articleEarly diagnosis of neonatal sepsis in primary health care unit.

Aim: The aim of the study is to find out the role of common haematological parameters along with micro-ESR, I/T ratio in diagnosis of neonatal sepsis for initiating early management. Methods: This is a descriptive study consisting of 35 neonates admitted at a sophisticated institute with clinical suspicion of septicaemia along with 40 neonates as the comparison group. The neonatal haematological parameters including total leucocytes count, absolute neutrophil count, immature neutrophil count, I/T ratio, platelet count were measured in all the neonates. Micro-ESR was measured as a bed side test. CRP was also measured using slide agglutination method and the results were compared with turbidimetric method. Blood culture was done as a gold standard test for sepsis. Micro-ESR more than age of the patient in days +3 mm in 1st hour was considered significant for sepsis. I/T ratio more than or equal to 0.2 was considered positive for sepsis. Results: The study revealed that micro-ESR and I/T ratio were significantly higher (p<0.001) in suspected cases of septicaemia as compared to the neonates in the comparison group. Sensitivity and specificity of micro-ESR were 87.09% and 75.0% respectively. Sensitivity and specificity of I/T ratio were 93.54% and 95% respectively. Conclusion: Micro-ESR and I/T ratio can be used effectively as cheap and simple tests to screen for septicaemia in neonate which is possible even in a primary health care centre.

Primary Tubercular ulcer in Glans Penis mimicking neoplastic lesion.

Tuberculosis is a very common disease especially in developing countries but primary tuberculosis of penis is extremely rare. Here we are presenting a case of Primary tuberculosis of glans penis of 82 years male.

An Over-View of Tuberculosis of Female Genital Tract With Reference To Experience in a Medical College in Rural Set-Up in West Bengal: A Retrospective.

Aim: To determine frequency of female genital tract (FGT) tuberculosis (TB) in the gynecological biopsies received in the Department of pathology of a peripheral medical college. Methods: This is a retrospective study conducted in the Department of Pathology of Burdwan Medical College & Hospital. Histopathological records of two year (2008-2010) were retrieved and searched for the cases of female genital tract TB. Relevant histopathological findings and clinical data were recorded and analyzed. Results: There were 1537 cases of gynecological biopsy and 9 cases were diagnosed as FGT tuberculosis based on histopathological and clinical findings. Ovarian benign cystic teratoma was seen in one case along with ipsilateral tuberculous salpingitis, one case showed B/L ovarian tuberculosis with involvement of both the tubes. Bilateral fallopian tubes were involved in 2 cases and endometrial tuberculosis was diagnosed in 5 cases with 1 case showing simultaneous involvement of the cervix. In one case omental biopsy received along with tubal specimen showed tuberculous granulomas. Conclusion: FGT tuberculosis was usually seen in age 16-28 years and constituted 0.59% of total gynecological cases. Fallopian tubes, ovaries and endometrium and cervix were affected with the involvement of peritoneum or omentum, commonest being tuberculous endometritis. Histopathology, in association with clinical findings still remains gold standard for the diagnosis of FGT tuberculosis in our country despite advancement in diagnostic modalities; however, incidental histological detection in clinically unanticipated cases is not an uncommon event.

C - reactive protein levels in women with pregnancy induced hypertension.

Objective: The main objective of this study is to determine the level of C- reactive protein in pregnancy induced hypertension (PIH) along its relation with normal pregnant mothers and also to compare it with different grades of pregnancy. C-reactive protein and inflammation are interrelated. Another objective of this study is to find out the relationship of C- reactive protein, biochemical and hematological parameter in PIH as well as its clinical correlation. Materials and Methods: The study was conducted in the department of Gynaecology and department of Pathology in Burdwan Medical College West Bengal India after taking permission from ethical committee. 50 cases of PIH mothers and age and gestational matched 50 cases of normal control pregnant mothers and 50 normal healthy non pregnant adult women were included in this present study. CRP was estimated by turbidometric method. Serum Uric acid, SGPT, Serum Creatinine were estimated by semi auto analyzer, Serum ß HCG was estimated by ELISA technique. The total leukocytes count, absolute Neutrophils count, Platelet counts were done in hematological cell counter with correlation from peripheral direct smear and manual counting. Urine protein was detected by dipstick method. Results: Serum C- reactive protein was positively correlated with severity of in PIH. Results shows a significantly increased C-reactive protein in PIH (Mean SD 42.02 mg/L±18 .01 mg/L, P<0.001) in comparison to normal control mother (Mean SD 4.2 ±0.93 mg/L). Conclusion: Serum C-reactive protein levels can be used as marker for early diagnosis and intervention of PIH and can be reduced maternal as well as fetal morbidity and mortality.

Bilateral tubercular abscess of breast in axillary tail in a 21 year old puerperal lady.

Tuberculosis is a very common disease in the Indian subcontinent. Though it can affect any system of the body, primary involvement of the breast is relatively rare even in India. Involvement of the axillary tail is even rarer. Bilateral involvement is also a rare phenomenon (3%). Moreover the disease is often overlooked and misdiagnosed as carcinoma or pyogenic abscess. Here we report a case of bilateral tubercular abscess of breast in the axillary tail in a 21 year old puerperal lady diagnosed by FNAC and AFB stains and further confirmed retrospectively by response to anti-tubercular drugs.

Pattern of renal pathology in fatal envenomation by indian cobra (naja naja).

Deaths due to poisonous snakebite are a significant health related problem especially the rural heartland of in tropical countries. Renal involvement in snakebite is well documented especially so in bites by the Viperidae group. The Elapidae family consisting of cobra and kraits among other varieties are mainly considered neurotoxic. The venom of neurotoxic variety predominantly has direct depressing action on the respiratory center and neuromuscular junction. We investigated the renal changes at autopsy and histology of fatal cobra bites. This series included autopsy examination of 14 cases of fatal cobra bite in our hospital-based study. Dissected kidneys were sectioned, stained with hematoxylin & eosin stain and histological examination was done under light microscope. Five cases from head injury subject were used as control. The study reveals renal involvement in 64.28 %of fatal bites by Indian cobra (Naja naja) primarily considered neurotoxic. The major renal changes were tubular necrosis 1(7.14%), cortical necrosis 3 (21.42%) and interstitial nephritis 3(21.42%). This fact is worth giving due consideration during management and monitoring of cases of envenomation by cobra.

Prognostic information of gastric carcinoma using Goseki system in relation to nuclear organizer region (AgNOR) and proliferating cell nuclear antigen (PCNA) expression.

Objective: The present study was undertaken to find out the relationship of Goseki grading system (I-IV) with existing classification of WHO, Lauren and tumour differentiation of gastric carcinoma and its prognostic information in relation to AgNOR & PCNA expression. Materials and methods: To assess the reproducibility and usefulness of Goseki grading system thirty five gastric carcinoma were selected from January 2007 to July 2009 in the department of Pathology, Burdwan Medical College in West Bengal, India and analyzed in relation to existing grading system by chi-squared testing. Mean AgNOR count & mean PCNA leveling index quantities of different tissue sections were assessed according to different classification system of gastric carcinoma and interobserver variations of all data were evaluated from Spearman Rank-order Correlation Coefficient (rs ). Results: Highly significant predictable correlation of Goseki grading system for existing classification of gastric carcinoma was obtained statistically. Increasing values of mean AgNOR count and PCNA leveling index (2.35% & 15.14%, 2.91% & 21.32%, 3.08 %& 24.76% and 3.2% & 25.12 respectively) were observed from Grade I – IV of Goseki grade. Mucin rich (3.05% & 23.22%) and tubule poor (3.14% & 24.76%) tumours higher values than mucin poor (2.71% & 19.95%) and tubule rich (2.63% & 18.23%) tumors. No significant correlations were observed in other grading system. Conclusion: Following Goseki grading system increasing expression of proliferating marker in mucin rich than mucin poor tumours and tubules poor than tubules rich tumors indicate poor prognosis and tumour behavior. Simple system may help to select patients for adjuvant therapy.

Immunogenicity and safety of live attenuated hepatitis A vaccine: a multicentric study.

OBJECTIVE: To evaluate immunogenicity and tolerability of single dose live attenuated injectable hepatitis A vaccine in four metropolitan cities of India. METHODS: Live attenuated hepatitis A vaccine was administered to 505 children aged 18 to 60 months in four centers across India. Immunogenicity of the vaccine was assessed by estimation of anti-HAV antibody titer at 6 weeks and 6 months following administration of the vaccine. Safety evaluation of the vaccine was also done during the visits. RESULTS: At 6 weeks, 480 subjects (95%) came for the follow-up and 411 (81.4%) subjects reported at the end of 6 months. The geometric mean titer (GMT) of anti-HAV antibody of the subjects who did not have the seroprotective titer at the baseline were assessed at 6 weeks and 6 months which was 81.04 mIU/ml and 150.66 mIU/ml respectively. At 6 weeks, 95.1 % seroconverted and at the end of 6 months, 97.9 % had seroconverted. Both solicited and unsolicited vaccine-induced local and systemic adverse events were insignificant at all the centers, except swelling and induration in a few. CONCLUSION: Live attenuated injectable hepatitis A vaccine was immunogenic and tolerable with minimal reactogenecity, in this study of single dose schedule. Safety profile was also satisfactory in the study population.

Oxygen uptake in relation to group size in the juveniles of a climbing perch, Anabas testudineus (Bloch).

The present work reports oxygen uptake in relation to group size in the juveniles (body weight: 0.70 to 1.30 g) of a climbing perch, Anabas testudineus (Bloch). The experiments were conducted at 21.5 +/- 1.0 degrees C using a cylindrical glass respirometer having continuous water flow system. With an increase in the number of fish at an interval of 5 from 5 to 40 in each fourth subsequent experiment, the weight specific aquatic oxygen uptake of a fish decreased from 0.192 +/- 0.030 to 0.800 +/- 0.006 ml O2 x g(-1)x(h(-1). When compared with a controlled fish, there was a reduction of 27.80% in the oxygen uptake in a group of 5 but 58.39% in a group of 40. A negative and significant correlation (r = 0.8411, p < 0.01) was calculated between oxygen uptake and group size of fishes. The investigation showed that probably due to shoaling behaviour, the aquatic oxygen uptake in the juveniles of A. testudineus always remained high in controlled fish or a fish in isolation than when they were in a group.

Experience with telepathology at a tertiary cancer centre and a rural cancer hospital.

BACKGROUND: Telepathology allows quick and timely access to an expert opinion, no matter where the patient is located. We analysed the experience with the use of telepathology between a tertiary cancer centre and a rural cancer hospital. METHODS: Ninety-three cases were analysed in which static telepathology was used to obtain a consultation between Tata Memorial Centre and Nargis Dutt Memorial Cancer Hospital at Barshi, a rural area. RESULTS: Successful teleconsultation was achieved in all cases. A diagnosis was offered in 92 cases (98.9%) and was deferred in 1 case (1.1%). Complete concordance, clinically unimportant minor discrepancy and hedged diagnosis were obtained in 83 cases (90.2%). Major discrepancies were encountered in 9 cases (9.7%). The number of images per case ranged from 3 to 27 (average: 7 images). Images were of diagnosable quality in 89.2% of cases. Most of the cases (77.4%) were reported within 3 days; 32.2% were reported within 8 hours (a single working day) and 45.1% within 1-3 days. CONCLUSION: Telemedicine can be effectively used to bridge the gap between medically underprivileged, geographically distant rural areas and advanced centres using the static store and forward methodology.

Platelet auto-antibodies in septicaemic patients.

Thrombocytopenia associated with acute Septicaemia has been reported which may be due to Disseminated Intravasscular Coagulation (DIC), but has also been reported even without any evidence of it. An immunological cause has been suggested to explain this observation. The present study involved the investigation of 50 patients with clinical and bacteriological evidence of Septicaemia. By Direct Platelet Suspension Immunofluorescence Test (PSIFT) antiplatelet antibodies were detected in 54% patients with septicaemia and 67.5% with those having thrombocytopenia. The septicaemic patients were treated with antibiotics (mean 14 days). After successful treatment, i.e., when there was no bacteriological evidence of septicaemia, there was in increase in the platelet count (> 150 x 10(9)/L) with a corresponding fall in "PSIFT" positivity in 17 cases (P < 0.001). Hence an immunological process is considered to play a significant role in the pathogenesis of thrombocytopenia in these patients with septicaemia.

Argyrophilic nucleolar organiser regions (AgNORs) in breast lesions.

Nucleolar organiser regions (NORs) demonstrated by argyrophilia of NOR-proteins are indicator of cellular proliferative activity. The NORs can be identified in the nuclei as brown or black dots with silver colloidal staining technique in formalin fixed paraffin sections and in cytology smears. Seventy-five cases including 45 tissue sections and 30 fine needle aspiration cytology (FNAC) smears of benign and malignant lesions of breast have been studied to evaluate the significance and practical application of AgNOR count per nucleus. Out of 45 tissue sections 15 belonged to fibrocystic disease, 10 fibro-adenomas and 20 carcinomas and of the 30 FNAC smears, 10 were fibrocystic disease, 8 fibro-adenomas and 12 carcinomas. In fibrocystic disease the mean AgNOR count was 1.60 (FNAC group-0.75, tissue section-1.61). In fibro-adenomas it was 1.61 (FNAC-1.63, tissue section-1.59). The mean count in carcinoma was 12.10 (FNAC-12.08, tissue section-12.10). The difference in AgNOR count in fibrocystic disease and fibro-adenoma was not significant, but that between benign breast lesion and carcinoma was significant. No difference was observed between FNAC and tissue section groups in benign or malignant lesions. The simple staining technique can be used as an additional criterion to differentiate the benign and malignant lesions of breast.

Profile and characteristics of animals bites in India.

Animal bites and so also the incidence of rabies in India are on rise. There are regional differences in the animal responsible for the bite. Different practices including use of traditional remedies are prevalent for wound treatment. In India this report analyses the profile and characteristics of animal bites in 869 patients from various regions. Apart from dog and cat, other animals such as cow, monkey, horse, pigs, camel were responsible for bite and could be possible vectors in transmission of rabies. Traditional remedies such as application of chilly paste is still practiced in state of Rajasthan.