CASE REPORT | May 12, 2020
Crohns Disease of Jejunum Masquerading as Malabsorption
Dr. Anil Mohan Rao. S, Dr. Syed Sajid Hussein Shah
Page no 247-251
Crohns Disease also referred to as regional enteritis is a chronic disease with waxing and waning course. This condition is associated with profound psychological and physical effect on the affected patient. The disease has diverse clinico-pathological manifestations with significant attendant complications, morbidity and mortality. In this study attempt is made to address the many clinico-pathological presentations of the disease with focus on various aspects of differential diagnosis along with description of diagnostic approach by appropriate use of variousdiagnostic modalities. In addition recent pathogenetic mechanisms will be described which will having bearing and implications on therapeutic aspects of disease, that can influence the natural history and overall course of disease. This case is presented in view of its uncommon location and associated clinical manifestation.
ORIGINAL RESEARCH ARTICLE | May 4, 2020
Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) - A Brief Review
Dr. Pallavi BR
Page no 230-232
Naked eye single tube red cell osmotic fragility test (NESTROFT) is a simple test to screen for thalassemia has been described for use in developing countries. We studied the articles published before regarding the use of NESTROFT in screening Thalassemia and found out the average sensitivity and negative predictive value was 95.94% and 95.33% respectively which indicates NESTROFT is a good screening tool for the beta thalassemia.
ORIGINAL RESEARCH ARTICLE | May 4, 2020
Histopathological Study of Psoriasis: A Prospective Cum Retrospective Study at a Tertiary Care Centre
Dr. Ramesh Waghmare, Dr. Vivek Parameshwar, Dr. Vikas Kavishwar, Dr. Chitra Nayak
Page no 233-238
Background and Objectives: Psoriasis is a chronic papulosquamous disorder with constant exacerbations and remissions. Based on the clinical overlap with other papulosquamous disorders and the role of histopathology in diagnosis, we undertook a study on psoriasis. The objective of this study was to identify combination of histopathological parameters for the diagnosis of psoriasis and establish their reliability and significance. Material and Methods: A retrospective cum prospective study over a period of 5 years was carried out. 56 clinically diagnosed cases of psoriasis were taken into consideration. Skin biopsies were taken from these cases and histopathological examination was done. These lesions were then assessed based on various histopathological parameters. Results and Discussion: Maximum number of cases were in the age group of 31–40 years, males being three times more affected than females. The most common symptom was pruritis and psoriasis vulgaris was the most common variant. Upper limbs and back were most frequently affected. Among the microscopic parameters, acanthosis and parakeratosis were observed and when present with features like hypogranulosis, elongation of rete ridges, dermal inflammation and vasodilation or perivascular lymphocytic infiltrate were likely to indicate psoriasis. Munro micro abscesses and spongiform pustules of Kogoj, diagnostic features of psoriasis were also seen in significant proportion. Conclusion: Diagnosis of psoriasis is made based on the analysis of clinical symptoms and signs with a correlation with histopathological features. The relative ambiguity associated with this disease makes such histopathologic studies all the more important.
CASE REPORT | May 27, 2020
A Rare Case of Pulse Granuloma Presenting as Sub-Acute Intestinal Obstruction: Case Report
Ram Babu K, Krishna Kanth GVRN, Sudhir Kumar Vujhini
Page no 294-296
Pulse Granuloma also known as Hyaline Angiopathy is a rare but benign lesion, foreign body reaction to vegetable particle being the probable aetiology. The patient presented with recurrent intestinal obstruction and partial excision of small bowel was performed and specimen sent for histopathological examination. The microscopy showed mixed inflammatory cells, foreign body giant cells, convoluted hyaline rings, vegetable matter and areas of fibrosis. Most of the reported cases are in oral cavity or lungs and very few cases were reported in gastrointestinal tract and still rare in small intestine. Barring low incidence of the lesion, the characteristic histology reveals the lesion which avoids erroneous diagnosis, delay in diagnosis and thus helps in proper management of the case. Treatment of Pulse granuloma is excision.
ORIGINAL RESEARCH ARTICLE | May 8, 2020
Caregivers’ Knowledge of Environmental Sanitation and Hygiene Practices in the Prevention of Acute Diarrhoea among Under-Five Children in Calabar-South, Cross River State, Nigeria
Eno-Obong M. Ndueso, Godwin I. Ogban, Anthony A. Iwuafor, Ubleni E. Emanghe, Simon N. Ushie, Regina I. Ejemot-Nwadiaro
Page no 239-246
Background: Diarrhoea is currently the second leading cause of childhood mortality globally, after pneumonia. It accounted for 9% of all under-five deaths which was greater than the mortality arising from malaria, HIV and measles combined. The under-five mortality has continued to spike despite medical intervention protocols.This study was therefore designed to assess Caregivers’ knowledge of environmental sanitation and hygiene practices in the prevention of acute diarrhoea among under-five children in Calabar-South, Cross River State, Nigeria. Materials and method: A Caregiver who met the inclusion criteria was enlisted as respondent from each of the 660 households to give a total of 660 respondents. Structured questionnaires were administered to the respondents to collect data. Answers to the questions were numerically weighted and summed up to breakpoints used in categorising the respondents’ knowledge of environmental sanitation and hygiene practices into poor, fair and good knowledge. Results: Six hundred and fifty (650) respondents completed the interview. Male under-five children were 352 (54.2%) and females 298 (45.8%).Child’s age and male sex were statistically significant predictors of occurrence of childhood diarrhoea. Occurrence of acute diarrhoea in under-five children was greatest among children 13 - 24 months149 (67.1%) and male under-five children 196 (55.7%) compared to female under-five children 131 (44.0%). Occurrence of diarrhoea reduced with improved Caregivers’ knowledge of environmental sanitation and hygiene practices. Occurrence of diarrhoea was also observed to reduce with improved educational status and income of Caregivers.
ORIGINAL RESEARCH ARTICLE | May 12, 2020
Physicochemical and Microbiological Analyzes of Non-Alcoholic, Non-Carbonated Flavored Beverages Marketed in Plastic Bags in the City of Douala, Cameroon
Bamal Hans-Denis, Mvogo Ottou Patrice Brice, Ngoule Charles Christian, Yinyang Jacques, Etape Fabrice Edie, Kidik Pouka Cathérine, Ngene Jean Pierre, Kenmogne Simo Thiery, Dibong Siegfried Didier, Claus Jacob, Etame Loe Gisèle
Page no 252-256
Flavored drinks are substances to be prepared or ready for consumption, including syrups and those containing caffeine. Their specific naming may be replaced by another, which is either usual or descriptive, such as "refreshing drink", "table drink" or "drink made from ..." that allows consumers to know the real nature of the beverage and to distinguish it from others. The quality of these dubious products is still poorly known although in terms of cost, they remain very accessible to the market. The objective of this experimental study was to contribute in improving awareness on the quality of these consumption items, by conducting physicochemical and microbiological analyzes of non-alcoholic and non-carbonated flavored beverages marketed in plastic bags in Douala, Cameroon. The physicochemical properties were evaluated by means of volumetric analysis, potentiometry, refractometry, titratable acidity and SO2 and vitamin C contents. Microbiological properties were assessed by performing a search for yeasts, molds and coliforms which sometimes act as antiseptic agents, such as ascorbic acid and citric acid. It would be necessary to review the production processes of these beverages as well as the enforcement of sanctions in salmonella and sulfate-reducing clostridium. Analyzes were performed on 50 samples in total. The results showed that 10% of the brands samples did not comply with the physicochemical quality standards. All brands samples met microbiological quality requirements, mainly due to a pH below 3 and the presence of preservatives with antiseptic properties. From the results obtained, it can be concluded that these drinks do not comply with the quality requirements defined by the standards for foodstuffs intended for human consumption. It would be of utmost importance to make improvements to the standards, the application of sanctions and to the production of better quality drinks, in order to ensure good food security for consumers.
ORIGINAL RESEARCH ARTICLE | May 14, 2020
Comparative Evaluation of the Antimicrobial Activities of some plants used in Natural Medicine – Spondias mombin, Calliaidra portoricensiss, Dennettia tripetala, Anthocleista djalonensis and Cronton zambesicus
Oguegbulu N. E, Abo A. K, Afieroho O. E
Page no 257-262
The bioactive constituents of five Nigerian plants in use in Traditional medicine namely, Spindias mombin (family: Anacardinaceae), Calliandra portoricensis (family: Fabaceae), Dennettia tripetala (family: Annonaceae), Anthocleista djalonensis (family: Loganiaceae) and Croton zambasicus (family: Euphoirbiaceae), were investigated for antimicrobial activities. The morphological parts of the plants evaluated were the leaf and root. The dried and pulverized samples were subjected to successive extraction using organic solvents; n-hexane, ethylacetate and 70% aqueous methanol. The respective extracts were concentrated en vacuo using a rotatory evaporator at less than 40o C. Seven human pathologically viable and clinical strains of microganisms comprising the G+ve, G-ve, fungi and nocosomial strains were used as test organisms, ciprofloxacin and fluconazole solutions served as the control reference standards. Agar well diffusion assay method was used and the Inhibition Zones of growth were measured to assess activities for all the extracts. The Minimum Inhibitory Concenyrations (MIC) and Total Activity (TA) were also determined. C. zambasicus exhibited a broad antibacterial activity whereas C. portoricensis showed the best spectrum of both antibacterial and antifungal activities. The extract of D. tripetala ranked lowest in activity of all the test samples. Ethyl acetate extracts ranked the highest of all the three organic solvents used for the study.
ORIGINAL RESEARCH ARTICLE | May 17, 2020
Application of Bethesda Reporting System of Thyroid Cytology and Its Clinical Significance
Dr. Pooja Shrivastava, Dr. Farah Jalaly Meenai
Page no 263-270
Final diagnosis of thyroid lesions requires morphological examination for which FNAC and histopathological examination become mandatory tests. In our study preoperative FNAC on 100 patients and along these histopathology reports of 22 patients were correlated and conclusions drawn after statistical analysis. Results: Diagnostic categorization of FNACs based on Bethesda classification showed that of the benign lesions (category 2), 45were Nodular colloid, 13Hashimoto thyroiditis, 13multinodular goitre, 3Primary hyperplasia and 2Hyperplastic nodule 1was of de-quervans thyroiditis, 1was of adenomatous goitre. Of the12 malignant lesions (category 6), 7were papillary carcinoma, 2anaplastic carcinoma, 1medullary carcinoma, 2 metastatic carcinoma on FNAC, 8 were suspicious for follicular neoplasm (category 4) and 1 was of follicular lesion of undetermined significance on FNAC (category 3). Among 100 cases, 22 were biopsied and subjected to histopathology. 11cases were benign. Out of these, 2 were of colloid goitre, 3follicular adenoma, 3multinodular goitre 2 was of hasimoto’s, 1 was of thyroglossal cyst. 11 cases were malignant, Out of these, 6 were papillary carcinoma, 3 were Follicular carcinoma and 1 medullary carcinoma 1 case of noninvasive follicular thyroid neoplasm with papillary like nuclear features. Out of 22 cases examined hitopathologically findings were similar to FNAC in 21 cases and findings differed in 1 case. The sensitivity & specificity for FNAC of thyroid neoplasm in present study were 82.6, 95.2%, respectively. Conclusions: FNAC is simple, safe & cost effective modality in investigation of thyroid swellings with high accuracy. The bethesda system of reporting has high concordance with the histopathological findings.
CASE REPORT | May 19, 2020
Maxillary Antrum Lipoma: A Rare Case Report
Dr. Sunita Singh, Dr. Bharti Sharma, Dr. Ritesh Kumar Sheorain, Dr. Tripti Jain, Dr. Pooja Dhamija, Dr. Rajeev Sen
Page no 271-272
Adipose tissue and lipomas are very rare in the paranasal sinuses. Here we report a case of 14 years old male presenting with history of nasal obstruction, excessive sneezing and mouth breathing who was eventually diagnosed as maxillary antrum lipoma. It is a very rare finding and very few cases have been reported till date.
CASE REPORT | May 21, 2020
Cytological Diagnosis of Cylindroma Scalp- A Rare Case Report
Dr. Sabina Khan, Dr. Sayika Hameed, Dr. Nehal Ahmad, Dr. Rubeena Mohroo, Dr. Mohd. Jaseem Hassan, Prof. Sujata Jetley
Page no 273-275
Cylindromas are rare slow growing benign skin appendageal tumors with eccrine and apocrine differentiation. Multiple cylindromas are commonly genetically inherited and also known as “turban tumor.” Here, we have discussed a case of scalp swelling in a male patient having lung cancer, which was clinically suspicious of metastasis. However, cytology revealed many clusters of small round to oval basaloid cells surrounded and attached with magenta coloured acellular hyaline material. The cells had very scanty cytoplasm and dark, round to oval hyperchromatic nuclei without any nuclear membrane irregularity. Cytologic diagnosis of cylindroma was rendered which was subsequently confirmed on histopathology. Cytology of cylindroma should be differentiated from adenoid cystic carcinoma and other benign adnexal tumors like spiradenoma. We wish to report this case as cytology of dermal cylindroma has rarely been dicussed previously in literature and to highlight its cytomorphologic features along with the differential diagnosis.
ORIGINAL RESEARCH ARTICLE | May 21, 2020
Novel Insights into the Hematological Parameter Abnormalities in Pediatric COVID-19 Cases: Observation from A Preliminary Study of 11 Pediatric COVID-19 Cases in A Tertiary Care Center of North India
Dr. Neema Tiwari, Dr. Devajit Nath, Dr. Jyotsna Madan, Prashant Bajpai, Dr. Ujjwal Madan, Dr. Savitri Singh
Page no 276-284
Introduction: The Corona Virus Disease 2019, caused by novel Coronavirus SARS-CoV-2 is an acute respiratory and systemic illness, and is declared as a global pandemic by WHO on the 11th of March 2020.Only 2.2% to 1.7% of pediatric COVID-19 cases have been reported from USA and China respectively. The hematological parameter alteration in the pediatric COVID-19 cases needs to be addressed in the Indian population. Aim: To assess the alteration of the baseline hematology parameters in the paediatric COVID-19 cases and to compare the values with the adult COVID-19 cases for any statistically significant difference. Methods: A single Centre retrospective study of 11 COVID-19 asymptomatic pediatric patients and asymptomatic gender-matched adult cases admitted to SSPH&PGTI NOIDA from March to April, were enrolled for the study. The demographic date, baseline hematological findings of both groups were recorded and analyzed statistically. Results: Demographic characterization shows a mean age of 8.7 years in the pediatric population. Baseline CBC findings of all the pediatric cases show mild anemia, normal leucocyte, normal absolute lymphocyte count, and neutrophilia.- Majority of the pediatric cases have NLR value below the cut-off point of 3.13.- PLR was slightly higher in pediatric cases. Comparison between two groups shows statistically significant differences for the hemoglobin and platelet value only. Conclusion: The comparative analysis of baseline hematologic parameters did not show any significant derangement of the CBC parameters in pediatric cases. Significance in the difference of Hemoglobin level and platelet count is observed in comparison to the adult cases.
ORIGINAL RESEARCH ARTICLE | May 21, 2020
A Study on Non Neoplastic Lesions of Skin and its Morphological Spectrum; In a Tertiary Care Hospital
Dr. Majety Dora Venkata Ramnath, Dr. Siva Ranjan D
Page no 285-289
Background: In India more than 50% of general hospital skin out-patient attendance consists of infections which are acute and usually recurrent like Scabies, Pyodermas, Superficial fungal infections, Parasitic and viral infections, Eczemas, Acne, Vitiligo, Pigmentary changes, Psoriasis, Lichen planus, Leprosy etc. The present study was therefore designed with the aim of studying the histopathological features of various skin diseases. So that, the clinicians can manages the case efficiently. Aims & Objectives: To find the clinicopathological correlation and to study the histopathological features of Non-neoplastic skin lesions. Materials & Methods: A total of 93 skin biopsies either Punch or Incision biopsies which were received in the department of histopathology were stained with Hematoxylin& Eosin, and studied microscopically. Results: Out of 93 cases, only 20 (21.5%) cases are not similar in clinical diagnosis and histopathological diagnosis but remaining 73 (78.5%) cases has similar diagnosis both clinicopathologically. Conclusion: histopathological study and comparing the clinical diagnosis serves as a very valuable diagnostic tool to understand and explain the pathology of various skin lesions.
REVIEW ARTICLE | May 23, 2020
Histopathology and Cytopathology in the Era of COVID-19 Pandemic
Samina A Khanday, Ruby Reshi, Neelofer Gul, Majid Mushtaque
Page no 290-293
COVID-19 (Coronavirus disease 2019) is a highly contagious infectious disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) in humans. It primarily spreads from person to person through respiratory droplets or by aerosols and less commonly by contact with infected surfaces or fomites. Pathologists and their technical staff can become exposed to potentially infectious patients and specimen. The current article provides a brief description of the current knowledge of the disease and the measures to be taken by the concerned health care workers to minimise their risk of contracting the virus during the ongoing pandemic.
ORIGINAL RESEARCH ARTICLE | May 30, 2020
Clinicopathologic Analysis of 90 Fibro-Osseous Jaw Lesions: A Single Institutional Experience
Adeola Ladeji, Oluwafemi Adesina, Adetayo Aborisade, Mofoluwaso Olajide, Olasunkanmi Kuye, Olalekan Aderemi, Kehinde Adebiyi, Ikechukwu Okoye, Busuyi Olowe
Page no 297-303
Background: Fibro-osseous jaw lesions are a group of tumours and proliferative disorders which present similar clinicopathological features. They comprise a range of developmental, reactive and neoplastic lesions characterized by replacement of normal bone by fibrous tissue, with subsequent formation of new mineralized tissue. Making diagnosis of fibro-osseus lesions may be challenging for clinicians and pathologists alike, owing to their overlapping clinicopathology. Objectives: This study aims to determine the pattern and clinicopathological distribution of fibro-osseous lesions of the jaws over a 7-year period. Methodology: This study retrospectively reviewed 90 fibro-osseous lesions diagnosed at the Oral Pathology laboratory of the department of Oral Pathology and Oral Medicine, Lagos State University College of Medicine, over a period of seven years (January 2013 to January 2019). Information regarding the type, frequency, age, sex and site distribution of FOLs were retrieved from the archival records of the Oral Pathology laboratory. Result: Fibro-osseous lesions (FOLs) of the jaws constituted 8.94% of all biopsies seen within the 7-year study period. Ossifying fibromas were the commonest FOL types accounting for 63.3% of all FOLs, followed by fibrous dysplasias at 20%. Lesions were observed within the age range of 9-72 years with an overall mean age of 31.9±15.5 years for all FOLs, 38.5±1.5 for Ossifying fibroma and 13.3±2.5 years for fibrous dysplasia. Female predilection for FOLs was recorded at a Male: Female ratio of 1:2.2. Mandible was the observed site of predilection for Ossifying fibroma, while the reverse was observed for Fibrous dysplasia. Conclusion: FOLs are relatively common jaw lesions, with ossifying fibromas occurring more frequently than others. Making an accurate diagnosis of FOLs in resource limited settings is greatly dependent on the availability of detailed clinical information, owing to their similar histopathologic appearances.
ORIGINAL RESEARCH ARTICLE | May 30, 2020
Prevalence of Dermatophyte Infections in a Tertiary Care Medical College in Eastern India
Mallika Sengupta, Tamasi Mukherjee, Rajat Dasgupta, Parthajit Banerjee
Page no 304-307
Background: Superficial mycoses are the fungal infections of skin, nail, and hair. Superficial mycosis is most prevalent in tropical and subtropical countries. The clinical lesions caused by the fungi are highly variable and closely resemble other skin diseases. Therefore, it is necessary to make a definite laboratory diagnosis of superficial skin infections. Dermatophytes are hyaline septate moulds which include the genera Epidermophyton, Microsporum, and Trichophyton that cause superficial mycoses. Materials and methods: The study was conducted for a period of one year (January to December 2019) in a tertiary care hospital in Eastern India. The skin, hair and nail samples were collected from patients with suspected dermatophyte infections. The samples were examined by KOH preparation and cultured on Saboraud’s dextrose agar (SDA) and cornmeal agar. The species identification was done by LPCB preparation and other tests. Results: A total of 68 samples were obtained of which 56 were skin scraping, 10 nail clipping and 2 hair samples. 60 (88.23%) were positive by KOH preparation where as 42 (61.76%) showed growth on SDA. The most common species was T.rubrum followed by T.mentagrophytes. There was a male preponderance and dermatophytic infections were most common among farmers. Conclusion: The most common dermatophyte infection was tinea corporis and T.rubrum was the commonest isolated organism. In the modern era of molecular diagnosis of infectious agents culture and microscopy still play an important role in the diagnosis of superficial mycoses.
CASE REPORT | May 30, 2020
COVID 19 and Pancytopenia: A Single Case Experience of a Pediatrics Institute
Neema Tiwari, Nita Radha Krishnan, Savitri Singh, Jyotsna Madan, Devajit Nath, Sangeeta Tripathi, Ravi Shankar, Umesh Shukla
Page no 308-310
Introduction: Covid 19 was declared as a pandemic by WHO in December 2019. Since then the whole world has been battling this crisis with large number of deaths worldwide. India reported its first case in March 2020 in Kerala . Experimental research findings indicate that an exaggerated immune response and a strong cytokine storm, which may include high levels of granulocyte-macrophage colony-stimulating factor and interleukin-6 (IL-6), are activated in severe COVID-19 [3, 4]. This can lead to a clinical presentation of pancytopenia and HLH like features. Case: A 15-year-old female presented with fever and breathing difficulties to the emergency. She had tachypnoea and tachycardia but no organomegaly, lymphadenopathy or any other relevant examination findings. Routine lab investigations revealed pancytopenia. And day 1 peripheral smear showed virocytes. She was evaluated for COVID-19 and came out to be positive. On treatment her symptoms subsided but pancytopenia persisted. Hence a repeat peripheral smear examination and done on day 10 post admission which showed 8% blasts. BMA/BMB was advised with serum ferritin levels. Result: A diagnosis of acute leukemia was made on imprint smears as bone marrow aspiration was haemodiluted and paucicellular. Biopsy showed presence of sheets of histiocytes with hemophagocytosis admixed with blasts. A final diagnosis of Acute leukemia with Hemophagocytosis was made and serum ferritin advised to rule out HLH. Conclusion: The case turned out to an ALL with HLH. Hence, we realised that the cytokine storm in COVID -19 can at times mask the underlying major etiology and patient might just present with HLH. We conclude it is very important to analyse each case of Covid with great alacrity