Pathological Study of Maternal Deaths - Experience from a Tertiary Care Centre in Central India

Introduction: Maternal death (MD) is defined as deathof a woman occurring while pregnant or within 42 days oftermination of pregnancy irrespective of the duration or itsmanagement. Accidental or incidental causes are not included.Maternal mortality rate (MMR) of the region indicates thequality of maternal health care, availability of health carefacilities and overall socio-economical status of the populationin general. It is essential to know the exact cause responsiblefor maternal death which is possible by detailed autopsy andcareful pathological study under expert guidance.Material and Methods: Autopsy study was performed in100 consecutive cases of maternal deaths, over a period of22 months. Detailed gross and microscopic examination ofthe visceral organs that included uterus, placenta was carriedout in all cases of maternal deaths. Analysis of pathologicalfindings was done in the light of available clinical data.Results: Out of the 100 cases of maternal deaths 87%belonged to age group of 21 to 30 years. There were 52%deaths in antenatal period. Direct causes were responsible formaternal deaths in 52% cases, indirect causes in 43% casesand in 5% cases the causes were coincidental.Conclusion: Direct causes of MD were more frequent thanindirect causes in the present study. Haemorrhage beingthe most common direct cause of MD. Lesser accessibilityto health care facilities at peripheral health centres for theprospective mothers is highlighted by the present study.

Assessment of Awareness towards Pap Smear among Nursing Staff – Experience at A Tertiary Care Hospital.

Cancer of the cervix, is second most frequent cancer among the Indian women. To bring down the burden of cancer, in addition to opportunistic cervical cytology along with Mass screening programs, it is imperative to involve nursing staff & paramedical personnel in educating the masses. This cross sectional study describes findings of a pilot screening program, undertaken among nursing staff of a tertiary care hospital. It was found that even among the educated nursing staff there is low level of awareness for usage of pap testing. Cervical cytology revealed wide variety of inflammatory lesions. With the low doctor to population, involvement of the nursing personnel for Periodical cytological screening for prevention of cervical cancer would go a long way in early detection of various cervical abnormalities and increasing awareness among them.

Tumoral Calcinosis at Unusual Site: Diagnosis on Fine Needle Aspiration Cytology.

Tumoral calcinosis (TC) is a rare benign clinical and histological entity. It presents as tumour-like periarticular deposits of calcium in hip, shoulder and elbow regions. Idiopathic tumoral calcinosis (TC) is different from the secondary calcium deposition associated with terminal renal diseases, hypervitaminosis D and milk alkali syndrome with disturbed calcium metabolism. There are no demonstrable abnormalities of calcium metabolism in Idiopathic TC. TC predominantly affects children and young adults and is rare in old age. When TC occurs in old patients, possibility of other differential diagnoses need to be considered and ruled out with the help of morphological examination of the tumorous swelling. Two cases of TC that occurred in 65 and 75 year old females respectively were initially diagnosed on the basis of fine needle aspiration cytology (FNAC) findings of the swellings and later confirmed by histopathological examination of the excised tissue. Diagnostic biopsies were avoided in these patients. Cytological study can prove to be a rapid and reliable method of preoperative morphological diagnosis of tumoral calcinosis.

Leishmaniasis in a patient with HIV co‑infection: Diagnosis on fine needle aspiration cytology.

Leishmaniasis is a vector borne parasitic disease caused by obligate intracellular protozoa Leishmania and is transmitted by the bite of sand fly. The disease typically presents in visceral, cutaneous and mucocutaneous forms and is endemic in some states of India. Cases with atypical presentation are seen when patient has co- infection with HIV. We report a case of Leishmaniasis occurring in a HIV seropositive expectant mother diagnosed initially on fine needle aspiration cytology. The patient was resident of non endemic area and had presented with isolated cervical lymphadenopathy and fever without spleenomegaly. Characteristic morphological features of Leishmania seen in the fine needle aspiration smears from the neck nodes were identified and definitive diagnosis of Leishmaniasis could be given. Cytological features were not suggestive of any other disease. Timely diagnosis of the disease facilitated proper management in our patient.

Pneumatosis cystoides intestinalis- a morphological curio or a pitfall for surgeons: report of two cases and literature review

Pneumatosis Cystoides Intestinalis (PCI) is an uncommon but well recognised clinical entity in which gas-filled cysts appear in the intestinal wall.PCI can be an incidental finding or it may be detected during radiography or laparotomy. We came across two cases of PCI with characteristic morphological features associated with perforation peritonitis in and sigmoid volvulus respectively. In both cases PCI was not suspected pre-operatively.Both patients underwent urgent surgical exploration for the abdominal emergencies and were discharged in good general condition. It is imperative that the imaging finding of PCI is carefully correlated with the findings of physical examination, clinical history, and laboratory test results to determine which patients can be managed medically by treating the underlying disease and which will require emergency surgery. This decision can be difficult because the origin of the gas is often unclear and the patient's symptoms can be volatile, presenting a major dilemma for the surgeon.

Tuberculous neuritis: A rare sequel of a common disease.

Tuberculosis (TB), a disease caused by Mycobacterium tuberculosis is an infectious disease that continues to be a significant health problem in a developing country like India. The cause of peripheral neuropathy associated with tuberculosis is controversial. Possibilities include the toxic effects of antituberculous chemotherapy (especially, rifampicin, streptomycin & ethambutol), immune mediated neuropathy, direct invasion of nerves, vasculitic neuropathy, compressive neuropathy, and meningitic reaction. This report describes an unusual fi nding of tuberculous granulomas in the peripheral nerve (Greater auricular nerve) of a patient ,who presented with a painful neck swelling. Granulomas were present in Greater auricular nerve (C2,C3) biopsy specimen associated with tuberculous peri-neuritis, but with no more specifi c indications of the mechanism of the neuropathy.