The spectrum of renal changes in patients with liver diseases: an immunofluorescent and light microscopic study

Background: There are divergent observations on renal function tests and renal morphology in patients with liver diseases. The present study was designed (1) To study the morphological changes in kidney in patients with various types of Liver diseases; (2) To study the correlation between the renal histology, clinical and other laboratory parameters in these cases; (3) To suggest the possible mechanisms of renal injury secondary to liver diseases.Methods: This prospective study was carried out at the department of pathology of a tertiary care centre in Delhi. A total of 30 patients admitted with liver diseases were included in the study. All kidney samples were evaluated by light microscopy and immunofluorescence microscopy. The sections were stained by fluorescent labeled antisera for human IgG, IgA and IgM. Postmortem kidney biopsy from 10 patients dying of unrelated diseases served as controls.Results: Glomerular changes on light microscopy were present in twenty four patients (80%) as compared to two controls (20%). The difference was statistically significant (x2= 11.75; p<0.001). Nine out of 13 patients with severe impairment of liver function tests (LFTs) showed specific glomerulopathies whereas only one out of 17 patients with mild to moderate impairment of LFTs, showed specific glomerular lesion. It was found to be statistically significant (x2= 13.4; p<0.001). Immunofluorescent study showed the presence of immune deposits in 21 out of 30 patients (70%). IgA positivity was seen in 18 cases, IgG in 9 cases and IgM in 10 cases.Conclusions: There is a wide spectrum of morphological lesions in the kidney in patients with liver diseases. These were mainly glomerular lesions and were directly related to the severity and chronicity of liver diseases. Immune deposits were commonly present in patients with chronic liver disease.

Prevalence of hepatitis-B surface antigen among population of inmates in Tihar Jail, New Delhi

Background: Hepatitis B Virus (HBV), a DNA virus with a human only reservoir, is a worldwide public health problem. Unlike other countries especially Europe and America, there is scarcity of published data on HBV infection among prison inmates in India despite its tremendous importance in public heath formulation compared to the general population. The present study was designed to investigate the prevalence of Hepatitis B surface antigen among population of Jail inmates (convicts).Methods:The study population comprised of all the 1102 prison inmates who were screened for Hepatitis B surface antigen (HBsAg) status using one step immunochromatographic array [INSTACHK Hepatitis-B]. Seroprevalence rate of seropositive was calculated and stratified by age and sex. The seropositives were further subjected to HBeAg and anti-HBe detection, HIV status, anti HCV status, HBV-DNA levels and Liver function tests (LFTs) and the patients were then classified into three groups based on HBV-DNA levels and alanine amino transferase (ALT) levels.Results:Out of 1102 inmates screened, 30 (2.72%) were HBsAg positive. Slightly higher percentage prevalence of HBsAg was found among males i.e., 3.19% (or 27/844) than females i.e., 1.16% (or 3/258). Out of 30 HBsAg positive cases, 16 were HBeAg negative, 8 were HBeAg positive and 6 refused to get investigated further. Ten of the 16 HBeAg negative cases were further subjected to anti HBe detection. Half of these cases (5) were reactive for anti-HBe. Based on HBV DNA levels and ALT levels, 8 patients were categorized as HBeAg positive chronic hepatitis-B patients, 12 patients were categorized as HBeAg negative chronic Hepatitis-B patients and 4 patients as inactive HBsAg carriers.Conclusion:HBsAg prevalence among Tihar Jail inmates is comparable to that among the non-incarcerated general population in India.

Pulmonary blastomycosis on autopsy: a rare case report

A case of pulmonary blastomycosis on autopsy in a middle aged male from rural background is presented herewith. Blastomycosis is a pyogranulomatous disease caused by the dimorphic fungus blastomyces dermatitidis. Blastomycosis is endemic in regions of North America that border the Great Lakes. It is one of the great mimickers in medicine. Pulmonary blastomycosis has a broad range of clinical presentations, varying from completely asymptomatic pulmonary infiltrates to diffuse and massive parenchymal involvement that can lead to Acute Respiratory Distress Syndrome (ARDS). Human infection occurs when soil containing microfoci of mycelia is distributed and airborne conidia are inhaled. If natural defences in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad- based bud. Most of the cases of blastomycosis reported in India are imported from the endemic areas of the World except a few authochthonous cases in North India

Adrenal ganglioneuroma; a rare neurogenic tumor in a 25-year-old female

Ganglioneuromas (GNs) are rare benign tumors originating from the neural crest tissue. They are characteristically located in the posterior mediastinum and retroperitoneum; and are rarely found in the adrenal gland. GNs are usually hormonally inactive, and most of the cases are detected incidentally. We report a case of 25-year-old female who presented with pain abdomen in the right upper quadrant. Imaging studies showed a large well defined hypodense lesion with calcification measuring 14.5×11.5×11cm in the region of right adrenal gland and a possibility of adrenocortical carcinoma was suggested. The patient underwent right adrenalectomy and histopathological examination revealed ganglioneuroma. This report emphasizes that GN can be misdiagnosed preoperatively as the presenting symptoms are nonspecific and imaging characteristics are variable. Histopathological examination is the mainstay of diagnosis

Isolated tuberculous epididymo-orchitis masquerading as testicular tumor: a diagnostic dilemma

Isolated tuberculous epididymo-orchitis is rare and may present with clinical and radiological features similar to those of testicular tumor. It is thus a diagnostic and therapeutic challenge. A 40 yrs old male presented with left sided mass in scrotum for past 6 months, which was clinically and radiologically diagnosed as testicular tumor with hydrocele. FNAC was attempted twice but was inconclusive. Left sided orchiectomy was done. However, the histopathological findings of testicular mass revealed features consistent with tuberculous epididymo- orchitis (TEO). This case emphasizes that patient may present with isolated TEO, which is considered an unusual presentation of tuberculosis and can masquerade as testicular tumor clinically and radiologically. But in countries where prevalence of tuberculosis is high, tuberculous orchitis must be considered in the differential diagnosis of testicular swellings

Inferior turbinate osteoma: a case report

Osteoma is the most common benign tumor of the paranasal sinuses. Turbinate osteomas are very rare and only five middle turbinate, two inferior turbinate and one superior turbinate osteoma cases have been reported. We present a rare case of osteoma of the left inferior turbinate in a patient presented with unilateral nasal obstruction that was removed endoscopically and conduct a literature review on turbinate osteomas arising from different turbinates

Spectrum of lymph node lesions on cytology in rural Haryana: a retrospective analysis

Background: Fine Needle Aspiration Cytology (FNAC) is a simple, rapid, cost effective and reliable technique which can be used as a routine outpatient department (OPD) procedure and first line of investigation in diagnosing a variety of superficial and deep lesions. Lymphadenopathy is of great clinical significance and the underlying cause may range from a treatable infectious etiology to malignant neoplasms. In this study, we describe the diagnostic utility of FNAC in the assessment of lymph node lesions with an emphasis on the diagnosis of non-neoplastic, benign and malignant neoplastic processes. Cytomorphological patterns of tuberculous lymphadenitis were also observed.Methods: This was a retrospective study and a total of 736 patients including all age groups and both sexes presenting with palpable or deep lymph nodes in FNAC clinic of our institute over a period of 2 years were included in our study. FNAC was conducted with 22-24 Gauge disposable needles attached to 20c.c syringes. Smears were fixed in 95% ethyl alcohol and stained with Papanicolaou stain. Leishman stain was done on air dried smears. Ziehl- Neelsen (ZN) staining was done wherever required.Results: Out of 736 aspirations from lymph nodes, the most frequent cause of lymphadenopathy was found to be Tuberculosis with 419 cases (56.92%). The next frequent diagnosis was reactive lymphadenitis with 193 cases (26.22%) followed by metastatic lymphadenopathy in 47 cases (6.38%). A diagnosis of lymphoproliferative disorder was rendered in 20 cases (2.71%). In 10 cases (1.35%) FNAC was inconclusive.Conclusion: In our study, the predominant cause of lymphadenopathy was tuberculous lymphadenitis, seen in more than half of total cases, followed by reactive lymphadenopathy and malignant neoplasms. FNAC was helpful in establishing the diagnosis in 98.65% of the cases.

Recent Trends in System-Scale Integrative Approaches for Discovering Protective Antigens Against Mycobacterial Pathogens

Mycobacterial infections are one of the deadliest infectious diseases still posing a major health burden worldwide. The battle against these pathogens needs to focus on novel approaches and key interventions. In recent times, availability of genome scale data has revolutionized the fields of computational biology and immunoproteomics. Here, we summarize the cutting-edge ‘omics’ technologies and innovative system scale strategies exploited to mine the available data. These may be targeted using high-throughput technologies to expedite the identification of novel antigenic candidates for the rational next generation vaccines and serodiagnostic development against mycobacterial pathogens for which traditional methods have been failing

Socio-demographic and Clinico-pathological Profile of Cervical Cancer Patients at a Tertiary Care Centre in New Delhi: A Five-Year Retrospective analysis

Background: Cervical cancer remains a major public health challenge in low and middle-income countries including India. However, if detected early, it is preventable and curable. Objective: The present study aimed to ascertain the sociodemographic and clinical profile of cervical cancer patients visiting a tertiary cancer center. Methodology: A retrospective study was carried out at the Delhi State Cancer Institute, New Delhi. The study population included 136 women who were diagnosed with cervical cancer. A pretested data extraction sheet was used as the study tool for collecting information from the inpatient records. Descriptive analysis and chi-square test were performed and the level of significance was set at p<0.05. Results: A total of 136 cervical cancer patients with mean age of 46 ± 9.85 and mean BMI of 23.78 ± 5.03, were studied retrospectively. About 36.8% of patients were aged between 40-49 years and 57.4% were illiterate. While 40.4% of the patients belonged to FIGO stage II, 27.2% had FIGO stage III cancer. Majority (63.2%) of patients were diagnosed with squamous cell carcinoma (SCC), while the rest were adenocarcinoma (25%) and adenosquamous (11.8%). Clinical stage of cancer was found to be significantly associated with educational status (p=0.03) and dietary practices (p=.007). Conclusion: Our study found higher percentage of women with stage II and III cervical lesions and reaffirms the importance of education and healthy diet in early detection and prevention of cervical cancer. Therefore, it is suggested that accelerated population awareness and screening, incorporating digital innovations including vaccination programs are mandatory

Patient satisfaction for telemedicine health services in the era of COVID-19 pandemic: A systematic review

IntroductionIn the year 2019, the whole world witnessed the COVID-19 pandemic. The pandemic has negatively impacted the health care delivery system. This has risen the necessity among health systems across the world to deliver health care services through telemedicine. This systematic review would assess the level of patient satisfaction with telemedicine health services during the time of the COVID-19 pandemic.MethodologyThe literature search was conducted in June 2022 using “PubMed” “Google Scholar” and “Embase” databases. A total of eight articles were included. ROBVIS Analysis was performed for the assessment of bias. Descriptive statistics were performed using Microsoft Excel.ResultsAll included studies were conducted in seven countries/states/cities: India (n = 2), Philippines (n = 1), Saudi Arabia (n = 1), UAE (n = 1), Los Angeles (n = 1), Iran (n = 1), and New York City (n = 1). Most used telemedicine tools were voice calls, video calls and messaging/email. Maximum patients used video for consultation (5 out of 9 studies) followed by voice call (4 out of 8 studies), messaging/emails (2 out of 8 studies) and other telemedicine Apps (2 out of 8 studies). Overall, the level of satisfaction was found highest amongst studies conducted in developed countries/states/cities such as New York City (94.9%), Los Angeles (82.7%), UAE (81%) and Saudi Arabia (77.9%) in contrast to studies conducted in developing countries which includes Philippines (82%), India (73.9; 51.3%) and Iran (43.4%).ConclusionMost of the participants were found to be satisfied with the quality of telemedicine they were offered. This systematic review will help to improve telemedicine services which will eventually improve the health care delivery system.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#myprospero