Clinicopathologic Study of Tongue Lesions at a Tertiary Care Hospital

Tongue lesions constitute a considerable proportion of oral mucosal lesions. Varying pathologic conditions may affect the tongue of which chronic lesions often necessitate biopsy and histological diagnosis.Most of the studies are based on clinical presentation of tongue lesions or histopathological study of oral cavity lesions as a whole. There are limited studies on clinico-pathologic review of histologically diagnosed tongue lesions which are mostly case specific. Lesions of tongue encompass a diverse spectrum of non-neoplastic and neoplastic entities. Varying pathologic conditions may affect the tongue of which chronic lesions often necessitate biopsy. Clinico-pathological correlation with microscopic examination helps in accurate diagnosis and management of patients.METHODSThis retrospective study included 192 tongue biopsies, and was conducted over a period of one year from January 2018 to December 2018 at a tertiary ENT hospital. Data on age, gender, tobacco usage, site distribution, type of lesion and histological diagnosis was analysed. RESULTSTongue lesions were seen in 133 males and 59 females. The predominant age group affected was the 5th decade of life accounting for 40 cases (20.8%). Biopsies of ulceroproliferative type of lesions were most commonly submitted. Neoplastic lesions constituted 137 cases (71.3 %) of total cases of which well differentiated squamous cell carcinoma was the most common malignant lesion accounting for 85 cases (44.2%). Using the WHO ICD-O code for topography of lesions, the tongue lateral border (ICD-O-2.1) was the most commonly affected site in the present study.CONCLUSIONSTongue lesions are relatively common in our environment with male predilection, above 40 years age group, strong association with tobacco usage, a predominance of neoplastic lesions, predilection for the lateral border of the tongue and squamous cell carcinoma as the most common histological diagnosis. The high frequency of tongue involvement emphasizes the importance of early adequate biopsy of elementary lesion. Histological characterization can help the clinician in planning early successful management of cases.

A study of clinical and etiological profiles of patients presenting with Pancytopenia in NRI General Hospital

Introduction: Pancytopenia is characterized by a decrease in the red blood cells, white blood cells along with the platelet count below the normal levels. It can be due to a number of pathologic mechanisms, depending on the geographic location. Early diagnosis and treatment are crucial in the management of pancytopenia. There are very few studies regarding the clinic-pathological profile of such patients. Materials and methods: A cross-sectional study was undertaken at NRI General Hospital, Chinakakani. All eligible participants more than 13 years of age were included. Data collection was done from August 2016 to August 2018. A thorough history taking along with clinical examination and laboratory investigations were performed among the study population. Data was analyzed using SPSS version 13. Results: The most common finding suggestive of etiology was megaloblastic anemia at 38.4%, which was more common among females. Aplastic anemia was the second most common finding at 24.6%. Other diagnoses included hypersplenism, myelodysplastic syndrome and acute leukemia. Fever and pallor were the most common presenting symptoms. Blood examinations demonstrated anisopoikilocytosis, hypersegmented neutrophils, erythroblasts, macrocytes and reticulocytes, which were found in differing proportions in the various etiological diagnoses. Conclusion: It is noteworthy that megaloblastic anemia, a reversible condition, is common in India compared to the higher occurrence of aplastic anemia and myelodysplastic syndrome in developed Vijaya Kumar Vasa, Sadhna Sharma, Rakesh Nukasani, Srivani Gulleli, Phani Kumar Reddy. A study of clinical and etiological profiles of patients presenting with Pancytopenia in NRI General Hospital. IAIM, 2019; 6(2): 114-120. Page 115 nations. Clinical alertness and suspicion can assure early diagnoses and treatment can prevent complications and reduce the burden. The need for more standard management protocols is immediate.

A study of clinical and histopathological correlation of lichen planus

Introduction: Lichenoid tissue reaction or interface dermatitis embraces several clinical conditions, the prototype of which is lichen planus and its variants. Others include drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and other disorders all of which have salient clinical and histological features. The aim of this study was to correlate the clinical features with histopathological findings in all clinically suspected cases of lichen planus and assess the clinical diagnostic accuracy. Materials and methods: This study had been carried out over a period of 2 years from July 2015 to June 2017 in the Department of Pathology, Gandhi Hospital. Histopathological sections of skin biopsies from 85 patients were studied after routine H and E staining and morphological changes were noted. The patients’ clinical findings were then correlated with the histological changes. The results were then analysed. Results: Total numbers of biopsies inclusive of LP and LP like lesions were 85. Among them, the number of patients having LP was 50. The age ranged from 18 to 65 years (mean 37.1 years). The mean duration of the lesion was 12.02 months (approx 1 year). Males were affected more than females. Out of the 85 cases, 50 were Lichen planus and 35 were lichenoid eruptions. Of the Lichen planus, 31 (61.6%) cases were of classical lichen planus, 6 (13.3%) cases were of hypertrophic lichen planus, 4 (8.3%) cases were of lichen planus pigmentosus, 4 (6.6%) cases were of actinic lichen planus, 3 (5%) cases were of eruptive lichen planus, 1 (1.6%) case each of atrophic lichen planus, annular lichen planus. N. Srivani, B.V.N. Sravani, Shyamala Srujana, O. Shravan Kumar. A study of clinical and histopathological correlation of lichen planus. IAIM, 2017; 4(9): 136-144. Page 137 Conclusion: In the present study, maximum number of cases occurred in age group of 18-28 years. Though pruritis is a common symptom, it is nonspecific. Therefore, histopathology remains the most important diagnostic tool for proper evaluation of Lichenoid eruptions/ Lichen planus.

A comparative assessment of thyroid hormones and lipid profile among hypothyroid patients: A hospital based case control study

Background: In India, thyroid disorders are the most common among all the endocrine disorders and hypothyroidism being more common than hyperthyroid state and carcinoma. Bandi A, Pyadala N, Srivani N, Borugadda R, Maity SN, Ravi Kumar BN, Polavarapu R. A comparative assessment of thyroid hormones and lipid profile among hypothyroid patients: A hospital based case control study. IAIM, 2016; 3(9): 108- 114. Page 109 Objectives: The present study was undertaken to assess the association of dyslipidemia in hypothyroid patients. Materials and methods: A total of 50 study subjects of both gender groups were selected from the medicine ward of Maheshwara Hospital during the period from January 2016 to April 2016. Fasting venous blood sample were analysed for Thyroid hormones like, T3, T4, TSH and lipid profile. Statistical analysis was done using student unpaired t test. Result: The thyroid stimulating hormone (TSH) and total cholesterol, LDL, VLDL values were significantly higher, whereas T3, T4 and HDL values were in a decreasing order with that of control group. Conclusion: The present study concludes that hypothyroidism is associated with dyslipidemia having raise in all lipid parameters, which may increase the risk of cardiovascular diseases. Finally regular assessment of thyroid hormones and lipid profile among hypothyroid patients can prevent progression of the disease to severity

Study of expression of P53 in Gastric Carcinoma As a prognostic indicator

Cancer of stomach remains the major cause of mortality worldwide despite a marked decline in the incidence of gastric carcinoma in the industrialized nations. Gastric cancer is the end result of multifactorial, multigenetic, multistep process. The knowledge of the factors that influence gastric carcinogenesis is determinant for the development of strategies effective for prevention and treatment. Our study emphasizes upon the role of p53 as a prognostic indicator of gastric carcinoma. 50 cases of gastric biopsies were taken at random over a period of 4 years, and p53 expression of these lesions was studied. Gastric carcinoma cases were followed and the TNM staging was assessed. In our study, p53 expression was associated with younger age group, increased depth of invasion and lymph node metastasis, thereby indicating that p53 is a prognostic indicator for gastric carcinoma.

Application and correlation of hematological scoring system and serum prolactin levels in early diagnosis of neonatal sepsis 3 year study

Neonatal septicemia is defined as a bacterial infection documented by a positive blood culture in the first 4 weeks of life. The clinical symptoms and signs are non specific and vague. So it is important to make diagnosis and to start treatment as early as possible to prevent serious morbidity and mortality caused by non-treatment or late treatment of septicemia. This study was conducted for a period of 3 years. 200 neonates under the age of 28 days were studied to find out hematological parameters including sepsis screen, hematological scoring system and serum procalcitonin levels in neonates suspicious of sepsis. We concluded that, though blood culture is a gold standard for the diagnosis of sepsis, combined use of sepsis markers increases the diagnostic accuracy in suspected cases and simultaneously prevents over treatment of clinically suspicious cases.

Incidence of fungal etiology in patients with nasal polyps

Background: Sildenafil causes vasodilatation by relaxing the smooth muscles of blood vessels. This enhances endometrial development, the health of which is indispensable for implantation and embryonic and fetal development. Aim: To assess the role of Sildenafil when used in ovulation induction cycles with Clomiphene Citrate (CC) with reference to Endometrial Thickness (ET), follicular development, Pregnancy rates and Side Effects. Materials and methods: In this prospective comparative study on 80 infertile women, we randomly divided them into two groups. In group A with 40 patients, ovulation induction with CC was given and in group B with 40 patients oral Sildenafil Citrate 25mg – BD, was added from Day 8 up to hCG trigger, in the CC induced cycle. A transvaginal ultrasound was done on Day 13 to assess follicular growth and ET. A urine β-hCG on Day 30 was done to detect pregnancy. Patients were followed up for 8 weeks to monitor miscarriages, ectopics and multi foetal gestation. Results: Mean ET at the time of hCG trigger was 9.64 in the Sildenafil group compared to 8.47 in group A without Sildenafil (p value 0.01). 65% of the patients in group B conceived with 3 cycles of ovulation induction compared to 42.5% who conceived in group A (p value 0.04). The mean of total number of follicles greater than 18 mm at hCG trigger was 1.62 and 1.91 in group A and B respectively (p – 0.09). Side Effects were significantly higher in group B with sildenafil compared to group A with CC alone (p – 0.006). L. Pranathi Reddy, Y. Madhavi, Mohammed Ismail Khan. Role of Sildenafil in ovulation induction – A comparative study of outcomes with Sildenafil in ovulation induction cycles with Clomiphene Citrate. IAIM, 2016; 3(12): 26-32. Page 27 Conclusions: As our study shows that use of Sildenafil improves ET and rates of conception, we recommend the routine use of Sildenafil in ovulation induction protocols.

Evaluation of 303 Cases of Thrombocytopenia

Thrombocytopenia is a common clinical problem with many etiological causes. Although transient bone marrow suppression and marrow infiltration by malignancies are important causes, certain non-malignant conditions such as nutritional causes and infections are equally important as the treatment is simple and cure is possible. Depending on the aetiology, the clinical presentation may vary. Knowing the exact aetiology is important for specific treatment and prognostication. A total of 303 cases of thrombocytopenia were studied out of which males were 44% and females were 56%. The patients’ age ranged from 5 months to 84 yrs. The commonest presenting symptom was fever with bleeding manifestations and jaundice. 14% of cases are of Grade 1, 20% of the cases of Grade 2, 5% of cases of Grade 3 and 31% of cases had counts less than 25000/cu.mm i.e. of Grade 4. 50% of cases in Grade 4 had a decreased number of megakaryocytes in the bone marrow. The most common cause of thrombocytopenia in our study was megaloblastic anaemia (48.6%), ITP (20%), post-viral (10.9%) followed by leukaemia, aplastic anaemia and others. Thrombocytopenia has a spectrum of causes which can be diagnosed by detailed history and peripheral smear examination supported by bone marrow examination. Megaloblastic anaemia was the commonest cause of thrombocytopenia followed by immune thrombocytopenia. Unlike in the western India megaloblastic anemia is highly prevalent and is the leading correctable cause of thrombocytopenia. Most of the patients with Grade 4 thrombocytopenia had a decreased number of megakaryocytes in the bone marrow suggesting a production defect.

Central Giant Cell Granuloma ; A Case Report.

Central giant cell granuloma ( CGCG) was classified as rarely aggressive idiopathic benign intraosseous lesion that occurs mostly exclusively in the jaws. It occurs most frequently in young women. It is usually slow growing and non neoplastic lesion which exhibits a spectrum of clinical behavior ranging from non aggressive to aggressive variants. The striking feature of this case is its aggressive nature and presence of this lesion in the anterior part of maxilla which considers being a rare finding as the lesion commonly occurs in the mandibular region anterior to first molar.

Profile of patients with intellectual disability visiting a tertiary care center in western India.

Background: Intellectual disability is commonly associated with variety of etio-pathological and co-morbid conditions influencing outcome of rehabilitative measures. Understanding of these factors helps in better management of disabled condition. Methods: A qualitative retrospective case record review, of patients with intellectual disability, visiting psychiatry department of a tertiary care hospital, within a period of one year, was conducted to assess their epidemiological and clinical profile. Results: Patients with Intellectual disability are brought to the hospital at all ages and commonly by their parents. Etiologically related various peri-natal factors (delayed birth cry and seizures being most common) as well as childhood medical conditions (epilepsy and recurrent respiratory/GI infections being most common) were commonly found in these patients. Milestones are delayed in almost 60-70% of cases whereas various physical and psychiatric conditions commonly co-existed with disability. Conclusion: Clinical profile of these patients demands a comprehensive evaluation and management apart from routine IQ assessment.

Effect of nitrogen sources on microbial production of xylitol.

Experimental investigation on batch fermentation of xylose to xylitol using Candida parapsilosis NCIM-3323 has been carried out and the effect of different nitrogen sources on xylitol production has been investigated. It is noticed that Ammonium sulfate is best suitable compared to other sources used. The present work utilized five nitrogen sources namely Potassium Nitrate, Ammonium Chloride, Ammonium Sulfate, Ammonium Nitrate and Urea in the experiments for a fermentation period of 144 h at 30 0C at pH of 3.5 with initial xylose concentration of 60 g/l. The work was also carried out varying concentration of Ammonium sulfate, wherein it was found that 4 g/l of ammonium sulfate gives highest yield.

Clinico-hematological profile of Chediak-Higashi syndrome: Experience from a tertiary care center in south India.

Introduction: Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by partial ocular and cutaneous albinism, increased susceptibility to pyogenic infections, the presence of large lysosomal-like organelles in most granule-containing cells and a bleeding tendency. The abnormal granules are most readily seen in blood and marrow leukocytes, especially granulocytes; and in melanocytes. Other clinical features include silvery hair, photophobia, horizontal and rotatory nystagmus and hepatosplenomegaly. Materials and Methods: The clinico-hematological profile of a series of 5 cases of CHS encountered at JIPMER Hospital with diagnostic work-up done in the Department of Pathology over the last 6 years is presented. The diagnostic work-up included complete hemogram with peripheral smear, bone marrow examination, skin and liver biopsies. Results: The age of the patients ranged from 5 months to 3 years. All patients had silvery hair and partial albinism and presented with fever and recurrent chest infection. Two patients were stable. Three patients were in accelerated phase; of them, 1 patient with associated hemophagocytic syndrome had a rapidly fulminant course. Peripheral blood smear showed anomalously large granules in the leukocytes. Skin biopsy showed sparse, coarse melanin pigment in the epidermis, and liver biopsy done in 2 patients with accelerated phase showed portal lymphohistiocytic aggregates. Conclusions: The diagnostic hallmark of CHS is the occurrence of giant inclusion bodies (granules) in the peripheral leukocyte and their bone marrow precursors. The case series is being presented because of the rarity of CHS and varied spectrum of clinical and hematological presentation.

EMM types of streptococcus pyogenes in Chennai.

The M protein of group A Streptococcus (GAS) is the major virulence factor and is coded by the emm gene. The current serologic M typing methods are now being replaced by alternate means of M type deduction such as emm gene sequencing. This is the first report of emm types of GAS which are prevalent in south India. We found no marked preponderance of any single emm sequence among our clinical isolates with 11 emm sequences being present in 34 isolates.