Screening for non-communicable diseases

Background: This study was conducted to enumerate the results of screening for non-communicable diseases in the NCD clinic over a period of one year in a tertiary health centre.Methods: The results from screening tests conducted in the NCD clinic, for detecting hypertension, diabetes mellitus, breast cancer and cervical cancer, in Government tertiary care Hospital for Women, Chennai, were recorded. The flowchart and screening methods followed were those recommended by the NHM - NPCDCS. Data thus obtained was analyzed using standard statistical methods.Results: Of 42,519 women screened for common non communicable diseases - hypertension, diabetes mellitus, breast cancer and cervical cancer, nearly 5.55% women (n = 2359) had positive results, for any one of the diseases screened. Of 11,708 women screened for diabetes mellitus and 13,971 screened for hypertension, positive results were found in 856 women and 1,216 women respectively. Around 7,568 women were screened for cervical cancer and 175 women tested positive. A large number of 9,272 women were screened for breast cancer and 112 women had positive results. As per the guidelines, women who tested positive for screening tests were referred to the concerned departments in RGGGH.Conclusions: Nearly 42,519 women were screened for common non-communicable diseases (NCDs) - hypertension, diabetes mellitus, breast cancer and cervical cancer, and 5.55% women had positive test results for any one of the diseases screened. The screening revealed, 8.7% of women had raised blood pressure, 7.31% had raised blood sugar levels, 1.21% women had positive screening test results for breast cancer, and 2.31% women for cervical cancer.

A comparative study of safety and efficacy of tiotropium bromide with salbutamol in moderate persistent bronchial asthma in a tertiary care hospital.

Background: The objective of this study was to compare the safety and efficacy of tiotropium bromide with salbutamol in moderate persistent cases of bronchial asthma at tertiary care hospital. Methods: This was an open label, randomized parallel group study done in Government General Hospital, Srikakulam for a period of 12 weeks. Group-1 was given tiotropium bromide metered dose inhalational therapy 18mcg once daily in 50 patients. Group-2 was given salbutamol metered dose inhalational therapy 100mcg thrice daily in 30 patients. Results: Symptomatic improvement was observed in l two groups. At end point, mean FEV1 in tiotropium bromide treatment group improved by 149.96% compared with 135.16% salbutamol treatment group. At end point, mean FVC value in tiotropium bromide treatment group improved by 145.71% compared with 122.34% in salbutamol group. Mean FEV1 / FVC also improved by 155.41% in tiotropium bromide group compared with 105.41 % in salbutamol group. Conclusion: The present study proved tiotropium provide superior safety and efficacy relative to control drug in bronchial asthma patients in both clinical assessment score and spirometrically.

Clinico-pathological profile of Hairy cell leukemia: Critical insights gained at a tertiary care cancer hospital.

Context: Hairy cell leukemia (HCL) is a rare, low grade, B-cell neoplasm with a characteristic morphologic and immunophenotypic profile. It has to be distinguished from chronic lymphoproliferative disorders because of different treatment protocol and clinical course. Aims: To evaluate clinicopathological features including immunophenotypic analysis of cases diagnosed as HCL. Materials and Methods: The present study included 28 cases diagnosed over a period of nine years (2002-2010). Clinical presentation, complete blood count, bone marrow aspirate, and flow cytometric analysis of cases were reviewed. Treatment and follow-up details (ranging from 3-90 months) were noted. Results: This study revealed 28 cases (referrals-7, indoor-21), aged 26-69 years with a median age of 47 years, with a male predominance (M:F=6:1). The presenting complaints were weakness (80%) followed by fever (56%) and abdominal pain. Physical examination revealed splenomegaly in most patients (92%) and hepatomegaly in a minority (28%). The common laboratory features were anemia in 23 cases, pancytopenia in 14 cases, while two patients had leukocytosis and three patients had normal WBC count. Dry tap was observed in 84% of the cases where hairy cells constituted 16-97% of non-erythroid nucleated cells. Tartarte resistant acid phosphate staining was positive in all the eight cases where it was done. CD5 was negative in all the cases, while CD10 was expressed in three cases (13%) and CD23 in five cases (19%). Conclusions: Though pancytopenia is common, occasional patient can present with normal blood counts or leukocytosis. Few unusual findings include presence of lymphadenopathy, absence of palpable splenomegaly, and expression of CD23 and CD10 by the leukemic cells.

Symptomatic gastroesophageal reflux amongst hospital personnel in South India.

Introduction: Prevalence of gastro-esophageal reflux (GER) disease is on the rise in South Asian countries. Though there are reports of GER prevalence amongst various ethnic populations there are fewer reports on its prevalence in different occupational groups. Materials and Methods: To study the prevalence of GER amongst hospital personnel at the tertiary referral hospital in south India. Results: Of the 1468 hospital personnel, the overall prevalence of GER was 28.5%. It was highest amongst the clerical staff (31.3%) and least among nursing students (3%). Eighty five percent of the symptomatic GER personnel were young; those below the age of 35 years had symptoms for less than 6 months while those above 55 years had symptoms for more than 6 months. Combination of reflux symptoms with ulcer or dysmotility type dyspepsia was the dominant type amongst all cadres. The nursing staff (62.5%) preferred antacids whereas the doctors (63%) preferred PPI. Conclusion: GER prevalence is not uncommon amongst the hospital personnel. It is significantly more common amongst doctors, clerical staff and housekeepers.

Parvovirus B19 presenting with persistent pancytopenia in a patient of T-ALL post induction chemotherapy diagnosed on bone marrow examination.

Manifestations of parvovirus B19 vary even in the normal host from asymptomatic or subclinical infection to a spectrum of illness with symptoms during viremic and immune complex mediated stage of disease. We report the morphological findings of parvovirus B19 infection (confirmed on serology) in a patient of T-acute lymphoblastic lymphoma (T-ALL) who underwent induction phase of chemotherapy (MCP 842 protocol). Persistent pancytopenia in the bone marrow aspirate with mild increase in blasts was thought to be due to failure to achieve marrow remission. However, giant pronormoblasts with prominent intranuclear inclusions confirmed on trephine biopsy led to the suspicion of parvovirus B19 infection which was later confirmed on serology. This case is presented to report the rarely seen classical morphological feature of parvovirus infection on bone marrow examination which was incidentally the first investigation to diagnose the viremic phase of the infection, indicating that a high index of suspicion needs to be kept in mind while examining bone marrows of susceptible patients.

Leukemic phase of anaplastic lymphoma kinase positive, anaplastic large cell lymphoma.

Anaplastic large cell lymphoma (ALCL) is a distinct type of CD30+ T/null-cell non-Hodgkin's lymphoma that frequently involves nodal and extranodal sites. The presence of leukemic phase in ALCL is extremely rare and occurs exclusively with ALK1-positive ALCL. We describe two patients with ALK1-positive ALCL who developed a leukemic phase with rapid progression of the disease. Immunophenotypic pattern assessed on peripheral blood by flow cytometry revealed CD45, CD30, and CD25 positivity in both cases but NPM-ALK1 was expressed in only one case. Both patients developed leukemic phase as a terminal event of the disease and we share the immunophenotypic features of both cases.

Functions of cytochrome c in regulation of electron transfer and protein folding.

Cytochrome c, a "mobile electron carrier" of the mitochondrial respiratory chain, also occurs in detectable amounts in the cytosol, and can receive electrons from cytochromes present in endoplasmic reticulum and plasma membranes as well as from superoxide and ascorbate. The pigment was found to dissociate from mitochondrial membranes in liver and kidney when rats were subjected to heat exposure and starvation, respectively. Treating cytochrome c with hydroxylamine gives a partially deaminated product with altered redox properties; decreased stimulation of respiration by deficient mitochondria, increased reduction by superoxide, and complete loss of reducibility by plasma membranes. Mitochondria isolated from brown adipose tissue of cold-exposed rats are found to be sub-saturated with cytochrome c. The ability of cytochrome c to reactivate reduced ribonuclease is now reinterpreted as a molecular chaperone role for the hemoprotein.