Research and Publication

Research and Publication

Abstract

BACKGROUND:

Tuberculosis is endemic in India and its prevalence is reported to be increasing in patients with human immuno-deficiency virus (HIV) infection. Several factors, including the level of immune deficiency, influence the clinical presentation of HIV-associated tuberculosis.

METHODS:

Between April 1994 and April 1996, 1820 patients with confirmed HIV infection were studied for their clinical, radiological and laboratory parameters. Severe weight loss was observed as a frequent presenting complaint. Hence, a case-control analysis was performed using severe weight loss as the presenting criterion among HIV-seropositive patients.

RESULTS:

Of the 1820 patients with HIV infection, 410 (23%) presented with severe weight loss of > 10% of body weight within the preceding month. Of these 410 patients, 176 (43%) had tuberculosis, 94 (23%) had chronic diarrhoea, and 89 (22%) had recurrent fever. Among 176 patients with tuberculosis, the following types of HIV-associated tuberculosis were seen: 115/176 (66%) had pulmonary, 49/176 (28%) had extrapulmonary tuberculosis; of these 49 cases with extrapulmonary tuberculosis 33 (18%) had disseminated tuberculosis, and 12/176 (7%) had both pulmonary and extrapulmonary involvement. In the group as a whole, 45/176 (25%) cases had disseminated tuberculosis. Clinical features of HIV-associated tuberculosis in decreasing order of frequency were chronic fever, chronic cough, lymphadenopathy and hepatosplenomegaly. The Mantoux skin test was significantly anergic among patients with extrapulmonary and disseminated tuberculosis (p = 0.001).

CONCLUSIONS:

There was a significant correlation between severe weight loss and tuberculosis (RR 17.5), chronic diarrhoea (RR 12.8) and recurrent fever (RR 4.5). The diagnostic value of the Mantoux skin test among HIV-associated tuberculosis is reduced, more so among those with extrapulmonary and disseminated forms.


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Abstract

Pneumocystis carinii pneumonia (PCP), the most common presenting manifestation in patients with AIDS from western countries, holds the distinction for being the first opportunistic infection that was associated with AIDS. There is marked paucity of clinically diagnosed and pathologically confirmed cases of PCP in India. This case represents the first complete autopsy report of pneumocystis carinii pneumonia inpatient with AIDS from our country. A high index of clinical suspicion and microscopic confirmation is needed to avert mortality due to PCP in patients with AIDS.


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Abstract

Metastasis into the hepatic hemangioma is a rare occurrence. We report a unique case of metastasis of intestinal carcinoma into hepatic hemangioma in a case of 65 year old male who presented with anorexia, weakness and headache. The postmortem examination revealed adenocarcinoma in the ileocaecal region. The liver showed a subcapsular hemangioma of 1.5 cms. diameter which on microscopic examination revealed metastasis of adenocarcinoma. The is the first documentation of metastasis in hepatic hemangioma. Such cases may pose problems of diagnostic difficulties and thus may result in mismanagement.


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Abstract

OBJECTIVE:

Although India has a high prevalence of HIV/AIDS, the associated pathologies responsible for morbidity have not been evaluated previously in a representative study. Hence, an autopsy study was carried out to analyse the spectrum of pulmonary lesions in patients with HIV/AIDS.

METHODS:

A retrospective and prospective autopsy study was carried out during 1988-2000 at Mumbai, India. Lungs from 143 adults, with at least 10 sections from each case, were examined using routine and special stains.

RESULTS:

The risk factors for 97 men (68%) and 38 women (27%) included: heterosexual sex with multiple partners (135 cases, 95%); blood transfusions (three cases; 2%); sex between men (two cases; 1%); and unknown risk factors (three cases, 2%). Pulmonary pathology was observed in 126 (88%) cases. The lesions identified were tuberculosis (85 cases, 59%), bacterial pneumonia (26 cases, 18%), cytomegalovirus (CMV) infection (10 cases, 7%), cryptococcosis (eight cases, 6%), Pneumocystis carinii pneumonia (seven cases, 5%), aspergillosis (four cases, 3%), toxoplasmosis (two cases, 1%), Kaposi's sarcoma (one case, 1%), squamous cell carcinoma (one case, 1%). Two or more infections were observed in 18 (13%) cases.

CONCLUSIONS:

Pulmonary diseases and risk factors among patients with AIDS in India differ from those reported in industrialized countries. Tuberculosis was the most frequently observed pulmonary infection, followed by bacterial pneumonia and CMV pneumonitis. In contrast with industrialized countries, PCP remains less common in our patients. The information on opportunistic infections obtained in this study will be useful for managing HIV/AIDS cases at district level hospitals where diagnosing specific HIV-associated diseases is not always possible.


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Abstract

Histopatholgoical analysis of cutaneous lesions in 195 patients with HIV/AIDS was carried out between 1989 to 1997 at tertiary level public hospital in Mumbai. 104/195 (53%) cases showed infectious diseases which comprised of molluscum contagiosum (28), condyloma accuminata (18), verruca vulgaris (7), varicella zoster (5), syphilis (14), tuberculosis (13), donovanosis (4), leprosy (2), chancroid (2), bacillary angiomatosis (2), lymphogranuloma venercum (1), Norwegian scabies (3), leishmaniasis (2), demodicidosis (1), crytococcosis (1), tinea versicolor (1). In 12 (6%) cases neoplasms were observed which included squamous cell carcinoma (9), basal cell carcinoma (2) and kaposi's sarcoma (1) case. The miscellaneous conditions were observed in 66(33.5%) cases which comprised of psoriasis (21), papular urticaria (13), Reiter's disease (7) and eosinophilic folliculitis (6). The prevalence of cutaneous tuberculosis observed in this study is high as compared with western literature while the prevalence of kaposis's sarcoma is quite low as compared with reports from Africa, USA and United Kingdom.


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Abstract

Guinea worm or Dracunculus medinensis is a well-documented helminthic infestation in many areas of Asia. In this report, we describe a rare case of guinea worm infestation in a 25-year-old woman who had developed symptoms of obstructive uropathy, in whom fragments of guinea worm were removed after urethral catheterization. To the best of our knowledge, adult guinea worm occurring in the urinary bladder has not been previously described.


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Abstract

BACKGROUND:

Although there have been few case series of primary non-Hodgkin's lymphoma (NHL) of ovary, no patient with AIDS-related primary ovarian lymphoma has been described in the literature.

CASE:

We report a case of human immunodeficiency virus infected female with primary ovarian NHL for which she could not receive standard NHL combination chemotherapy and standard HIV highly active antiretroviral therapy (HAART) and succumbed to death within 7 months after diagnosis.

CONCLUSIONS:

Primary ovarian lymphoma is rare as compared with other ovarian tumors and has similar presentation to other common ovarian malignancies. The patients from developing countries cannot afford standard NHL combination chemotherapy and HAART as these drugs are expensive and are not provided freely to all patients, in state government run public hospitals.


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Abstract

Ubiquitously present fungi in the environment find a nidus in the human body and adopt its metabolic machinery to be in symbiosis or become pathogenic. Immunocompromised states like human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS), systemic neoplasia and organ transplantation have enhanced the frequency of fungal infections. High-risk behavior, IV drug abuse and air travel have led to the emergence of new fungal infections hitherto geographically localized. The pathology in the central nervous system (CNS) is dictated largely by the size of the fungus - the yeast forms, by virtue of their small size enter the microcirculation to cause meningitis and microabscesses, while hyphal forms invade the vasculature to manifest as large pale or hemorrhagic infarcts. The growth kinetics of fungi, the antigenic character of the capsule. the proteases secreted by the mycelial forms and the biochemical milieu in the host also determine clinical manifestations. A hospital-based analysis of the available information from India suggests that in the non-HIV patient population, hyphal forms like Aspergillosis and Zygomycosis are the most common pathogens, while yeast forms like Cryptococcus and Candida are the prime pathogens in cases of HIV/AIDS, the altered macrophage function acting in synergy with suppressed cell-mediated immunity. In Northeastern states, systemic infection by Penicillium marneffei is reported in association with HIV though CNS involvement is not recorded. Although fungal infections of the CNS are reported from various hospitals in India, studies are limited by non-availability of relevant microbiological studies and the reported prevalence data is biased by the surgical practices, availability of postmortem and microbiology and laboratory support. Detailed clinical and mycological investigations related to the interaction between the fungus and host environment is a fertile area of research to understand the basic pathogenetic mechanisms.

 

Keywords:

 Aspergillosis, central nervous system, cryptococcosis, dimorphic fungi, mycotic infections, pathogenesis, penicilliosis, pheohyphomycosis, zygomycosis


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Abstract: Giant-cell myocarditis is a disease of relatively young, predominantly healthy adults. The patients usually die of heart failure and ventricular arrhythmia unless a cardiac transplantation is performed. We are reporting here an autopsy case of idiopathic giant cell myocarditis with no symptoms in a 27-year old -worker who died suddenly.

The purpose of this report was to emphasize that idiopathic giant cell myocarditis was a rare disease and that it could exist in the absence of any symptomatic heart disease.

 

Keywords: Idiopathic giant cell myocarditis, Sudden death, Giant cells


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Ramteerthkar NA, Pethkar AS. Hydrolithalus syndrome-Autopsy report. Ind Med Gazette


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Abstract

Transient leukemia (TL) also referred to as transient abnormal myelopoiesis (TAM) or transient myeloproliferative disorder (TMD) is a unique syndrome that frequently occurs in newborns with Down syndrome (DS). It manifests in the first few days of life and shows leukocytosis with blast cells in the blood and bone marrow. This leukemia resolves spontaneously within first few months of life in the majority of cases. In this report we describe two newborns with a karyotype of 47,XY,+21, presented with marked leukocytosis and many blast cells in the peripheral blood. In both the cases, the blasts disappeared and the total leukocyte count reverted to normal without any specific treatment.

 

KEYWORDS:

Down syndrome; Transient abnormal myelopoiesis; Transient leukemia; Transient myeloproliferative disorder


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Plasma cell granuloma, also known as inflammatory pseudotumor is a tumor-like lesion that manifests primarily in the lungs. But it may occur in various other anatomic locations like orbit, head and neck, liver and rarely in the oral cavity. We here report an exceedingly rare case of gingival plasma cell granuloma in a 58 year old woman who presented with upper gingival polypoidal growth. The histopathological examination revealed a mass composed of proliferation of benign spindle mesenchymal cells in a loose myxoid and fibrocollagenous stroma along with dense infiltrate of chronic inflammatory cells predominantly containing plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma.

 

Keywords: Inflammatory pseudotumor, plasma cell granuloma, plasma cells, polyclonal plasma cells


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Mesoblastic nephroma (MN) is the most common renal tumor diagnosed in infancy. A case of congenital MN was diagnosed in a 6-month old child by fine-needle aspiration cytology. The smears were cellular and consisted of plump spindle cells arranged in clusters along with scattered naked nuclei in the background. Blastemal, epithelial, or glomeruloid structures were not seen. Considering the age and the cytomorphology, a diagnosis of cellular variant of MN was offered which was confirmed on histopathology. Unlike Wilms tumor, preoperative chemotherapy is not required for MN. Hence cytologic diagnosis is important.


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ABSTRACT:  A 22-year-old male became unconscious and was found to have left-sided weakness and facial asymmetry. Previously, he had up to 35 excisions for subcutaneous swellings all over the body, commencing at age 6 years. Examination revealed small nodular skin lesions on the neck, the eyelid and hard palate. Two-dimensional echocardiography showed two left atrial masses. Histopathological examination of the subcutaneous lesions showed cutaneous myxomas with a prominent epithelial component. The left atrial masses were also myxomas. The case attempts to highlight the importance of histopathological examination of subcutaneous swellings. Cutaneous and subcutaneous manifestations, including cutaneous myxomas, are among the earliest presentations in Carney’s complex and may herald potentially fatal cardiac myxoma. The prominent epithelial component in cutaneous myxomas may be confusing and cause diagnostic difficulties.

 

KEY WORDS: Cardiac myxoma, Carney complex, cutaneous myxoma, lentingines


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Lanjewar DN, Agale S, Dongaonkar D, Murthy A. Myiasis in vulvar carcinoma in a patient with acquired immunodeficiency syndrome Indian J Pathol Microbiol 2015;58: 400-401.


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Background: Estimation of stature has a very significant role to play in forensic anthropometry for personal identification.

 

Objective: To discover out the correlation among proportions of feet with stature in tribals of Udaipur district in Rajasthan (India).

 

Material and Methods: The present study was conducted on a total number of 481 male tribals of Udaipur district by using standard anthropometric techniques.

 

Results: There was a high correlation between height and right (0.184) foot length & left (0.186) Foot Length in males.

 

Conclusion: Linear regression equations were deduced in males out of which lowest standard error of estimate was experienced in combined foot length of males.

 

Key Words: Stature, Foot length, Regression equations


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Background: Although formalin preserved organs in dissection- hall are used for teaching purpose but the odour and carcinogenic effect of formalin has made us to search for some alternate method for preparing teaching models. One of such methods is plastination but it requires well equipped laboratory and costly chemicals. So our objective was to develop a cheap and easy and feasible method of preparing formalin free teaching models of organs.

 

Materials and Methods: Heart with great vessels, brain, spleen and liver were removed from cadavers and a fine dissection was done to clear arteries and veins. Organs were washed thoroughly in running tap water to remove small blood clots and formalin. Volume of each organ was measured and recorded in millilitres (ml) by dipping the fresh organ in water and raised of water column was measured. Organs were then dehydrated in three subsequent change of absolute alcohol. Each bath lasted for 3-7 days according to size of organs. They were then put in two subsequent baths of xylene; each lasted for 1-3 days. After xylene bath organs were put in melted wax at 65 degree Celsius. Three changes of wax penetrated the tissue. Again volumes were taken by the same method and recorded. They were coloured for a better differentiation. Varnish paint was applied on the prepared models. Dry and formalin free models were thus ready for demonstration and study purposes.

 

Results: Models maintained their original shape and had shown shrinkage of 04.54 percent in heart, 43.7 percent in one half of brain, 38.4 percent in spleen, and 47 percent in liver. Results of this method were highly appreciable.

 

Conclusion: This method was helpful in preservation of valuable human organs in their original shape like a bone for the study of students. Models prepared with this technique were lively in appearance; odour free and without any carcinogenic property so therefore could be safely used for study purposes. Teaching models prepared with this technique no longer needed any preservative material for their storage.

 

KEY WORDS: Anatomy, Museum, Cadaver, Teaching Model, Wax


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Background: The hypertension and Diabetes are common health problem in India. The aim of the present study was to evaluate the association of BMI and hypertension with type II diabetes mellitus.

 

Material and Method: 200 type II diabetic subjects were included in the present study. FBS, PPBS done by GOD/POD enzymatic method & HBA1C by ion exchange resin method in the laboratory. Height, weight and basal metabolic index were recorded by standard method. Blood pressure was recorded by Blood pressure was measured and classified as per the Seventh Report of the Joint National Committee, Geneva, Switzerland. Analysis was done by SPSS software. Blood

 

Result: out of 200 subjects 150 were male & 50 were female. 17% case had good & 83% had poor glycemic control. 51% were hypertensive, 10% were in the prehypertenion stage & 39 % had normal blood pressure

 

Conclusion: This study shows that increased prevalence of hypertension with type II diabetic patients. So early modification of lifestyle, diet, exercise & treatment of diabetes mellitus plays important role to decrease its prevalence

 

Keywords: Type II diabetes mellitus, Hypertension, Body mass index


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