Congenital tuberculosis with multisystem involvement

Congenital tuberculosis is an uncommon condition, but in a country like India, where largest tuberculosis burden is found, there should be an eye on early diagnosis and management of this condition so as to prevent the devastating consequences of this disease considering the absence of specific pathogenic signs and symptoms. Here, we present a case of congenital tuberculosis in a newborn who was admitted on the 17th day after birth with the complaint of difficulty in breathing and lethargy for 3 days. On observing the antenatal history, it was found that mother after conception was diagnosed with pulmonary tuberculosis and was inadequately treated. The clinical indexes included no increase in body weight, hepatosplenomegaly, lethargy, and emaciated appearance. The treatment was initiated with antibiotics in intravenous form along with 4-drug antitubercular treatment (ATT). The 4-drug ATT was stopped after 1 week due to negative outcome in the tubercular screening, which leads to respiratory complications. The 4-drug ATT regimen was started again after a week on clinical basis which resulted in significant improvement within a few days. Hence, the present case presents a perspective that congenital tuberculosis can be considered in a newborn when mother has a history of tuberculosis before or during pregnancy

Endoscopic-Ultrasound-Guided Fine-Needle Aspiration and the Role of the Cytopathologist in Solid Pancreatic Lesion Diagnosis

Endoscopic ultrasound (EUS) is the most sensitive imaging modality for solid pancreatic lesions. The specificity, however, is low (about 75%). It can be increased to 100% with an accuracy of 95% by the addition of fine-needle aspiration (FNA). Cytopathology plays an important role. The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features. A close interaction with the cytopathologist is required in improving the diagnostic yield. In this paper, we present an overview of the role of EUS-guided FNA and importance of close interaction with the cytopathologist. Day to day examples of different solid pancreatic lesions have been presented at the end

Comparative study of harmonic scalpel haemorrhoidectomy versus conventional (milligan and morgan) haemorrhoidectomy

Background: Haemorrhoids are dilated veins occurring in relation to the anus. There are various treatment modalities for haemorrhoids and among them surgical treatment is considered to be most effective one. Harmonic scalpel hemorrhoidectomy was compared with conventional in terms of symptomatic relief and complications.Methods: The aim of our study was to compare harmonic scalpel haemorrhoidectomy with conventional in terms of various intraoperative and postoperative factors for the treatment of grade III and IV haemorrhoids.Results: In our case study of 25 patients average time taken was 17.68 ± 2.84 minutes, while it was 28.44 ±3.69 minutes in control group. The mean blood loss was 8.96 ± 2.15 ml, 31.72 ± 3.28 ml in the case and control group respectively. Postoperative pain with VAS in case group on the first postoperative day was 5.92 ± 0.72, while it was 8.52 ± 0 in the control group. The dose of analgesia was less in case group. The postoperative wound site soakage was less in case study, early ambulation and return to normal work was faster in case study group.Conclusions: Harmonic scalpel haemorrhoidectomy is a simple, bloodless, safe and effective procedure in terms of blood loss, postoperative pain early return to routine work because of less lateral thermal injury

Molecular Epidemiology and Sequence Analysis of Rabies Virus Isolates from North and North East India

In the present study phylogenetic analysis of 30 rabies virus (RV) isolates collected from North and North East India between 2013 and 2016 was carried out. Analysis of two sets of sequence of non-coding G-L intergenic region, based upon a 132-nucleotide region of the cytoplasmic domain (CD) of the G gene (G-CD) and a 549-nucleotide (Psi-L) was done. The phylogenetic tree constructed using 549 nucleotide sequence of hyper variable region (Psi-L) showed the same topology as that obtained on the basis of 132 nucleotide sequence of G-CD region. Four different genetic clusters (GCs) distributed among three geographical regions were identified. Comparison of deduced amino acid (aa) sequences showed four amino acid changes - aa462G, aa465H/R and aa468K in G-CD region. The change observed at position aa465R indicated the spillover of Indian wild strain (mongoose) to domestic animals in Delhi region. The homology among the Indian RV isolates shared >97% nucleotide similarity irrespective of their geographical regions and hosts. The study revealed that the RV isolates are region specific, not host specific and all belonged to genotype 1

Selenium levels in hospitalized preterm very low birth weight neonates in North India

Background: Most of the morbidity and mortality of very low birth weight (VLBW) neonates are due to oxidative stress and infection. Selenium can address these issues due to its antioxidant role and synthesis of glutathione peroxidase for scavenging free radicals. Objective: The objective of the study was to find the serum selenium levels in hospitalized preterm VLBW neonates. Materials and Methods: This was a prospective observational study conducted in the Neonatal Unit of Department of Paediatrics in a tertiary care hospital, Lucknow, for the duration of 1 year. A total of 126 preterm VLBW neonates admitted within 72 h of birth and having a venepuncture for any reason were enrolled, and those with major congenital abnormality, prior supplementation, and necrotizing enterocolitis on admission were excluded. Blood sample was collected after enrollment in plain vacutainer under aseptic precautions and after ½ h serum was separated by centrifugation. Selenium levels were estimated in serum by inductively coupled plasma optical emission spectrometry method (Perkin Elmer Optima 8000). Results: Mean birth weight was 1150±210 g and mean gestational age was 30.21±3.76 weeks in our study population. Mean levels of selenium were 9.49±3.49 μg/dl. Mean selenium levels in neonates with gestational age <30 weeks, 30–32, and >32 weeks were 8.90±3.32, 9.32±3.74, and 10.57±3.15 μg/dl (p=0.107), respectively. Thus, the selenium levels were seen increasing with an increase in the gestational age. Furthermore, serum selenium level of neonates with birth weight >1 kg (10.08±3.55 μg/dl) was found to be significantly higher than those with birth weight ≤1 kg (8.40±3.12 μg/dl) (p=0.009). No significant association was seen with birth centiles or gender. Conclusion: Serum selenium levels were significantly lower in preterm neonates with lesser gestational age and lower birth weight although the baseline levels were within normal limits. Thus, the significant difference in levels can be linked with most of the morbidities and mortality in preterm neonates

Cytological spectrum of granulomatous mastitis: diagnostic and treatment challenges

Background: Granulomatous mastitis (GM) is an inflammatory disease of the breast which clinico- radiologically mimics both inflammatory and malignant lesions. This leads to diagnostic dilemmas and delay in treatment. The aim of the present study was to review the cases diagnosed as granulomatous mastitis on Fine Needle Aspiration Cytology (FNAC) with an objective to co-relate their clinico-radiological findings, histology review where available and follow up treatment received to establish etiology and study the treatment outcome.Methods: Cytologically diagnosed cases of granulomatous mastitis were retrieved and reviewed from August 2015 - July 2017 records. Clinico-radiological co-relation, histology review where available and follow up treatment records were sought for.Results: Around 31.7% (530/1670) cases were reported as malignant, 60.3% (1009/1670) as benign proliferative and 7.9% (131/1670) as inflammatory lesions by breast FNA. 3.1% (51/1670) cases were reported as GM of all breast FNAC and 38% (51/131) of all inflammatory lesions. Follow up was available for 47 cases. Of which 26 (55.3%) cases were diagnosed as Tubercular Granulomatous mastitis (TGM) and 21(44.7%) were idiopathic granulomatous mastitis (IGM).Conclusions: Countries where tuberculosis is endemic, high degree of clinical suspicion and detailed work-up to rule out TGM is essential for all cases of granulomatous mastitis. Authors recommend a multidisciplinary workup with microbiological culture and molecular based tests on FNA material. This retrospective study illustrates that the cause of GM needs to be determined accurately for timely treatment, to avoid unnecessary delays and treatment dilemma in these patients

Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study

Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM). Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion. 0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases. The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly

Significance of Immunohistochemistry Testing in the Diagnosis and Subtyping of Lung Carcinomas- A Retrospective Study from a Tertiary Care Centre in Southern Rajasthan

Introduction: In the present era, the classification of lung carcinoma is not confined to Small Cell Lung Carcinoma (SCLC) and Non Small Cell Lung Carcinoma (NSCLC). Precise subtyping of lung carcinoma has a direct impact on patient management and prognosis. Further molecular study helps in identifying adenocarcinoma receptors, such as Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK), which are useful in targeted therapy. Aim: To assess the role of Immunohistochemistry (IHC) in accurate diagnosis and subtyping of lung carcinoma and to analyse the prevalence of EGFR mutations and ALK rearrangement in lung adenocarcinoma. Materials and Methods: A retrospective hospital-based, observational study was conducted at the Department of Pathology of American International Institute of Medical Sciences, Udaipur, Rajasthan from January 2020 to August 2021. Total of 105 cases of guided core needle biopsies from lung and bronchoscopic biopsies were included. IHC markers were applied based on histopathological diagnosis from a panel of p63, Cytokeratin 7 (CK7), AE1/AE3, Thyroid Transcription Factor (TTF1), Napsin A, p40, synaptophysin, chromogranin, CD56 and Ki67. Adenocarcinoma cases were further analysed for EGFR mutations and ALK rearrangements. Data was tabulated and analysed statistically using Microsoft Excel to determine the percentage frequency distribution of cases. Results: Among 105, there were 88 males and 17 females and the mean age of the population was 60.57 years. The most prevalent subtype of lung malignancy was squamous cell carcinoma (44.7%) followed by adenocarcinoma (29.5%). The diagnostic accuracy of squamous cell carcinomas and adenocarcinomas on morphology was 93.1% and 84.6%, respectively and for small cell carcinoma it was 100%. Amongst 28 cases of adenocarcinoma, EGFR mutation was found in 46.42% cases whereas ALK mutation was found only in 21.42% cases. Conclusion: The study highlights the importance of IHC, and a substantial prevalence of EGFR mutations was found in patients with lung carcinoma

Role of laparoscopic surgery in cancer of stomach: Our early experience

Purpose: To study the clinical outcome and scope of laparoscopic management in patients of cancer stomach. Methods: This is a prospective study of our first 25 patients of cancer stomach managed laparoscopically. Following procedures were undertaken: 1) Gastric resection in resectable cases; 2) Palliative bypass; 3) Tumor/ nodal/ peritoneal/ any other/ biopsy in cases of unresectable tumors. Results: Growth was resectable in 10 (40%) patients, and unresectable in 15 (60%) patients. Diagnostic laparoscopy had sensitivity of 100%, while other modalities of investigation were not totally useful in 1/3 to ½ of cases. Laparoscopic gastrojejunostomy was done in 5 (20%) patients, laparoscopy assisted distal partial gastrectomy was performed in 8 (32%) patients while totally laparoscopic gastrectomy was possible in 1 (4%) patient. Long term follow up was observed. Conclusion: In cancer stomach laparoscopy is a safe, effective, and cost effective means of directing appropriate therapy especially in patients requiring diagnostic, staging and palliative procedures