Real-time reverse transcription-polymerase chain reaction assays for identification of wild poliovirus 1 & 3.

Background & objectives: The poliovirus serotype identification and intratypic differentiation by real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay is suitable for serotype mixtures but not for intratypic mixtures of wild and vaccine poliovirus strains. This study was undertaken to develop wild poliovirus 1 and 3 (WPV1 and WPV3) specific rRT-PCR assays for use. Methods: Specific primers and probes for rRT-PCR were designed based on VP1 sequences of WPV1 and WPV3 isolated in India since 2000. The specificity of the rRT-PCR assays was evaluated using WPV1 and WPV3 of different genetic lineages, non-polio enteroviruses (NPEVs) and mixtures of wild/wild and wild/Sabin vaccine strains. The sensitivity of the assays was determined by testing serial 10-fold dilutions of wild poliovirus 1 and 3 stock suspensions of known titre. Results: No cross-reactivity with Sabin strains, intertypic wild poliovirus isolates or 27 types of NPEVs across all the four Enterovirus species was found for both the wild poliovirus 1 and 3 rRT-PCR assays. All WPV1 and WPV3 strains isolated since 2000 were successfully amplified. The rRT-PCR assays detected 104.40CCID50/ml of WPV1 and 104.00CCID50/ml of WPV3, respectively either as single isolate or mixture with Sabin vaccine strains or intertypic wild poliovirus. Interpretation & conclusions: rRT-PCR assays for WPV1 and WPV3 have been validated to detect all the genetic variations of the WPV1 and WPV3 isolated in India for the last decade. When used in combination with the current rRT-PCR assay testing was complete for confirmation of the presence of wild poliovirus in intratypic mixtures.

Serum IgG and IgA Levels in Polio and Non-polio Acute Flaccid Paralysis Cases in Western Uttar Pradesh, India.

Objective: IgG and IgA immunocompetence of children with wild poliovirus poliomyelitis and non-polio acute flaccid paralysis. Methods: 932 cases of acute flaccid paralysis, reported in 2008-2009, were tested for presence of polio and non-polio enteroviruses according to the WHO standards. Serum IgA and IgG levels were determined by sandwich ELISA. Results: Mean (SD) IgA levels [0.87 (0.62)g/L; n=28] of virologically confirmed poliomyelitis cases were lower than those of virus negative [1.21 (0.83)g/L; n=612] and non-polio Enterovirus positive [1.22 (0.79)g/L; n=240] cases of acute flaccid paralysis. No significant difference was observed in the concentration of IgG among these groups. Conclusion: IgA plays an important role in protection against poliomyelitis.

Malignant melanoma of breast: a case report.

Malignant melanoma rarely affects the breast. Malignant melanoma of breast is divided into two categories: primary and metastatic lesions. Primary melanoma involves the skin and less commonly the glandular parenchyma of the breast. Differentiating them is very important in deciding on treatment strategies. This case report aims to increase awareness of unusual neoplasms of the breast which requires a different surgical and adjuvant therapeutic approach.

Role of urine sediment cytology in the diagnosis of renal disorders in comparison with biochemical and histopathological findings.

Background: The functional reserve of the kidney being large, serum biochemical parameters do not show abnormality until late. The need to recognize minimal damage in the kidneys is hence valuable. Urine sediment examination is cost effective, time saving and is called “liquid renal biopsy”. The present study was aimed to evaluate the role of urine sediment examination in predicting the severity of renal damage and compare the results with serum biochemical parameters, 24 hour urine protein values and renal biopsy findings. Methods: A total of 149 patients presenting with symptoms pertaining to renal disease were included in the study. Clinical information and serum biochemical parameters were obtained. Urine examination was done and renal biopsy performed in all the cases. 2 scoring systems were adopted to grade the urine sediment findings and renal biopsy grading devised by A. Z. Gyory et al. was used to grade the renal injury. 24 hour urine protein was estimated by Esbach’s method. Urine sediment scores, serum biochemical parameters, 24 hour urine protein values were compared with the grades of renal injury on renal biopsies and statistical significance calculated. Results: 32.8% of patients with renal disease were in the age group of 31-40 years. Nephrotic syndrome was the most common clinical presentation (33.5%) followed by nephritic syndrome (21.4%). The most common histopathological diagnosis was post infectious glomerulonephritis (n = 26) followed by acute interstitial nephritis (n = 17). 14 cases of lupus nephritis were diagnosed all of which were confirmed by “full house” pattern of immunofluorescence. Both the urine sediment scores had high specificity and positive predictive values in predicting the severity of renal injury. 24 hour urine protein had high positive predictive value in predicting the severity of renal injury. Serum biochemical parameters were insignificant in predicting the severity of renal injury. Conclusion: Urine sediment examination can be used as an effective diagnostic test for predicting the severity of renal injury. The decision of further investigations and follow-up can be certainly decided by taking urine microscopy findings and 24 hour urine protein values into consideration.

Giant pleomorphic adenoma of parotid gland.

Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenomas are the most common benign neoplasms of the parotid gland. The vast majority are 2-6cms in size, when resected. Untreated pleomorphic adenomas can enlarge in size and weigh several kilograms. There are only few cases of giant pleomorphic adenomas reported in the literature. Here we present one of such case.

Lymphocytic thyroiditis: a correlation of cytological grades with clinical, biochemical and ultrasound findings.

Background: Hashimoto’s thyroiditis sometimes referred to as goitrous thyroiditis is a synonym of chronic lymphocytic thyroiditis or autoimmune thyroiditis. Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis) is one of the most common cause of goiter and hypothyroidism, it is found most commonly in middle aged and young female, but can also occur in other age groups, including children. Chronic lymphocytic thyroiditis can be graded based on cytomorphology. In this study an attempt has been made to correlate the grades with clinical findings, biochemical levels and ultrasonography findings. Methods: This is a prospective study conducted on 309 patients in the Department of Pathology, Andhra Medical College, Visakhapatnam. The various parameters like patient’s clinical presentation, biochemical levels and thyroid ultrasound were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. Chi-square tests were used for statistical correlation and p value of <0.05 was considered significant. Results: Most of the patients were females (297, 96.11%) who commonly presented with a diffuse goiter (263, 85.11%). Asymptomatic cases (193, 62.46%) and elevated TSH (194, 62.78%) were common. Most of the cases had grade I/II disease (299, 96.76%) by cytology. Conclusion: FNAC is a simple, safe and cost effective procedure and is a sensitive and specific diagnostic tool in diagnosing chronic lymphocytic thyroiditis. Cytological grading of chronic lymphocytic thyroiditis helps in assessing the severity of the disease and can predict the thyroid functional status. A combined approach of cytological grading of chronic lymphocytic thyroiditis along with ultrasonography and biochemical levels can detect subclinical hypothyroid states and provide a guide to therapy.

Giant congenital melanocytic nevus scalp: report of a rare case.

Giant congenital melanocytic nevus (garment nevus) is a kind of congenital malformation of neural crest cells with size greater than 20 cm. Malignant melanoma may develop in 2-31% of these lesions. The objective of this paper is to present a unique case of giant nevus which is rare.