Pathology of heart, coronaries and aorta in autopsy cases with history of sudden death: an original article

Background: Natural deaths represent a large proportion of sudden (unexpected and unattended) deaths. The term “sudden cardiac death” (SCD) refers to death from the abrupt cessation of cardiac function due to cardiac arrest. The objective of this study was to identify various causes, risk factors, age and sex distribution associated with sudden cardiac death in an Indian setting.Methods: Detail review of medical records and an autopsy study of all cases of sudden cardiac death that occurred instantaneously or within 24 hours of onset of symptoms in a tertiary care institution, between December 2010 and December 2015 was carried out.Results: In total, 124 cases of sudden death were studied during this period. Out of 124 cases, 109 cases (87.90%) showed pathology in heart and aorta. Atherosclerotic coronary heart disease was the most common cause of death (72.58%) followed by Hypertensive heart disease (4.83%), Hypertrophic cardiomyopathy (3.22%), Myocarditis (3.22%), Infective endocarditis (1.61%), Rheumatic heart disease (0.8%), Aortic dissection (0.8%), and syphilitic aortitis (0.8%).Conclusions: Sudden death is a source of concern and a detailed postmortem examination is mandatory to ascertain its cause. Presence of co-existing conditions like diabetes and hypertension contribute immensely to the risk of sudden death. Occurrence of sudden death at a younger age presents a formidable challenge. Prevention of development of risk factors of atherosclerosis at an early age can be an effective strategy to counter this ailment at all levels

Haemostatic abnormalities in solid malignancies

Background: Though the actual symptoms of any haemostatic abnormalities in patients of solid malignancies are not seen commonly screening in all such cases can guide us to correct those abnormalities in time and improve the outcome. The present study is undertaken with an objective to find out coagulation disorders in patients of solid malignancies and compare their levels according to the stage of the cancer.Methods: A prospective study was undertaken in a tertiary care centre in Maharashtra, India from December 2010 to September 2012. Total 102 cases with malignancies diagnosed on histopathology/cytological examination were tested for BT, CT, Platelet count, PT, APTT, TT and D-dimer levels. These tests were repeated on first postoperative or post chemotherapy day wherever possible. Early and advanced stages of cancer were divided according to the spread of the tumor. Results were compared between the two. DIC cases were also noted.Results: Out of 102 cases studied, haemostatic abnormalities were more common in adenocarcinomas that too in mucin secreting adenocarcinomas. The percentage of cases with increased D-dimer values was higher in the advanced disease compared to early disease. The PT, APTT, TT and platelet count showed statistically significant differences between the early and advanced disease groups. Compared to preoperative values, postoperative values were abnormal but the change was not statistically significant.Conclusions: Screening for coagulation profile in all solid malignancies can help to predict the chances of complication and therapeutic interventions can be done

Histopathological study of endometrium in cases of abnormal uterine bleeding

Background:Abnormal uterine bleeding is one of the commonest complaints in women and when it occurs without   organic lesions like tumor, inflammation, it is called as dysfunctional uterine bleeding. Aim of current study was to find out the histopathological pattern of endometrium in Abnormal Uterine Bleeding (AUB) also to study organic causes of AUB.Methods:Specimens received as endometrial curettage and hysterectomy specimens were studied followed by correlation of histopathology with age and clinical presentation.Results:The patients were mainly from the age group of 30-49 years (74.24%). The most common menstrual disorder was menorrhagia (46.86%). In dysfunctional uterine bleeding the most common histological pattern of endometrium includes proliferative endometrium (22.8%) followed by endometrial hyperplasia (19.40%), atrophic endometrium (7.16%), secretory endometrium (5.97%), irregular shedding [1.80%], irregular ripening (1.20%) and anovulatory endometrium (0.59%). Organic lesions encountered in AUB cases were leiomyoma (17.92%), endometrial polyp (1.79%), endometrial carcinoma (1.50%), endometriosis (0.59%) and choriocarcinoma (0.29%).Conclusion:It is important to know the histological pattern of the endometrium like proliferative endometrium, endometrial hyperplasia, atrophic endometrium, secretory endometrium, irregular ripening and shredding and organic lesions in patients diagnosed as AUB in different age groups since recognition of these conditions will help and will avoid further complications.

Surfactant protein D inhibits HIV-1 infection of target cells via interference with gp120-CD4 interaction and modulates pro-inflammatory cytokine production

© 2014 Pandit et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Surfactant Protein SP-D, a member of the collectin family, is a pattern recognition protein, secreted by mucosal epithelial cells and has an important role in innate immunity against various pathogens. In this study, we confirm that native human SP-D and a recombinant fragment of human SP-D (rhSP-D) bind to gp120 of HIV-1 and significantly inhibit viral replication in vitro in a calcium and dose-dependent manner. We show, for the first time, that SP-D and rhSP-D act as potent inhibitors of HIV-1 entry in to target cells and block the interaction between CD4 and gp120 in a dose-dependent manner. The rhSP-D-mediated inhibition of viral replication was examined using three clinical isolates of HIV-1 and three target cells: Jurkat T cells, U937 monocytic cells and PBMCs. HIV-1 induced cytokine storm in the three target cells was significantly suppressed by rhSP-D. Phosphorylation of key kinases p38, Erk1/2 and AKT, which contribute to HIV-1 induced immune activation, was significantly reduced in vitro in the presence of rhSP-D. Notably, anti-HIV-1 activity of rhSP-D was retained in the presence of biological fluids such as cervico-vaginal lavage and seminal plasma. Our study illustrates the multi-faceted role of human SPD against HIV-1 and potential of rhSP-D for immunotherapy to inhibit viral entry and immune activation in acute HIV infection. © 2014 Pandit et al.The work (Project no. 2011-16850) was supported by Medical Innovation Fund of Indian Council of Medical Research, New Delhi, India (www.icmr.nic.in/)

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

CASE REPORT: Primary Bilateral Non Hodgkins Ovarian Lymphoma A Case Report

Background: Involvement of the ovary by malignant lymphoma is a well known late manifestation of disseminated nodal disease. Primary ovarian lymphoma is rare. Case History: We report an autopsy case of primary ovarian non Hodgkin’s lymphoma with bilateral involvement. A 30 years old woman was admitted with signs and symptoms suggestive of an ovarian cancer. Computed tomography revealed two abdominal masses measuring 10cm in diameter, without enlarged lymph nodes. Patient died on second day of treatment, so her autopsy was performed. Diagnosis of malignant lymphoma was made on histopathology. Tumour was classified as a diffuse large B cell lymphoma with the help of immunohistochemistry. Absence of disease in blood and bone marrow, no lymphadenopathy favours the diagnosis of primary lymphoma

Study of hematological parameters in cases of splenomegaly

Background: This was a prospective study carried out in the department of pathology of a tertiary care hospital during a period of one and half years (Nov 2016- June2018). All patients presented with palpable spleen were included in study. Blood samples were collected for complete hemogram, reticulocyte count, sickling test, osmotic fragility and other haematological investigations if needed. Bone marrow examination and serum electrophoresis was done whenever necessary. Grading of splenomegaly was done by Hackett’s classification. Data collected was analysed to find out the etiology of splenomegaly and its haematological manifestations. Maximum cases were seen in the age group of 11-20 years (19.23%) with a male preponderance. Objectives: To study haematological parameters in cases of splenomegaly in all age groups. To correlate splenomegaly with various hematological parameters and to evaluate hematological and non hematological causes of splenomegaly. Results: Total 260 cases of splenomegaly were studied in this present study. Hematological causes of splenomegaly (53.85%) were more common than the non hematological causes (46.15%). Anemia (38.85%) was the most common cause of splenomegaly among the hematological disorders followed by leukemia (11.92%) where as infective etiology (30.77%) was the predominant cause among the non hematological disorders. Hackett’s grade I splenomegaly was seen in maximum number of case (38.46%). Conclusion: There was no significant correlation between degree of splenomegaly and degree of cytopenia. Increasing splenic size was significantly associated with occurrence of hypersplenism