Preeclampsia Biomarkers - The quest goes on

Preeclampsia (PE) is a multisystem disorder of pregnancy and a major cause of maternal morbidity and mortality worldwide. The disease is recently attributed to maternal endothelial dysfunction. The quest for ideal biomarker goes on. Pregnancy-associated plasma protein A (PAPP-A), Placental growth Factor (PLGF) and sFlt-1 (soluble fms-like tyrosine kinase-1) are the new biomarkers that hold promise for future. We present a short review on current biomarkers that would enable us to diagnose PE timely leading to reduced maternal morbidity and mortality , justifying the saying,  ‘ a stitch in time saves nine’

Molecular detection of quaternary ammonium compound resistance genes of Staphylococcus aureus from udder surface and mastitis milk of bovines

Quaternary ammonium compounds (QAC) are widely used biocides in the field of medical and veterinary practice. Resistance to QACs is an emerging problem due to this widespread use. The present study was undertaken to detect the presence of genes that contribute to resistance to QACs in Staphylococcus aureus isolates obtained from udder surface and mastitis milk. A total 22 isolates of S. aureus were obtained from udder washings and milk of bovine mastitis cases. Among these, seventeen isolates were from udder wash samples and five isolates from clinical and subclinical cases of mastitis. Broth microdilution assay was performed to assess the minimum inhibitory concentration (MIC) of the isolates against Cetyltrimethylammonium bromide (CTAB), a QAC. Polymerase chain reaction (PCR) was done targeting qac A/B gene which codes for efflux pump which targets QACs. In the present study qac A/B gene was detected in seven out of 22 isolates of S. aureus. Three of these isolates were obtained from udder washings before milking and four, after milking. None of the S. aureus isolates from mastitis milk possessed the gene. The average minimum inhibitory concentration of qac A/B positive isolates against CTAB was 0.63 ± 0.55 μg/ml. The average MIC between qac A/B positive and negative isolates were statistically insignificant. The study points to the fact that multiple factors could be contributing to biocide resistance in S. aureus

Neuromuscular Disorders: A Histomorphological and Clinicopathological Evaluation in a Tertiary Care Centre

Background: Neuromuscular disorders are rare, inherited progressive disorders leading to major disabilities over the years. As a group, there prevalence is not so uncommon and requires attention in view of their rising cases. Muscle biopsy forms an integral part of the diagnostic workup for patients with neuromuscular disorder but is performed in a very few institutes in Asia. In this study, we learn the spectrum of neuromuscular disorders presenting in a tertiary care centre of a developing country, India and evaluate the importance of open muscle biopsy. Material and Methods: 112 Muscle biopsies were reviewed and analysed for investigation of patients with suspected myopathy. Results: Of the 112 cases, 74% of the cases were adults. Mean age of presentation was 25 years and 57% of the cases were males. Pediatric cases constituted 26% of the total cases and 71% of them were male patients. Definitive diagnosis following muscle biopsy was made in 58% (n=65) of cases. Routine histological evaluation revealed the diagnosis of inflammatory myopathy 41% (n=46), muscular dystrophy in 34.8% (n=39),7.1% (n=8) neurogenic, 1.78%(n=2) mitochondrial and 0.8%(n=1) congenital myopathy of the cases. Conclusion: The burden of neuromuscular disorders has increased over the years. Molecular tests are not always helpful in diagnosing LGMD and not accessible to everyone. The role of muscle biopsy is inevitable in detecting false positive cases in mitochondrial myopathy, and for the management of Inflammatory myopathies. Awareness of the utility of muscle biopsy, expertise in diagnosing, and diagnostic challenges need more attention of the clinicians, pathologists and orientation of postgraduates to ease the journey of the patients and their families. Keywords: Muscle biopsy, Enzyme histochemistry, Neuromuscular disorders, Mitochondrial myopathy, Inflammatory myopathy, Morpholog

Aquaintance of sample collection -Must for patient care

The clinical laboratory plays an increasingly important role in the patient-centered approach to deliver healthcare services. Physicians rely on accurate laboratory test results for proper disease diagnosis and for guiding therapy; it is estimated that more than 70% of clinical decisions are based on information derived from laboratory test results.  The total test process show that the pre-analytical phase accounts for 46% to 68.2% of errors. The awareness and knowledge to recognize preanalytical errors is the goal of achieving total laboratory quality is must for patient care

Lung malignancy: Diagnostic accuracies of bronchoalveolar lavage, bronchial brushing, and fine needle aspiration cytology

Background: Early diagnosis of lung cancer plays a pivotal role in reducing lung cancer death rate. Cytological techniques are safer, economical and provide quick results. Bronchoscopic washing, brushing and fine needle aspirations not only complement tissue biopsies in the diagnosis of lung cancer but also comparable. Objectives: (1) To find out diagnostic yields of bronchioalveolar lavage , bronchial brushings, FNAC in diagnosis of lung malignancy. (2) To compare relative accuracy of these three cytological techniques. (3) To correlate the cytologic diagnosis with clinical, bronchoscopic and CT findings. (4) Cytological and histopathological correlation of lung lesions. Methods: All the patients who came with clinical or radiological suspicion of lung malignancy in two and a half year period were included in study. Bronchoalveolar lavage was the most common type of cytological specimen (82.36%), followed by CT guided FNAC (9.45%) and bronchial brushings (8.19%). Sensitivity, specificity, positive and negative predictive value for all techniques and correlation with histopathology was done using standard formulas. Results: The most sensitive technique was CT FNAC – (87.25%) followed by brushings (77.78%) and BAL (72.69%). CT FNAC had highest diagnostic yield (90.38%), followed by brushings (86.67%) and BAL (83.67%). Specificity and positive predictive value were 100 % each of all techniques. Lowest false negatives were obtained in CT FNAC (12.5%) and highest in BAL (27.3%). Highest negative predictive value was of BAL 76.95 % followed by BB 75.59% and CT FNAC 70.59%. Conclusion: Before administering antitubercular treatment every effort should be made to rule out malignancy. CT FNAC had highest diagnostic yield among three cytological techniques. BAL is an important tool in screening central as well as in accessible lesions. It can be used at places where CT guided FNAC is not available or could not be done due to technical or financial limitation

Informed Consent in Medical decision making in India

Consent is one of the key elements for protection of welfare of patients or research participants. The physician has a legal and ethical responsibility to provide adequate information to the patient so that he or she is able to process the information and make appropriate decisions. The patient’s consent must be voluntary and competent. In order to meet the requirements for effective, informed decision making, a physician must disclose material facts, which are relevant to decision making, including the patient’s diagnosis, proposed treatment, risks and benefits of the treatment, alternative treatments along with their risks and benefits, and the risks of refusal. A physician must answer truthfully about the number of similar procedures or cases performed, and disclose success rates, and any financial conflict(s) of interest. The physician must advise patients of all personnel involved in their care and their respective roles, including residents, students, and equipment representatives.

Aquaintance of sample collection -Must for patient care

The clinical laboratory plays an increasingly important role in the patient-centered approach to deliver healthcare services. Physicians rely on accurate laboratory test results for proper disease diagnosis and for guiding therapy; it is estimated that more than 70% of clinical decisions are based on information derived from laboratory test results.  The total test process show that the pre-analytical phase accounts for 46% to 68.2% of errors. The awareness and knowledge to recognize preanalytical errors is the goal of achieving total laboratory quality is must for patient care

Incubation and its effect on Leishman stain

BACKGROUND: Leishman stain is the universal stain used in staining of peripheral blood smears all over the world. AIMS: To study the effect of incubation of buffer solution, slide alone and slide & buffer both on standard Leishman staining. The staining at times causes difficulty particularly in rainy season when there is increased moisture. METHOD: The study comprised of twenty peripheral blood smears selected consecutively in batches of ten each for two successive days . Minor modification in standard Leishman stain was done by either incubating slide or buffer solution or both. The staining characteristics were scored using system by NG et al and the statistical analysis was done. RESULTS: The highest mean score for background (1.5), nuclear (1.55), cytoplasmic features (1.5) and granules visualization (1.8) were seen in technique involving incubation of both slide and buffer. The results were statistically significant. CONCLUSION: We found that incubating glass slides or buffer solution or both yield better stained slide. Our study showed that there was better staining features seen in incubated slide verses routine method

Aquaintance of sample collection -Must for patient care

The clinical laboratory plays an increasingly important role in the patient-centered approach to deliver healthcare services. Physicians rely on accurate laboratory test results for proper disease diagnosis and for guiding therapy; it is estimated that more than 70% of clinical decisions are based on information derived from laboratory test results.  The total test process show that the pre-analytical phase accounts for 46% to 68.2% of errors. The awareness and knowledge to recognize preanalytical errors is the goal of achieving total laboratory quality is must for patient care