ABSTRACT
Background@#Morphological diagnosis of non-Hodgkin lymphoma (NHL) is usually based on lymph node biopsy. Bone marrow biopsy (BMB) is important for staging, and morphology alone can be challenging for subtyping. Immunohistochemistry (IHC) allows a more precise diagnosis and characterization of NHL using monoclonal antibodies. However, there is a need for a minimal panel that can provide maximum information at an affordable cost. @*Methods@#All newly diagnosed cases of B-cell NHL with bone marrow infiltration between 2017 and 2019 were included. BMB was the primary procedure for diagnosing B-cell NHL. Subtyping of lymphomas was performed by immunophenotyping using a panel of monoclonal antibodies on IHC. The primary diagnostic panel of antibodies for B-cell NHL included CD19, CD20, CD79, CD5, CD23, CD10, Kappa, and Lambda. The extended panel of antibodies for further subtyping included CD30, CD45, CD56, Cyclin D1, BCL2, and BCL6. @*Results@#All cases of B-cell NHL were classified into the chronic lymphocytic leukemia (CLL) and non-CLL groups based on morphology and primary IHC panel. In the CLL group, the most significant findings were CD5 expression, CD23 expression, dim CD79 expression, and weak surface immunoglobulin (Ig) positivity. In the non-CLL group, they were CD5 expression, positive or negative CD23 expression, strong CD79 expression, and strong surface Ig expression. An extended panel was used for further subtyping of non-CLL cases, which comprised CD10, Cyclin D1, BCL2, and BCL6. @*Conclusion@#We propose a two-tier approach for immunophenotypic analysis of newly diagnosed B-cell NHL cases with a minimum primary panel including CD5, CD23, CD79, Kappa, and Lambda for differentiation into CLLon-CLL group and Kappa and Lambda for clonality assessment. An extended panel may be used wherever required for further subtyping of non-CLL.
ABSTRACT
Providing anesthesia for cesarean section to a patient with mitral stenosis [MS] with congestive heart failure can be a big challenge. The authors present a report of a known patient of hypothyroidism, who presented with cardiac failure in 9[th] month of gestation with severe MS, significant resting pulmonary hypertension and pericardial effusion. She was successfully managed with epidural anesthesia and intrathecal fentanyl. A skillful multidisciplinary approach in the diagnosis and management can reduce the morbidity and mortality in patients of this setting
ABSTRACT
Postdural puncture headache [PDPH] in children has rarely been registered, but some recent studies indicate that children may also develop headache after lumbar puncture
We report two cases of PDPH that occurred in male children aged 6 yr [20 kg] and 10 yr [25 kg] who received subarachnoid block under sedation for herniotomy using 27 G Quincke spinal needle at L4-L5 space with 0.5% hyperbaric bupivacaine at a dose of 0.3 mg/kg
They developed typical postural headache after 24 hr and 48 hr respectively
They were successfully managed with complete bed rest, forced hydration, coffee drink twice, oral analgesics; and were discharged uneventfully
We conclude that now a days spinal anesthesia is being used in children and PDPH can occur in this population which can be treated on same lines as in adults
We believe that parents need to be informed about PDPH as there is inability of children to verbalise this pain
ABSTRACT
Pregabalin and gabapentin are compounds, which have been alleged to possess anxiolytic, analgesic, and anticonvulsant properties. Both are amino acid derivatives of gamma amino butyric acid. Pregabalin has a similar pharmacological profile to that of gabapentin. It has an amino acid substitution at third position which allows better lipid solubility and diffusion across blood brain barrier, better pharmacokinetic properties and fewer drug interactions due to absence of hepatic metabolism. We hypothesized that premedication with oral pregabalin and gabapentin would produce dose-related reductions in acute [state] anxiety and increase in sedation [sleepiness] before induction of general anaesthesia. 90 women were randomly assigned to receive 300 mg pregabalin and 900 mg gabapentin and placebo 60 minutes prior to surgery. Anxiety and sedation was assessed before administration of drug and 1 hour later. A uniform anaesthetic technique was used in all groups. Parameters including sedation scores and various side effects were assessed. Demographic variables were comparable. The preinduction anxiety scores were statistically significant from the baseline values in group 1 and 11. The sedation scores were statistically significant 1 hour after the drug. There was statistically significant difference between group I and II [p=0.000], I and III [p=0.000] and II and III[p=0.015]. Analysis of sedation scores after surgery were comparable at all time intervals between group I and II. However statistically significant difference was noted between group I and III [p=0.000] and group II and III [p=0.000]. A higher percentage of patients in the pregabalin group complained of dizziness and somnolence than the gabapentin and control group. Preoperative pregabalin [300mg] and gabapentin [900mg] administration 1 hour before surgery led to significant reduction in preoperative anxiety and improves sedation without producing significant side effects
ABSTRACT
Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale [VAS] >/= 3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo