number of male breast cancer cases has been seen. Due to rarity of the disease the reporting of such cases is important to support the present status of this aggressive malignancy. Fine needle aspiration method for breast FNA is an invasive procedure but can provide a diagnosis without causing much morbidity to the patient. Hence, objective of the present work was to report and study the clinico-pathological behaviour of male breast cancer at a tertiary care centre in North India using fine needle aspiration-based diagnosis. Present study includes cytologically diagnosed male breast carcinoma cases over a period of 4 years. Eleven cases of male breast cancer were identified. Median age of presentation was 57years. All the eleven patients presented with main complaint of swelling in breast (100%), nine (81.8%) patients presenting in left breast and two (18.2%) in right breast. Four cases presented with nipple retraction. Also, axillary lymphadenopathy was evident in four (34.4%) patients. Male breast cancer an aggressive disease having distinct clinical presentation, can be cytologically diagnosed easily as other benign conditions are rare in male breast.

Evaluation of renal profile in asymptomatic HIV patients with special reference to proteinuria

Introduction: Renal disease has now become a well-recognised complication of HIV infection. If not recognized early it frequently progresses to end stage renal disease, thus becoming a major cause of morbidity and mortality. Aim of the research : The purpose of this study was to know the prevalence of renal dysfunction in asymptomatic HIV patients in terms of proteinuria and various risk factors associated with it and to study the histopathological lesions associated in patients with nephrotic range proteinuria. Material and methods : We conducted a cross-sectional, single-centre study on 100 asymptomatic HIV patients aged between 18 and 50 years. Baseline investigations including kidney function tests and CD4 count were done on in all patients. Proteinuria was defined as 1+ on urine dipstick in spot urine sample. Urine microalbumin was measured by immunoturbidimetry or nephelometry. 2-D ultrasonography was done to determine kidney size and echogenicity. Renal biopsy was done in patients with nephrotic range proteinuria. Results: The total prevalence of proteinuria among the study subjects was 21%. It was significantly associated with older age, lower CD4 counts, higher serum creatinine, and lower haemoglobin levels. There were no significant differences between patients with and without proteinuria with regard to sex and concurrent antiretroviral therapy. Proteinuria was also associated with increased kidney size and echogenicity. In the patients with nephrotic syndrome focal segmental glomerulosclerosis was the most common histological pattern. A progressive decline in glomerular filtration rate was observed as the disease progressed in terms of duration of disease and decrease in CD4 count. Conclusions : Renal dysfunction in HIV is dependent on a variety of host and immunological factors. Careful screening can help identify the subjects who are at higher risk. Various simple investigations such as 2D ultrasonography and urine dipsticks can serve as an effective screening tool

Hypereosinophilic syndrome mimicking acute coronary syndrome

Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders with peripheral blood hypereosinophilia and eosinophil-mediated organ involvement. It may be primary, secondary, or idiopathic. In very rare cases, HES can be familial occurring as an autosomal dominant disorder. Cardiac involvement usually presents as heart failure, intracardiac thrombus, arrhythmias, and rarely as acute coronary syndrome (ACS) and is a major cause of morbidity and mortality. Cardiac magnetic resonance imaging has emerged as a diagnostic modality in diagnosis of eosinophilic endomyocardial disease. We report a case of a young male with familial HES presenting as ACS and discuss diagnostic and therapeutic clinical management

Macrophage activation syndrome in a patient with systemic onset of the juvenile idiopathic arthritis

Systemic onset juvenile idiopathic arthritis (sJIA) is defined as arthritis affecting one or more joint usually in the juvenile age group (< 16 years of age) with or preceded by fever of at least 2 weeks duration that is documented to be daily (“quotidian”) for at least 3 days which may be associated with evanescent (non-fixed) erythematous rash or generalized lymph node enlargement or hepatomegaly/splenomegaly/both or serositis. Macrophage activation syndrome (MAS) is a life-threatening complication of sJIA marked by sudden onset of non-remitting high fever, profound depression in all three blood cell lines (i.e. leukopenia, anemia, and thrombocytopenia), hepatosplenomegaly, lymphadenopathy, and elevated serum liver enzyme levels. In children with systemic juvenile idiopathic arthritis, the clinical picture may mimic sepsis or an exacerbation of the underlying disease. We report a case of a 16-year-old female patient presenting with high grade fever with joint pains and generalized weakness which proved to be systemic onset juvenile idiopathic arthritis with macrophage activation syndrome after ruling out all other differential diagnoses and responded well to intravenous steroids