A CROSS-SECTIONAL STUDY EVALUATION OF DIAGNOSTIC IMPLICATIONS OF PLATELET INDICES IN THROMBOCYTOPENIA.

Introduction: Thrombocytopenia (TCP) refers to a reduction of platelet count below 150 x 109/ L; it’s not a disease entity by itself, but a finding that may result from a number of disease processes. Automated hematology analyzers that determine the Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet Large Cell Ratio (P-LCR), could be very helpful to facilitate the differential diagnosis of thrombocytopenia and to monitor thrombocytopenic conditions. Materials and methods: A cross-sectional study of platelet indices of 512 thrombocytopenic samples by automated hematology analyzers was done. Results: The cases of thrombocytopenia were classified into hypo-productive (362 cases) and hyper-destructive (150) groups. A most common cause of hypo-productive and hyper-destructive thrombocytopenia was Aplastic anemia and ITP, respectively. All the indices were significantly higher (p-value < 0.05) in hyper-destructive TCP compared to hypo-productive TCP, except Plateletcrit. Conclusion: The results of the present study show platelet indices to be a useful and reliable test to differentiate between hyper-destructive thrombocytopenia from the hypo-productive type with statistically significant differences

Isolation and identification of Candida albicans from clinical specimens received at tertiary care centre

Background &Method: The aim of this study is to study Isolation and identification of Candida albicans and non candida albicans species in all clinical specimens received at Tertiary Care Centre.A detail history was taken with demographic details. Patient’s hospital records were used to know the use of any antifungal agents and past medical conditions. Result: 23.3% of the patients of age group < 1 year, followed by (16.6%) 41-50 years of age group and 6.6% of patients are 61-70 years of age group. 56.6% were male patients and 43.3% were female.53.4 % were Candida albicans and 46.6% were non-albicans Candida spp. By using unpaired t test, P value- 0.041, which is less than 0.05, hence it is statistically significant. Conclusion: C. albicans remains the main species but increasing incidence of non albicans Candida spp. has also been reported, and their antifungal drug susceptibility among patients visiting our tertiary care hospital. An increase in the predisposing conditions in recent years has resulted in an increasing incidence of Candida infections. Among 3000 of total samples processed during the study period, 30 isolates were positive for Candida infection. So prevalence rate was 0.81%.&nbsp

Tuberous Sclerosis: An uncommon cause of hyperprolactinemia

Tuberous Sclerosis is a multi system genetic disorder affecting skin, central nervous system,kidney,heart and lungs. We present a case report of a 26 year old female with tuberous sclerosis who presented with galactorrhea and menstrual irregularities due to hyperprolactinemia

Coexistence of pheochromocytoma with uncommon vascular lesions

Background: Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities. Materials and Methods: From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed. Results: Of the 50 patients with pheochromocytoma, 7 (14%) had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation. Conclusion: There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis

Dysgerminoma in a female with turner syndrome and Y chromosome material: A case-based review of literature

We report a 17-year-old girl evaluated for primary amenorrhea. Cytogenetic analysis of the peripheral blood lymphocytes revealed normal autosomes with 46X inv (Y) confirming the diagnosis of Turner's syndrome with Y cell line. Treatment was initiated with conjugated estrogen while recommending bilateral prophylactic oophorectomy to the patient. One year later the patient presented with abdominal mass, biopsy of the specimen following resection confirmed dysgerminoma originating from right ovary with no invasion or metastasis. The literature is reviewed with regard to the various pathogenetic mechanisms proposed for the development of germ cell tumors in ovary, the cytogenetic findings and recommendations to handle such scenario

Ovarian granulosa cell tumor: An uncommon presentation with primary amenorrhea and virilization in a pubertal girl

A 16-year-old girl presented with primary amenorrhea and excess hair growth on her body and face for the last three years, along with pain and a mass in her lower abdomen for last one year. Examination revealed hirsutism and other virilizing features, with an irregular mass in the lower abdomen corresponding to 16 weeks′gestation. Serum testosterone was 320 ng / dl and ultrasonogram of the pelvis revealed a solid mass of 5 × 4 cm in the left adnexa. Suspecting it to be a virilizing tumor of the left ovary, the patient was subjected to staging laparotomy, which revealed stage 1a ovarian involvement amenable to surgical resection alone. Histopathological examination confirmed the diagnosis of granulosa cell tumor of the ovary. Postoperatively the serum testosterone returned to 40 ng / dl and her menstrual cycle started after two months of surgery

Renin-angiotensin system activity in vitamin D deficient, obese individuals with hypertension: An urban Indian study

Background: Elevated renin-angiotensin-aldosterone system (RAAS) activity is an important mechanism in the development of hypertension. Both obesity and 25-hydroxy vitamin D [25(OH)D] deficiency have been associated with hypertension and augmented renin-angiotensin system (RAS) activity. We tried to test the hypothesis that vitamin D deficiency and obesity are associated with increased RAS activity in Indian patients with hypertension. Materials and Methods: Fifty newly detected hypertensive patients were screened. Patients with secondary hypertension, chronic kidney disease, or coronary artery disease were excluded. Patients underwent measurement of vitamin D and plasma renin and plasma aldosterone concentrations. They were divided into three groups according to their baseline body mass index (BMI; normal <25 kg/m 2 , overweight 25-29.9 kg/m 2 and obese ≥30 kg/m 2 ) and 25(OH)D levels (deficient <20 ng/ml, insufficient 20-29 ng/ml and optimal ≥30 ng/ml). Results: A total of 50 (male:female = 32:18) patients were included, with a mean age of 49.5 ± 7.8 years, mean BMI of 28.3 ± 3.4 kg/m 2 and a mean 25(OH)D concentration of 18.5 ± 6.4 ng/ml. Mean systolic blood pressure (SBP) was 162.4 ± 20.2 mm Hg and mean diastolic blood pressure (DBP) was 100.2 ± 11.2 mm Hg. All the three blood pressure parameters [SBP, DBP and mean arterial pressure (MAP)] were significantly higher among individuals with lower 25(OH)D levels. The P values for trends in SBP, DBP and MAP were 0.009, 0.01 and 0.007, respectively. Though all the three blood pressure parameters (SBP, DBP and MAP) were higher among individuals with higher BMIs, they were not achieving statistical significance. Increasing trends in PRA and PAC were noticed with lower 25(OH)D and higher BMI levels. Conclusion: Vitamin D deficiency and obesity are associated with stimulation of RAAS activity. Vitamin D supplementation along with weight loss may be studied as a therapeutic strategy to reduce tissue RAS activity in individualswith Vitamin D deficiency and obesity

Fetal endocrinology

Successful outcome of pregnancy depends upon genetic, cellular, and hormonal interactions, which lead to implantation, placentation, embryonic, and fetal development, parturition and fetal adaptation to extrauterine life. The fetal endocrine system commences development early in gestation and plays a modulating role on the various physiological organ systems and prepares the fetus for life after birth. Our current article provides an overview of the current knowledge of several aspects of this vast field of fetal endocrinology and the role of endocrine system on transition to extrauterine life. We also provide an insight into fetal endocrine adaptations pertinent to various clinically important situations like placental insufficiency and maternal malnutrition