Bone marrow evaluation of patients having pancytopenia at tertiary care center, M. Y. hospital, Indore, India: one-year study

Background: Pancytopenia is reduction of all three formed elements of blood below the normal reference range leading to anemia, leucopenia, thrombocytopenia. Bone marrow aspiration is extremely helpful in evaluating the cause of pancytopenia by cellularity and cytology in order to prevent grave complications and mortality as the underlying pathology determines the management and prognosis of the patients. Aim of research study was to evaluate the patients having pancytopenia at tertiary care center, M.Y.H. Hospital, Indore, India.Methods: The present study was carried out over a period of one year from 2017 to 2018, in the Department of Pathology, M. Y. Hospital, Indore. During this period, a total of 109 bone marrow smears were examined. Out of these, 42 cases had the clinical presentation of pancytopenia. A detailed study was done regarding clinical examination and hematological and radiological investigations.Results: In this study 42 cases of pancytopenia were examined over a period of one year. The commonest cause of pancytopenia was megaloblastic anemia (33.34%) followed by aplastic anemia (19.05%). Others includes myelodysplastic syndrome (MDS), acute leukemia, erythroid hyperplasia and plasmacytosis.Conclusions: Bone marrow aspiration can diagnose majority of the cases of pancytopenia. Megaloblastic anemia and aplastic anemia are the commonest causes of pancytopenia.

Histological correlation of nasal mass: a five year retrospective and prospective study.

Background: The presence of mass in the nose may seem to be a simple problem; however it raises several issues about the differential diagnosis. The aim of this study is to evaluate the histological profile of nasal masses in the environment. Methods: This is a retrospective and prospective study of nasal masses during a period of five years of patients presenting to the clinician in our hospital. Results: A total of 90 patients were analysed age ranging from 3 to 80 years. Majority of patients were in the second decade. Sex wise distribution showed a male to female ratio of 2.2:1. The main presenting symptom was nasal obstruction seen in 53.30% patients, while proptosis was seen only in malignant lesion. Among a total of 90 lesions in the nasal cavity 81.1% were benign, 15.5 % were malignant and 3.3% were inadequate sample The commonest non neoplastic lesion was nasal polyp which comprised about 83.33% followed by rhinoscleroma, while the commonest benign neoplastic lesion was papilloma and comprised about 42.10% and squamous cell carcinoma was the most common malignant neoplastic lesion in the nasal cavity and comprised about 42.85%. Most patients with benign lesion were in the second decade. Malignant lesions occurred mainly after fifth decade, while inadequacy of sample was seen in the second decade. Conclusion: Males are more commonly affected then females. Nasal obstruction is the commonest symptom Simple inflammatory nasal polyp is still the commonest histological pattern seen while papilloma being the most common benign lesion and squamous cell carcinoma the most common malignant lesion.

Role of scrape cytopathology in early diagnosis of neoplastic lesions& its histopathological correlation.

Background: Scrape cytology is quick method to know difference between benign & malignant lesions hence aid in early diagnosis. This can in turn lead to quick management even intra operatively. This diagnostic discipline has arisen in parallel but much before contemporary histology. Aims & Objective: (1) To establish scrape cytology techniques as a routine procedure for diagnosis of surgical specimen; (2) To evaluate the diagnostic accuracy of scrape cytological techniques in the diagnosis; (3) To study the merits and pitfalls of scrape cytological techniques in the diagnosis; (4) Correlations of findings of scrape cytology with histopathological findings. Materials and Methods: This was a prospective study of 100 surgical specimens submitted in Department of Pathology, MGM Medical College, Indore. Smears obtained were stained with Papanicolaou Stain & studied. Results: Out of total 33 benign lesions, 31 (94%) were diagnosed correctly and 1 (3%) was false negative & 1 (3%) was not correlating well with histology. Out of total 67 malignant lesions 60 (89.6%) were diagnosed correctly, 2 (3.0%) were false negative and 5 (7.4%) did not correlated with histology. Conclusion: Scrape cytology is rapid technique for diagnosis & can be utilized in place of frozen section as well as adjuvant to histological diagnosis.

Study of imprint smears of various lesions with histological correlation.

Background: Imprint smear is simple and rapid technique for tissue diagnosis. Imprint is a touch preparation in which tissue is touched on the slide and it leaves behind its imprint in the form of cells on glass slide; studies are made after proper staining. Aims & Objective: (1) To evaluate utility of imprint smears as diagnostic modality; (2) To study the merits and pitfalls of imprint smears techniques in the diagnosis; (3) To correlate the findings of imprint smears with histopathological findings. Materials and Methods: This was a prospective study of 100 surgical specimens submitted in Department of Pathology, MGM Medical College, Indore. Smears obtained were stained with Papanicolaou Stain & studied. Results: Out of total 35 benign lesions, 32(91.4%) were diagnosed correctly and 03(8.6) was false negative. Out of total 65 malignant lesions 58 (89.2%) were diagnosed correctly, 07 (10.8%) were false negative. Conclusion: Imprint smear is rapid technique for diagnosis & can be utilized for adjuvant to histological diagnosis.

Congestive heart failure in a male with "carcinoma tongue": a case of mistaken identity.

We present a case of primary amyloidosis with macroglossia and restrictive cardiomopathy, that was mistakenly diagnosed as carcinoma of the tongue. He had characteristic echocardiographic findings, and bone marrow plasmacytosis but with normal serum electrophoresis and no Bence Jones proteins in the urine.

Influence of caffeine on pharmacokinetic profile of sodium valproate and carbamazepine in normal human volunteers.

The present study evaluates effect of pharmacokinetic interaction between caffeine (300 mg) in three divided doses with sodium valproate (400 mg) and carbamazepine (200 mg) given as single doses, in normal human volunteers, using a open cross over design. Both the serum concentration of sodium valproate and pharmacokinetic parameters remained unaltered, as against significant reduction in plasma concentration and area under the concentration curve of carbamazepine following the coadministration of caffeine. Also, the plasma t 1/2 (of carbamazepine was prolonged by two folds and bioavailability reduced by about 32% in presence of caffeine. The results are of clinical significance as xanthine consumption may have to be restricted in patients on carbamazepine therapy and this aspect may need further investigation.

Influence of adenosine, dipyridamole, adenosine antagonists and antiepileptic drugs on EEG after discharge following cortical stimulation.

The effects of adenosine (100 nM, icv), dipyridamole (DPM, 5 mg/kg, i.p.), adenosine A1 receptor antagonist 8-cyclopentyl-theophylline (8-CPT, 10 mg/kg, i.p.), and aminophylline (AMP) and caffeine (CAF) (at equivalent doses of 35 mg/kg, i.p.), were examined in rats. Anti-epileptic drugs (AEDs) were also administered i.p., viz, carbamazepine (CBZ, 10 mg/kg); phenobarbitone (PB, 10 mg/kg); phenytoin (PHT, 20 mg/kg); valproic acid (VPA, 300 mg/kg); and diazepam (DZP, 10 mg/kg), to study their effects on EEG after discharge (AD) and postictal depression (PID) induced by cortical stimulation. The AD parameters: (1) duration of EEG-AD (sec) and (2) number of spikes was noted both during pre and post drug treatment sessions. Adenosine and DPM had no special effects on AD parameters but showed significant prolongation of PID. All the adenosine antagonists, 8-CPT, AMP and CAF produced significant prolongation of AD duration, increase in number of spikes and reduced the duration of PID to a significant extent. Interestingly, some of the AEDs, viz. CBZ, VPA and DZP showed abolition of all the EEG-AD parameters whereas PB and PHT failed to show any significant effect. The results confirm previous findings on involvement of adenosine in postictal events.

Aminophylline alters pharmacokinetics of carbamazepine but not that of sodium valproate--a single dose pharmacokinetic study in human volunteers.

Pharmacokinetic interaction of aminophylline with single dose sodium valproate (400 mg) and carbamazepine (200 mg) was evaluated in normal healthy volunteers using a cross over design. Neither the serum concentrations nor the pharmacokinetic parameters of sodium valproate (SV) were altered by the coadministration of aminophylline (AMP). In contrast AMP significantly decreased the plasma concentrations of carbamazepine (CBZ). The Cmax of CBZ was significantly lowered from 1.73 +/- 0.18 to 0.94 +/- 0.08 microgram/ml and the AUC o-t was significantly decreased from 76.19 +/- 6.20 to 52.66 +/- 1.84 micrograms/h/ml (P < 0.05). The pharmacokinetic parameters of CBZ that were altered in the presence of AMP were: the Tmax and t1/2 which was prolonged about threefold from 5.60 +/- 1.60 to 16.80 +/- 7.94 h and 44.88 +/- 4.50 to 125.07 +/- 29.09 h, respectively. The Vd was marginally increased from 2.19 +/- 0.13 to 3.85 +/- 0.57 L/kg and the Cl was decreased from 34.07 +/- 3.78 to 25.26 +/- 5.15 mL/min. None of these alterations are statistically significant. Bioavailability of CBZ was reduced by 29% in the presence of AMP, while that of SV was increased by about 8%. Results are of clinical significance because simultaneous administration of CBZ and AMP may reduce the efficacy of CBZ in epileptic patients.

An inexpensive method for fabrication of intracerebroventricular cannulae for rats.

An inexpensive and simple method to fabricate intracerebroventricular (i.c.v.) cannulae for rats with readily available material is described here. The procedure is cost effective and quick. The cannulae thus designed are suitable for injecting minute quantities (microliters) of drugs/chemicals interacerebroventricularly for acute or chronic experiments in rats.

Involvement of adenosine in postictal events in rats given electroshock.

The effect of a selective adenosine antagonist, 8-cyclopentyl 1,3-dimethylxanthine (8-CPT) was used to examine involvement of adenosine in ictal and postictal events in rats subjected to maximal electroshock (MES). MES induces the ictal event of hindlimb tonic extension (HLTE) followed by postictal depression (PID). 8-CPT 10 mg/kg, ip produced maximal significant reduction of PID without affecting HLTE, further confirming involvement of adenosine in PID. Carbamazepine and sodium valproate were studied independently and were coadministered with 8-CPT to determine if their anticonvulsant activity was modulated by adenosine and if they altered PID. 8-CPT did not antagonize the seizure protection afforded by CBZ or SV. CBZ significantly reduced postictal events whereas SV had no significant effect. These observations further confirm a role for adenosine in postictal phenomena.

Reverse single radial immunodiffusion for estimation of titre of anti IgG antibody.

Reverse Single Radial Immunodiffusion (SRID) for estimating titre of anti IgG antisera is reported. Unlike the conventional radial immunodiffusion, the antigen (IgG) is held immobile in the gel while the antibody (Anti IgG) diffuses radially from the well (7 microliters) and the diameter of the resulting immuneprecipitates after immunodiffusion at 4 degrees C for 24 hr, represents a linear correlation with the antibody titre. The procedure was standardised by an extensive trial and error employing different concentrations of human IgG in the gel (60-240 micrograms) against varying dilutions of the standard antibody (titre: 3.8 mg/ml). The best results were obtained at 80 micrograms of IgG in the gel. The locally raised rabbit anti IgG antisera displayed a distinctive titre pattern under optimised conditions. Technical reproducibility, high-sensitivity threshold (0.25 mg/ml), simultaneous visual scrutiny of several antibody batches at a glance and ability to assess the shelf life of the stored antisera are its distinct assets.

Inhibition of Salmonella ferlac by enterobacteria under in-vitro conditions.

Interactions of Proteus morganii, Proteus mirabilis, Proteus sp. Klebsiella oxaenae and Serratia marcescens isolated from vegetable salads of mass feeding systems with Salmonella ferlac (a new subgenus VI of Salmonella) isolated from a hostel cook's hands and lizard droppings were recorded following in-vitro nephelometric analysis. Nephelometric analysis revealed inhibition of S. ferlac by all the tested isolates from fifth hour of mixed culture interaction. K. oxaenae was the strong inhibitor.

Antiepileptic drugs delay the onset of seizures induced by aminophylline in conscious rats.

Aminophylline, 285.7 +/- 2.19 mg/kg infused intravenously in unanaesthetized rats produced onset of seizures within 3.2 +/- 0.99 minutes. Seizures were repetitive and death occurred in 10.5 +/- 1.75 minutes. Pretreatment of rats with carbamazepine, sodium valproate and diazepam at doses that prevented electroshock induced seizures were effective in significantly postponing seizures and death, but did not reduce mortality. Concomitant EEG studies in aminophylline infused rats showed that cortical excitability evidenced by initial cortical spiking occurred at 42 secs and polyspiking at 165 seconds. Following diazepam, the initial cortical spike was delayed 50 fold, appearing after 36 minutes. Antiepileptic drugs and EEG monitoring may prove useful in patients with status asthmaticus receiving intravenous aminophylline.

Influence of adenosine receptor antagonists, aminophylline and caffeine, on seizure protective ability of antiepileptic drugs in rats.

Interaction of methylxanthines, aminophylline (AMP) and caffeine (CAF) on seizure protective ability of various antiepileptic drugs (AEDs), diphenylhydantoin (DPH), phenobarbitone (PB), diazepam (DZP), sodium valproate (SV) and ethosuximide (ESM) was investigated in rats. In the maximal electroshock seizure (MES) test, ED100 doses (mg/kg, ip), against hind limb tonic extension (HLTE) were DPH, 20; PB, 10; DZP, 10 and SV, 300. The interaction of AEDs with AMP (100 mg/kg, ip) reduced the seizure protection afforded by DPH, PB and DZP to 20%, while the efficacy of SV remained unimpaired. Interaction with CAF (200 mg/kg, ip) abolished the seizure protection by DPH and DZP, reduced that by PB to 20%, while the protective effect of SV was unchanged. In pentylenetetrazole (PTZ, 70 mg/kg, sc) induced seizure test, ED100 doses (mg/kg, ip) against clonic convulsions were PB, 10; DZP, 1; SV, 300 and ESM, 200. Complete seizure protection against clonic convulsions following SV or ESM was not significantly influenced by either AMP or CAF, whereas the protective effect of PB and DZP was reversed. SV and ESM showed a qualitative departure in their anti-seizure activity profiles following interaction with either AMP or CAF when compared with the other AEDs.

Inhibition of anticonvulsant action of carbamazepine by aminophylline and caffeine in rats.

Interaction of two well known methyl xanthines, aminophylline--an antiasthmatic agent--and caffeine--commonly present in beverages, on the seizure protective ability of carbamazepine (CBZ) against electrically and chemically induced seizures in rats was investigated. Aminophylline (75 mg/kg, ip) did not alter the activity of CBZ (10 mg/kg, ip; ED100) on maximal electroshock seizures while dose dependent antagonism of CBZ efficacy was seen at 100 and 150 mg/kg, ip. Similar effects were observed with caffeine (200 and 250 mg/kg, ip). At the highest tolerated doses, aminophylline (150 mg/kg, ip) and caffeine (250 mg/kg, ip) produced antagonism of CBZ protection against pentylenetetrazole seizures. These observations support the possibility that the antagonism due to the interaction of these drugs could be related to their action at adenosine receptor sites in the brain.