Abstract

Kidneys from 55 cases (20 with HIV infection and 35 with AIDS) were studied by routine Haematoxylin and Eosin stains and special stains (PAS, PASM GMS, ZN, Mucicarmine and Congo red) to evaluate, glomerular, interstitial and vascular pathology. Twenty-four of the 35 (68.6%) cases of AIDS showed infective aetiology which included 17 cases (48.5%) of tuberculosis, 5 cases (14.4%) of fungal infection (3 cryptococcus neoformans and 2 candida species) and 2 cases (5.7%) of CMV infection. Other lesions noted were amyloidosis and tubular calcinosis. HIV associated nephropathy (HIVAN) was not detected in any of the cases. Intravenous drug abuse was not a risk factor in our cases which probably explains the absence of HIV associated nephropathy in the present study.

Fine needle aspiration diagnosis of a breast fibroadenoma with multinucleated giant cells.

Abstract :

A 45-year-old heterosexual male patient with retroviral disease since 12 years presented with hyperpigmented lesions, misdiagnosed initially as purpura due to an associated thrombocytopenia, but was biopsy proven to be Kaposi’s sarcoma (KS). Bone marrow examination revealed excess megakaryocytes. Low CD4 count and absence of platelet specific IgG reduced the likelihood of immune thrombocytopenia (ITP). However after 6 weeks of antiretroviral therapy the patient’s lesions have reduced and platelet counts are improving, possibly suggesting a sequestration thrombocytopenia in the abnormal tumor vessels of KS

Abstract

CONTEXT.—:

Grant Medical College and Sir J. J. Hospital, Mumbai (India), have a long tradition of clinical autopsies, wherein autopsy records have existed since 1884. The old autopsy records from 1884 to 1966 were discovered during a refurbishing drive of the pathology department in 2007.

OBJECTIVE.—:

To know the relative causes of deaths in Sir J. J. Hospital Mumbai from 1884 through 1966. To determine the rate of antemortem and postmortem discrepancies in the prehistology and posthistology era.

DESIGN.—:

The reports of clinical autopsies in the archives of Department of Pathology from January 1884 to December 1966 were reviewed. Data such as sex, age, and clinical and autopsy diagnoses were collected, based on the autopsy records of 13 024 patients.

RESULTS.—:

Of 13 024 patients, 10 197 (78%) were male and 2827 (22%) were female. Most deaths (55%) involved individuals ages 21 to 40 years. Infections were the cause of death in 7281 of 13 024 patients (56%), followed by cardiovascular diseases in 2138 (16%) and neoplasms in 963 (7%). The overall disagreement between clinical diagnoses and postmortem findings was 4105 of 13 024 patients (31%). Discrepancy between antemortem and postmortem diagnoses in the prehistology era (before 1950) was found in 3053 of 8951 patients (34%), whereas in the posthistology era (after 1950), discrepancy was found in 1019 of 4073 patients (25%).

CONCLUSIONS.—:

Historical collections provide baseline data against which modern observations can be compared. Such collections also offer a window on the past and often provide a less biased account of events. Historical collections of museum materials such as ours are valuable because they can serve as potential biorepository materials to facilitate future research. Apart from providing reliable data on the occurrence of diseases, the autopsy has an important role in providing information about conditions that are no longer prevalent. Medical institutes possessing old autopsy records, wet specimens, paraffin blocks, and slides should preserve such historical collections.

Abstract: 

The recognition of cardiac toxoplasmosis has increased in patients with acquired immunodeficiency syndrome. The functional consequences of toxoplasmosis of heart vary considerably depending on the intensity of inflammatory reaction, the extent of involvement of myocardial muscle fibers by necrosis and intramyocytic presence of tachyzoites of Toxoplasma gondii. This report describes a case of toxoplasma myocarditis that lead to fatal cardiac arrest. To the best of our knowledge, this is the first reported case of cardiac toxoplasmosis in the Indian literature, which has manifested as sudden death

Abstract:

Kimura’s disease is a chronic inflammatory disorder involving the skin, subcutaneous tissues and lymph nodes, predominantly in the head and neck region. Though surgery, intralesional or systemic steroids or radiation therapy have been the mainstay of treatment recurrence is a common problem.1 On the basis of occasional case report of Kimura’s disease responding to cyclosporine,2 we attempted oral cyclosporine in our patient with dramatic improvement.

Abstract:  Cutaneous and cerebral chromoblastomycosis are two clinical forms of chromoblastomycosis caused by dematiaceous (naturally pigmented) fungi. Sporadic cases have been reported as case-reports hence, definite incidence is not known. Thirty cases have been reported in the Indian literature between 1957-1997. The highest number of cases were reported in Southern part of India. We report a rare case of cutaneous chromoblastomycosis of thigh of one year duration in a 54 year old male. Histopathology showed characteristic sclerotic bodies. Special stains were done to highlight the sclerotic bodies. Cultural examination isolated Fonsacea Pedrosoi species.

Abstract: We report a case of a 40 year old HIV infected male, citizen of Somalia who presented with multiple painful, livid reddish brown plaques, papules and nodules on both lower limbs and purplish red nodules on the hard palate. The cutaneous nodular lesions on biopsy showed characteristic features of Kaposi’s sarcoma. This case is reported due to paucity of Kaposi’s sarcoma in Indian literature. 

Abstract

Cardiac function has long been known to be altered in patients with thyrotoxicosis and atrial fibrillation occurs in patients with hyperthyroidism. In addition to its disabling symptoms, atrial fibrillation is a strong risk factor for systemic embolism, especially with regard to cerebral circulation. A right atrial appendage thrombus formation in atrial fibrillation is a rare phenomenon. In this report, we describe a case of a 30-year-old female, who suffered from hyperthyroidism and subsequently developed atrial fibrillation and a right atrial appendage thrombus with infarction of right atrial appendage.

ABSTRACT: Although there have been a few reports of simultaneous infections and neoplasm in patients with acquired immune defi ciency syndrome, no reports of coexistent lymphoma with tuberculosis and Kaposi’s sarcoma with tuberculosis occurring in the same lymph node have been described. In this article, we describe coexistent lymphoma with tuberculosis in one case and Kaposi’s sarcoma with tuberculosis in another case of human immune defi ciency virus–infected individuals.

KEY WORDS:  AIDS, autopsy, Kaposi’s sarcoma, lymphoma, tuberculosis

The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

ABSTRACT: Multiple infections are a common feature of acquired immunodeficiency syndrome (AIDS), but coexistent infections at the same site are rare. In this report, we describe a 35-year-old human immunodeficiency virus infected male with coexistent cryptococcal and mycobacterial lymphadenitis. He presented with generalised lymphadenopathy. Fine needle aspiration cytology of enlarged cervical lymph node, aided by special stains, revealed coexistent cryptococcal and mycobacterial infection. Coexistent infections pose diagnostic problems in AIDS patients and are likely to be missed. Special stains are valuable for accurate diagnosis of coexistent infections.

Key words: Acquired immunodeficiency syndrome; coexistent infection; cryptococcal infection; human immunodeficiency virus; tuberculosis.

Nasolabial cyst is a rare extraosseous lesion normally appearing beneath the ala of the nose on the maxillary alveolar process. In this report we present a case of 63-year-old women having a nontender, fluctuant, soft, cystic lesion in left gingiviolabial sulcus. Based on the history, clinical findings and radiological features, a provisional diagnosis of a nasolabial cyst was made, which was later confirmed by histopathological examination.

Keywords: Nasolabial cyst, Nasoalveolar cyst

Background: Hematological abnormalities are probably the commonest complications with Human Immuno-deficiency Virus (HIV). Some antiretroviral (ARV) drugs have been 
documented to have cytopenic effects, in particular when used as a mono-therapy. The use of antiretroviral drugs could positively or negatively affect these parameters,
depending on the choice of combination used. Records of transfusion associated with HIV patients during treatment in Cameroon are scarce. Hematological profile is supposed to 
be properly monitored during treatment with respect to other associated risk factors like duration on Anti-Retroviral Therapy (ART) and adherence to ART, to improve on the
care of the patients and prevent further complications like transfusion.

Method: A hospital-based descriptive cross-sectional study was conducted from January 2015 to May 2015. A total of 285 HIV-1/AIDS adult patients on Highly Active
Antiretroviral Therapy (HAART) for at least 6 months were enrolled in this study. Participants were grouped into four based on, duration on HAART; Group one (6 months-1 year), Group two (>1 year-3 years), Group three (>3 years-5 years) and Group four (>5 years). Venous blood was collected and analysed using an automated hematology analyzer (Hematology analyzer Sysmex KX-21) for the following parameters: hemoglobin, number of platelets, total white blood cells and differential in HIV-1 patients.

Results: Of the 285 patients studied, 167 (58.6%) were anemic, among which 52 (18.2%) were from group one; 113 (39.7%) had eosinophilia, among which 33 (11.6%) were
from group one; 83 (29.1%) were neutropenic, among which 25 (8.8%) were from group four; 57 (20%) had leucopenia, among which 16 (5.6%) were both from group
one and three; 40 (14%) had thrombocytopenia, among which 14 (4.9%) were from group three; 15 (5.3%) had thrombocytosis, among which 6 (2.1%) were from group
two; 4 (1.4%) had leukocytosis, among which 2 (0.7%) were from group four; and 3 (1.1%) were neutrophilic. There was a significant statistic difference in hematological disorder
among treatment groups (groups one, three and four) only for anemia P<0.05. Among the 285 patients, 22 (7.7%) had been transfused either one or more times during HAART.
The prevalence of transfusion with respect to treatment groups were 8 (11%) from group two, followed by 5 (7%) from groups one and three, and lastly 4 (6%) from group
four, with a statistically significant association between gender (P<0.001), age (P<0.020) and HAART regimen (P<0.001) with transfusion.

Conclusion: There were significant prevalence of anemia, eosinophilia, neutropenia, leucopenia and thrombocytopenia in HIV-1 patients on HAART in the south
west region of Cameroon. A close monitoring of hematology abnormalities of these patients on HAART is advised. The transfusion rate after initiation of HAART is common in the  south west region of Cameroon, and it is significantly associated with HAART regimen, age and gender.

Keywords: HIV; HAART; Anemia; Thrombocytopenia;
Neutropenia; Eosinophilia; Leukopenia; Thrombocytosis;
Leukocytosis; Neutrophilia; Transfusion; Cameroon

Meshram AH, Dode CR, Lanjewar DN. Estimation of age of Indian adolescents by radiographic study of mandibular third molar. Indian journal of Forensic Medicine and Toxicology.2013;7:246- 250.

Momin YA, Lanjewar DN, Agale SV, Ghodke BA, Ansari SAH. Solid serous adenoma of pancreas. Oncology, Gastroenterology and Hepatology Reports. 2014; 1:13-15.

Key words: parietal cell, chief cell, mucous neck cell, histogenesis, gastric pits, pyloric antrum

Background: The course of human immunodeficiency virus infection and the acquired immunodeficiency syndrome can be complicated by a variety of endocrine abnormalities, including abnormalities of thyroid gland.

Materials and Methods: This study was designed to understand the spectrum of pathology of thyroid in Indian patients with AIDS. The present study describes the findings of retrospective autopsy findings of 158 patients with AIDS which revealed infectious diseases from a time period before the use of highly active antiretroviral regimen.

Results: A wide range of bacterial, fungal, and viral infections were observed. Tuberculosis was recorded in 14 (09%) patients, Cryptococcus neoformans in 11 (7%) patients and cytomegalovirus in 3 (2%) patients. Hashimoto’s thyroiditis and lymphocytic thyroiditis were seen in 02 (01%) patients each. One patient had dual infection comprising of tuberculosis and cytomegalovirus infection. The other microscopic findings observed were goiter (2 patients), interstitial fibrosis in thyroid (7 patients), and calcification in thyroid (8 patients).

Conclusions: Abnormalities of thyroid are uncommon findings in patients with HIV infection however several case reports of thyroid involvement by infectious agents and neoplasm are described in these patients; hence patients with HIV infection should be closely followed up for development of goiter or abnormalities of thyroid functions.

KEY WORDS: Acquired immunodeficiency syndrome, human immunodeficiency virus, infections, neoplasm, thyroid

Pathologic lesions in children with acquired immunodeficiency syndrome, An autopsy report of 11 cases from Mumbai Indian J Pathol Microbiol 2016;59:166-171.

Sagnik Roy, Nivedita Roy, A study of morphogenesis & mitral cell population of human fetal olafactory bulbs- National Journal of Clinical Anatomy Vol. 6(4) Pg 243-249 (2017)

Introduction: The aim of the study was to correlate the thyroid hormone profile with the age, height, weight, body mass index (BMI), with body fat percentage (BF%) in apparently healthy person.

Materials and Method: 84 normal subjects were included in the present study. In thyroid hormone profile S. TSH, Total S. T3, and Total S. T4 were estimated by lumax chemiluminescence immunoassay strip reader in the laboratory. Height, weight and BMI were recorded by standard method and BF% was calculated by the formula. Analysis was done by SPSS software.

Result: Of 84 subjects, 39 were males and 45 were females. The correlation coefficient of thyroid hormone profile: For S. TSH (r=+0.261, p=0.02), (r=+0.064, p=0.57), (r=+0.330, p=0.00), (r=+0.368, p=0.00), (r=+0.387, p=0.00); For S. T3 (r=-0.299, p=0.01), (r=-0.208, p=0.06), (r=-0.447, p=0.00), (r=-0.377, p=0.00), (r=-0.257, p=0.02); For S. T4 (r=-0.086, p=0.44), (r=-0.174, p=0.11), (r=-0.365, p=0.00), (r=-0.297, p=0.00), (r=-0.072, p=0.52) with age, height, weight, BMI and BF% respectively.

Conclusion: The S. TSH shows significant positive correlation with age, weight, BMI and BF percentage. While S. T3 shows significant negative correlation with age, weight, and BMI and BF percentage and S. T4 shows significant negative correlation with weight and BMI. That suggests the physical parameters also play an important role to determine the thyroid function, as thyroid hormone play an important role in the metabolism of almost all the cell of the body.

Keywords: Thyroid hormone, Physical parameters, Normal subjects

Background: Academic institutions throughout the globe conduct orientation programs for their students at entry level to help them adjust to the campus environment and academic programs. In India, students enter medical profession at a tender age of 17-19 years with dissimilar psychological characteristics, diverse expectations from the medical profession, and burden of various expectations from family and society.

Aims and Objectives: To facilitate the transition from school phase to a professional course, the Medical Education Unit (MEU) of Gujarat Adani Institute of Medical Sciences (GAIMS) designed and evaluated an orientation-cum-foundation program for the first-year MBBS students.

Materials and Methods: Three-day long orientation program and foundation course were organized by the MEU, GAIMS for the incoming first-year MBBS students of 2016-2017 batch. 112 students voluntarily participated in this cross-sectional study. Their feedback was obtained by a pre-designed and pre-validated questionnaire on a five-point Likert scale.

Results: 107 students responded with the feedback about orientation program, whereas all the 112 students gave feedback on foundation course. 78% students responded positively for orientation, and 88% responded positively for foundation course. Students were largely satisfied with the program.

Conclusion: Orientation and foundation program for MBBS students at the entry level, as suggested by the Medical Council of India, helps reduce students’ anxiety and boosts their confidence.

KEY WORDS: Orientation; Medical Education; Medical Students; Professionalism; Ethics; India

Objective. The aim of this study was to establish a baseline titre for the population of Mumbai, Maharashtra, India. 

Method. Four hundred healthy blood donors, attending blood donation camps, were screened using a survey questionnaire. Widal tube agglutination test was performed on the diluted sera (with 0.9% normal saline) of blood donors, with final dilution ranging from 1 : 40 to 1 : 320. 

Results. Out of 400 individuals providing samples, 78 (19.5%) individuals showed antibody titres ≥ 1 : 40 for at least one antigen and 322 (80.5%) showed no agglutination. The baseline antibody titres against O antigen and H antigen of Salmonella enterica serotype Typhi were found to be 1 : 40 and 1 : 80, respectively. Similarly, the baseline antibody titres for the H antigen of Salmonella enterica serotypes Paratyphi A and Paratyphi B were found to be 1 : 40 and 1 : 80, respectively.

 Conclusion. Thus, it was noted that the diagnostically significant cutoff of antibody titre from acute phase sample was ≥ 1 : 80 for S. Typhi O antigen and titre of ≥ 1 : 160 for both S. Typhi H antigen and S.Paratyphi BH antigen. Antibody titre of ≥ 1 : 80 can be considered significant for S. Paratyphi AH antigen.

Lanjewar DN, Ramraje SN. Congenital cytomegalovirus infection in a neonate born to HIV-infected mother-A case report. . Indian J Pathol Microbiol 2017; 60:130-131.

Background and Objectives: Obesity has become an important public health concern as it is associated with an increased risk of diabetes, dyslipidemia, kidney disease, cardiovascular disease, and even cancer. Moreover, obesity is linked to many endocrine abnormalities, including thyroid dysfunction. Many studies on euthyroid individuals have shown a significant association between body massindex (BMI) and thyroid function. Identifying the complex inter-relationship between thyroid function and obesity may help in prevention and treatment of obesity and thyroid dysfunction, as both are very common dilemma. The present study aimed at understanding the effect of BMI and age on thyroid function in apparently healthy euthyroid individuals.

Materials and Method: 84 apparently healthy euthyroid subjects of 18-60 years of age were included in the study. The subjects were classified according to their age & BMI and their thyroid hormone profile was estimated by Lumax chemiluminescence immunoassay (Acculite CLIA microwells kit) strip reader. Students’t test and one way ANOVA with Tukey HSD post hoc test were used for data analysis. p < 0.05 was considered significant.

Results: BMI was significantly higher in older adulthood group as compared to young and middle adulthood groups. S. TSH was higher, while S. T3 and S. T4 were found to be lower in obese subjects. With increasing grades of BMI from normal to over-weight to obese, S. TSH values increased whereas S. T3 and S. T4 values were found to be decreased. The thyroid hormone profile does not shows any significance difference in different age group of normal and obese subjects

Conclusion: Obesity is associated with decreased thyroid gland function while age does not significantly affect the thyroid function.

Keywords: Body Mass Index, Obesity, Hyperthyroidism, Hypothyroidism, Thyroid Hormones.

Background: A normal untrained individual remains perplexed about which warm-up one should perform to get the maximum benefits. Aim of present study was- which warm-up has better effect on exercise in untrained individuals. Parameters- Aerobic capacity and time taken to complete exercise were considered.

Method: It is a cross-sectional study conducted at GCS Medical College, Ahmedabad during the January 2015 with the permission of ethical committee of Institute and after written informed consent 30 (out of total 61) apparently healthy untrained medical students were randomly enrolled after exclusion. They were called at regular interval to perform Rockport Fitness Walking Test (RFWT) to calculate aerobic capacity by 3 steps: - 1st control exercise without warm up, 2nd RFWT following dynamic stretching and 3rd RFWT following static stretching. Parameters recorded were incorporated in RFWT formula to calculate aerobic capacity

Results: Subjects took significantly less time (14.45± 1.45 minutes, p < 0.05) to complete step 2 than step 1 control. But none showed any significant improvement in aerobic capacity.

Conclusions: Dynamic stretching decreases time taken to complete exercise hence should be preferred for activities requiring more speed.

Keywords: Dynamic stretching; Rockport Fitness Walking Test (RFWT); Static stretching; Untrained; VO2max; Warm up