Study of leukocyte profile in patients of fever with splenomegaly

Background: There are many different possible etiologies of fever with splenomegaly; few patients with prolonged fever will remain undiagnosed despite an intensive diagnostic work-up. The presence of splenomegaly in patients with fever narrows down the differential diagnosis. Objectives: The objectives of this study were as follows: (I) To evaluate the causes of fever with splenomegaly and (II) to study the leukocyte profile which includes pattern of total leukocyte count and differential leukocyte count (DLC) in various diseases presenting as fever with splenomegaly. Materials and Methods: A total of 100 patients with fever and splenomegaly were included in the study. Complete hematological study such as complete blood count provided with main focus on total leukocyte count and DLC including neutrophil, basophil, eosinophil, lymphocyte, and monocyte and peripheral blood smear to especially note the morphology of white blood cells (WBCs) and to determine their relative percentage in blood. Results: A total of 100 patients of fever with splenomegaly with male and female ratio of 1.7:1 were included in the study. While considering age-wise distribution, the highest percentage of cases was fell in the age group of 21–30 years. Infectious causes constituted 55% of cases, followed by hematological malignancies constituting 33% of cases. Other causes included 12% of cases. Kala-azar was the most common cause of fever with splenomegaly in our study followed by malaria and acute myeloid leukemia. Pancytopenia was found in 29% of cases and followed by 38% of bicytopenia cases in our study. About 32% of cases presented with normal total leukocyte count, 39% of cases showed leukopenia, and 29% of cases showed leukocytosis. Leukopenia was commonly found in kala-azar followed by hypersplenism. Neutropenia was most commonly present in kala-azar. Conclusion: This study helps in understanding the distribution of leukocyte count and DLC pattern in various diseases presented as fever with splenomegaly and also the variable presenting signs and symptoms of these diseases so that the patients of fever with splenomegaly investigated and treated in a proper manner.

Expression of Immunohistochemical Markers Estrogen Receptor Alpha, Progesterone Receptor A, Her2-neu, p53, and Ki-67 in Epithelial Ovarian Tumors and Their Correlation with Clinicopathologic Variables

Background: This study aims to assess the expression of estrogen receptor alpha (ERα), progesterone receptor A (PRA),Her-2-neu, p53, and Ki-67 in epithelial ovarian tumors and evaluate their correlation with various clinicopathologic variables.Materials and Methods: A total of 50 cases of epithelial ovarian tumors received from the department of obstetrics andgynaecology and surgical oncology were included in this study. Immunohistochemistry (IHC) was performed on sections takenfrom paraffin-embedded tissue blocks. Chi-square test and ANOVA were used for statistical analysis.Results: Among 50 cases of ovarian epithelial tumors, 26 (52%) malignant, 18 (36%) benign, and 6 (12%) borderline. The medianage of patients was higher (53 years) in malignant tumors. ERα had lower expression in benign (27.7%) and PRA had higherexpression in malignant (69%) while Her-2-neu and p53 were negative in benign tumors. ERα and PRA had higher expressionin serous (57.1% and 53.6%), postmenopausal (83.3% and 70%), advanced stage (55.6% and 53.3%), Grade 3 (44.4% and40%), and tumors with ascites (77.8% and 53.3%). Her-2-neu and p53 were negative in benign and higher in malignant (23%and 58%), serous (66.7% and 67%), Grade 3 (57% and 35%), and tumors with ascites (71% and 88%). Ki-67 had a significanthigher expression in malignant (52 ± 28) and Grade 3 tumors (72 ± 20) as compared to benign tumors (4 ± 2).Conclusion: The difference in expression of these markers among benign, borderline, and malignant tumors reveals their rolein differentiation and prognostication of ovarian tumors. Ovarian tumors are extremely heterogeneous as proved by the lackof coexpression of these markers. Tumors with adverse prognostic factors express ERα and PRA; this supports the mitogenicrole of estrogen and estrogenic regulation of PR. Her-2-neu and p53 are expressed only in malignant tumors supporting theirrole in the differentiation of borderline and malignant tumors. Similarly, differential expression of Ki-67 in tumors with adverseprognostic factors would help in prognostication and differentiation.

Herpes simplex virus type 2 and cytomegalovirus perigenital ulcer in an HIV infected woman

We report a case of mucocutaneous Herpes Simplex Virus (HSV)-2 and Cytomegalovirus (CMV) infection in a 39-year-old female with acquired immunodeficiency syndrome, who presented with a perigenital ulcer. The patient was receiving antiretroviral treatment (ART) for 3 months before presentation. Scraping from the perigenital ulcer was positive for HSV-2 and Treponema pallidum using polymerase chain reactions (PCR). The extent and duration of the lesions led us to consider the possibility of coinfection with CMV. The patient also tested positive for CMV by PCR. On subsequent follow-up after 8 weeks, the genital lesions had healed completely. This is possibly ascribable to the ART, which led to significant immune reconstitution.

Incidence of Choledocholithiasis in Gallstone Disease in Eastern Zone of India: A Single Centre Study

Common bile duct stones are found in 10-15% of patients having gall stone disease and the incidence increases with the age, both in India and in western countries and the majority of common bile duct stones are secondary to gall bladder stones, their incidence is more in Northern India

Formulation and in-vitro bioequivalence evaluation of verapamil hydrochloride matrix tablets with Calan SR.

The purpose of the current work was to formulate Verapamil Hydrochloride (VH) sustained release matrix tablets by using natural polymers and comparison with leading national brand Calan SR of Searle Pharmaceuticals. Tragacanth and pectin were used in various concentrations. Pre compression studies i.e. angle of repose, bulk density, tapped density, Carr’s compressibility index and Hausner’s ratio were also performed and found within the Pharmacopoeial limits. Eight formulations (F1-F8) of (VH) were prepared by direct compression method. Post compression studies i.e. Thickness, Hardness, Diameter, Friability and Dissolution studies were conducted. Different kinetic models i.e. zero order, first order, Highuchi model and Korsmeyer Peppas were applied to study release patterns and similarity index was calculated. Dissolution studies were carried out in phosphate buffer of pH 6.8 showed that formulations (F4 and F8) formulated with higher polymers concentration showed comparatively better drug retardation. F5 was the most comparable with the reference product. Verapamil hydrochloride released was observed non-fickian as diffusion following Higuchi model.

Formulation and in-vitro bioequivalence evaluation of verapamil hydrochloride matrix tablets with Calan R.

The purpose of the current work was to formulate Verapamil Hydrochloride (VH) sustained release matrix tablets by using natural polymers and comparison with leading national brand Calan SR of Searle Pharmaceuticals. Tragacanth and pectin were used in various concentrations. Pre compression studies i.e. angle of repose, bulk density, tapped density, Carr’s compressibility index and Hausner’s ratio were also performed and found within the Pharmacopoeial limits. Eight formulations (F1-F8) of (VH) were prepared by direct compression method. Post compression studies i.e. Thickness, Hardness, Diameter, Friability and Dissolution studies were conducted. Different kinetic models i.e. zero order, first order, Highuchi model and Korsmeyer Peppas were applied to study release patterns and similarity index was calculated. Dissolution studies were carried out in phosphate buffer of pH 6.8 showed that formulations (F4 and F8) formulated with higher polymers concentration showed comparatively better drug retardation. F5 was the most comparable with the reference product. Verapamil hydrochloride released was observed non-fickian as diffusion following Higuchi model.

Knowledge, Attitude, and Practices (KAP) study on HIV / AIDS among HIV patients, care givers and general population in north-eastern part of India.

Background: HIV, the disease, whose mode of transmission is known and is largely preventable, but due to lack of knowledge and practices about HIV/AIDS in general population causes its rapid spread. Aims & Objective: To assess and compare the knowledge, attitude and practices about HIV in patients group, care giver and in general population. Material and Methods: A total of 102 HIV/AIDS patients, 60 care givers (35 attendant, 19 nurses, 6 doctors) and 40 general population (control) were included in the present study. The patients who were registered for study were followed up for three visits. The responses were recorded on a pre-designed and pre-tested, semi- structured questionnaire. Results: Illiteracy was more common in HIV patient group (27.5%) . A high proportion of HIV/AIDS cases were engaged in transport/ production industry (24.5%). Electronic media and print media are major source of information. 35.3% patients, 22.9% care givers and 47.5% general population group thought that with medication HIV is curable. Sexual contact (63.8%) was the commonest mode of transmission. 80.0% medical staff thought that a newly diagnosed HIV person, first to talk with doctor. After 6 month follow up: 82% patients write sexual contact as major mode of transmission, and Use of condom was most important preventive measure (68%). Conclusion: Understanding the KAP about HIV/AIDS of Patients, care givers and in general populations will help us in formulating strategy for prevention and treatment.

Prescribing pattern of higher generation antibiotics in the out-patient setting in Bhutan hospitals

Background: The emergence of antibiotic resistance is a complex problem contributed by the interplay of various parties such as prescribers, patients or health settings. In particular, prescribers play a vital role in the use of antibiotics both in rational prescribing of drugs and influencing patients on the appropriate use. Objectives: Determine the appropriateness of the higher generation antibiotics (cephalosporin and flouroquonolone groups) in the out-patient setting of Bhutan hospitals. Materials and method: A cross-sectional study was conducted in three referral hospitals of Bhutan where the prescriptions were collected from the pharmacy. All prescriptions containing higher generation antibiotics were selected based on the appropriateness using a modified Medication Appropriateness Index. Three hundred thirty three prescriptions containing higher generation antibiotics were analyzed. Results: The use of antibiotics was common with 37.1% of the prescriptions containing antibiotics out of which 14% were higher generation antibiotics. When assessed on the appropriateness of the prescription, 55.9% of the prescriptions containing higher generation antibiotics were prescribed inappropriately. In addition, only 47.1% of the prescriptions had appropriate indications for higher generation antibiotics. Conclusion: There is a widespread inappropriate use of higher generation antibiotics in Bhutan.

Malignant myelomatous pleural effusion with good response to combination chemotherapy.

Malignant pleural effusion in myeloma is a rare terminal event with 91 cases reported so far. Majority of the patients survive less than 4 months. We are presenting a short series of four such cases, who had a good clinical response to combination chemotherapy.

TLC-spectrophometric separation and trace determination of monocrotophos and dichlorvos in enviromental and biological samples.

Organophosphorus insecticides, monocrotophos and dichlrovos are increasingly being used in agriculture to control insects on a wide range of crops. Their ready access has resulted in misuse in many instances of homicidal and suicidal poisoning cases. This paper describes about a chromogenic spray reagent for the detection/determination of monocrophos and dichlrovos in environmental and biological samples by TLC and spectrophotometric method. Monocrotophos and dichlorvos on alkaline hydrolysis yield N-methyl acetoacetamide and dichlroacetaldehyde respectively, which in turn react with diazotized p-amino acetophenone to give red-violet and red coloured compounds. Other organophosphorus insecticides do not give this reaction. Moreover, organochlorine and synthetic pyrethroid insecticides and constituents of viscera (amino acids, peptides, proteins etc), which are generally coextracted with the insecticides, do not interfere. However, phenolic compounds and hydrolysed product of carbamate insecticides may interfere and differentiate from monocrotophos and dichlrovos by Rf values. The lower limit of detection is 0.2 mg for monocrotophos and 0.1 mg for dichlorovos. The absorption maxima of the reddish-violet and red colour formed by monocrotophos and dichlrovos, are measured at 560 nm and 540 nm respectively. Beer's Law is obeyed over the concentration range of 1.2 to 6.8 mg and 6.2 to 35 mg in the final solution volume of 25 mL. The molar absorptivity and Sandell's sensitivity of monocrotophos and dichlrovos were found to be 7.1 x 10(5) (+100) 1 mole(-1) cm(-1) and 0.008 mg cm(-2), 1.2 x 10(5) 1 mole(-1) cm(-1) and 0.003 mg cm(-2) respectively. The standard deviation and relative standard deviation were found be +/- 0.005 and 2.05% +/- 0.007 and 2.02% respectively. The developed method has been successfully applied to the detection and determination of monocrotophos and dichlrovos in environmental and biological samples.

Management of visceral leishmaniasis: Indian perspective.

Diagnosis and treatment of Indian visceral leishmaniasis (VL) is extremely unsatisfactory. For diagnosis, demonstration of parasites in splenic/marrow smears remains the gold standard, though k39 rapid strip test is a useful method in regions where access to parasite demonstration is difficult. pentavalent antimony remains the mainstay for the treatment of all forms of leishmaniasis globally; however, development of large-scale antimony resistance in Bihar has necessitated search for alternative drugs. Amphotericin B is the most effective, though toxic, drug for patients with refractory VL. Lipid formulations of amphotericin B, though safe and effective, are too expensive to be useful for poor patients of this region. These hold advantage as large quantity of the drug can safely be given over a short period of time, thus leading to a decrease in the hospital stay to a few days instead of several weeks. Oral miltefosine, an alkyl phospholipid, has recently been approved and marketed in India for the treatment of VL. Miltefosine cures 94% patients with VL if given in a daily dose of 50-100 mg for 28 days. Most common adverse events are mild vomiting and diarrhea. Paromomycin, an amino glycoside, is undergoing a pivotal phase-III clinical trial, and is likely to be approved and available to patients with VL at an affordable cost. To protect the already scarce inventory of antileishmanial drugs, it is time that combination chemotherapy is introduced for the treatment of VL in India.

Role of ELISA in H. pylori detection and its correlation with urease test.

Helicobacter pylori is one of the most common chronic bacterial infection in humans linked to acid peptic diseases, gastric carcinomas and lymphomas. The bacilli produces large amounts of urease and this property has formed the basis of detection of H. pylori by the Christensen's urease test. Where endoscopy is not clinically indicated, serology may be used to establish the diagnosis. This study was undertaken to diagnose H. pylori with the help of Christensen's urease test on endoscopic biopsy specimens & correlated with the detection in Sera, of IgG antibodies against H. pylori, by ELISA technique. The study was conducted on 100 patients suffering from acid peptic disorders out of which 40 (40%) tested positive for H. pylori both by urease and serology. Christensen's urease and ELISA were found to have sensitivities of 85.7% & 90.9% and specificities of 96% and 87.5% respectively. Christensen's urease was taken as a standard method of diagnosis and its correlation with ELISA worked out to (+1) which meant there was a strong positive association between both the tests. Hence either test could be used for primary diagnosis of H. pylori instead of histopathological study and/or culture of H. pylori.

Antithrombin III activity in cerebrovascular accidents.

Cerebrovascular accidents are commonly due to occlusive or haemorrhagic lesions. The present prospective study was planned to find out role of antithrombin in possible etiopathological process, which might predispose an individual for stroke. METHOD: Biological activity of antithrombin III was done by the method as described by Innerfield et al (1976). Immunological estimation of an antithrombin III was done by single radial immunodiffusion by the technique of Mancini et al modified by Fahey and Mckelvey. RESULTS: The biological and immunological activity of antithrombin III was measured in 98 patient of occlusive and 56 patients of haemorrhagic strokes. Significant depression in biological as well as immunological activity (p<0.001) was observed in occlusive stroke. In haemorrhagic stroke both, biological and immunological activity was increased. In follow up study, there was progressive normalization of both, biological as well as of immunological activity in both group. CONCLUSION: Decrease of antithrombin III in occlusive and increase in haemorrhagic stroke indicates that these changes have at least an additive role in the pathogenesis of stroke.

Chronic lymphocytic leukaemia terminating into plasma cell leukaemia.

Transformation of chronic lymphocytic lymphoma into plasma cell leukaemia is extremely rare. The diagnosis is made on if the circulating plasma cells in peripheral blood is in excess of 2000 cells/mm3.

Non-Hodgkin's lymphoma with pure red cell aplasia.

Pure red cell aplasia (PRCA) associated with non-Hodgkin's lymphoma, is an extremely rare condition, with few cases reported worldwide. More commonly PRCA is associated with thymoma or viral infections. Steroids and other immunosuppressive drugs are the preferred treatment of PRCA.

Low dose cyclosporine-a therapy in severe aplastic anaemia.

OBJECTIVE: The present study was conducted to evaluate the efficacy of low dose cyclosporine-A in the patients of severe aplastic anaemia, who cannot afford allogenic bone marrow transplantation and immunosuppressive therapy with antithymocyte globulin. METHODS: The diagnosis of severe aplastic anaemia was established by standard criteria. Twelve patients were given cyclosporine-A orally at a dose of 6 mg/kg body weight in divided doses in two daily equal proportions for six months. Eleven patients were put on oral stanozolol in the dosage of 1 mg/kg body weight/day in divided doses. All surviving patients were evaluated at three and six months. RESULTS: At the end of six months, 41.66% of twelve patients responded to cyclosporine-A. One patient had complete response and four patients had partial response. Only one out of 11 patients receiving stanozolol responded. CONCLUSIONS: i) Cyclosporine-A is a viable therapeutic option in the treatment of severe aplastic anaemia, ii) Low dose cyclosporine-A is able to slow down the stormy course of the severe aplastic anaemia, iii) Androgens have very little effect on the survival of patients of severe aplastic anaemia.

Effect of titanium exposure on embryonic development during pre-implantation period in rats.

Doses of titanium trichloride (1/10th and 1/5th of LD50) were administered once and daily to pregnant rats to assess their effect on embryonic development. 1/5th dose of TiCl3 administered once orally on 1st, 2nd and 3rd day post-coitum. Similarly 1/10th of LD50 was administered daily. Results revealed that 1/10th LD50 dose of TiCl3 was more effective during pre-implantation period as number of 4 and 8-celled embryos decreased as compared to 1/5th. Delayed hatching of the blastocysts on day 5 was registered in TiCl3 treated dam.

Prevalence of human immunodeficiency virus infection in and around Varanasi, Uttar Pradesh, India.

Human Immunodeficiency Virus (HIV) infection is rising rapidly in the eastern Uttar Pradesh; however no data is available regarding its positivity rate. We have screened 1239 cases of various groups. HIV seropositivity rate of 0.28% was noted. These results suggest that HIV infection is spreading rapidly in this part of the country. M. tuberculosis was the commonest co-infection amongst them (29.5%). We recommend routine HIV screening of all patients of tuberculosis, especially if the persons frequent the cities, visit foreign countries where sex tourism is encouraged or stay away from their spouses for long periods as true history of sexual contact with commercial sex workers was difficult to obtain from them.

In vitro evaluation of inhibitory nature of extracts of 18-plant species of Chhindwara against 3-keratinophilic fungi.

Effect of extract of 18 plant species, viz., Acorus calamus, Adhatoda vasica, Amomum subulatum, Andrographis paniculata, Boerhaavia diffusa, Cassia occidentalis, Centella asiatica, Cymbopogon citratus, Hemidesmus indicus, Hyptis suaveolens, Malvestrum sp., Passiflora edulis, Pergularia daemia, Peristrophe bicalyculata, Shuteria hirsuta, Solanum nigrum, Tecoma stans, and Verbascum chinense on the growth of Microsporum gypseum, Chrysosporium tropicum and Trichophyton terrestre was evaluated and discussed. The sensitivity of the keratinophilic fungi was evaluated by dry-weight method. The maximum inhibition of mycelial growth was shown by M. gypseum (86.62%) followed by T. terrestre (81.86%) and C. tropicum (74.06%) when treated with S. hirsuta whereas the minimum inhibition was exhibited by M. gypseum (0.29%), C. tropicum (0.16%) and T. terrestre (1.76%) when tested with the extract of P. edulis, A. vasica and B. diffusa respectively.