COMPARING THE EFFECTIVENESS OF LIQUID BASED CYTOLOGY (LBC) WITH CONVENTIONAL PAP SMEAR: A PROSPECTIVE STUDY

Background: Cervical cancer is unique among human cancers which is mostly attributable to infection. Conventional PAP smear method is most effective for prevention and detection of cervical cancer but the accuracy of this method is low. This PAP smear now evolved to Liquid Based Cytology (LBC). Method: All the patients visiting Gynaecology OPD who fulfilled the inclusion Criteria in the duration starting from 1 January 2020 to 30 June 2021 in the Department of Pathology of Gajra raja Medical College, Gwalior (MP) were included in this study. 50 atypical smears by Conventional PAP test were then collected and these cases were subjected to Eziprep Liquid Based Cytology and Conventional PAP smear in private laboratory setup after taking history and clinical examination. The smears were studied by using 7 morphological parameters. Smears were analysed for adequate cellularity, clean background, uniformResult: distribution of cells, cellular overlapping, inflammation, distinct cell border, nuclear irregularity and then categorise by Bethesda reporting system. The results were significant only for clean background, uniform distribution of cells, cellular overlapping and inflammation. Conclusion: Results of cervical cytology smears by both methods showed that LBC provides more representative sample with reduced obscuring material, improved clarity allowing better morphological evaluation.

Universal Leukoreduction Decreases the Incidence of Febrile Nonhemolytic Transfusion Reactions to Cellular Blood Components: A 5 Year Study.

Background: Febrile nonhemolytic transfusion reactions (FNHTRs) are common complications associated with allogenic transfusion and it is caused by the leucocytes and cytokines released by leucocytes during storage of blood/ blood components. These reactions are generally not life threatening, but they are expensive in their management, evaluation, and associated blood-product wastage. 1st log prestorage universal leukoreduction (ULR) i.e. removal of Buffy coat is a useful and effective procedure in developing countries to control FNHTRs significantly. Aims and Objects: To know the efficacy of pre-storage 1st log universal leuckoreduction in controlling febrile nonhemolytic transfusion reactions (FNHTRs). Place and Duration of Study: Study was carried out at Blood Bank, Department of Pathology, G. R. Medical College, Gwalior from January 2009 to December 2013 (5years). Materials and Methods: Study was divided into control group (Year: 2009) and study group (Years: 2010-13). 14,292 recipients in control group and 45,064 in study group were transfused with non-leukoreduced and prestorage 1st log leukoreduced blood/ blood components respectively. Usefulness of prestorage 1st log ULR over non-leukoreduced blood/ blood components was observed, compared and discussed. Result: In the control group 610 (4.26%) out of 14,292 (p=0.0003) and in study group 381(0.84%) out of 45,064 (p=0.0003) recipients were reported to have FNHTRs. The comparative study showed significant reduction in FNHTRs from 4.26% to 0.84% (↓ 3.42%) (p=0.000001). Conclusion: 1st log Universal Leukoreduction (ULR) is a better option over Selective Leukoreduction (SLR) to prevent FNHTRs and it also helps the transfusion services of under-resourced developing countries in many ways.

Transfusion Transmissible Infections among Blood Donors at the Blood Bank of Medical College of Gwalior: A 5 Year Study.

Introduction: Transfusion Transmitted Infections (TTIs) are a major problem associated with blood transfusion. Accurate estimates of risk of TTIs are essential for monitoring the safety of blood supply and evaluating the efficacy of currently employed screening procedures. Aims: To determine the prevalence of transfusion transmitted infections among blood donors in greater Gwalior region and its surrounding areas i.e. central India and its comparison with other relevant studies. Place and Duration of Study: Study was carried out at Blood Bank, Department of Pathology, Gajra Raja Medical College, Gwalior, India from January 2009 to December 2013 (5 year study). Methodology: Total 67,123 blood units collected from blood donors were tested for transfusion transmitted infections (TTIs) i.e. HIV I & II, HBV, HCV,VDRL and Malaria parasite at Blood Bank as per guidelines of World Health Organization (WHO) for Asia Pacific region and Food and Drug Administration, Government of India. Results: Out of 67,123 blood units studied, voluntary units were 61309(91.3%) and replacement units were 5823 (8.7%). In the present study total TTIs positive units were 2747 (4.09%) (p=0.000005). Amongst them HBV were 2360 (3.51%) (p=0.000005), HIV positive units were 91(0.13%), HCV were 161 (0.24%), VDRL were 114 (0.17%) and Malaria 21 (0.03%). Conclusion: Our study concluded that amongst all the TTIs in the blood donors in Gwalior and its surrounding area, seroprevalence of HBV was significantly higher than other infections. It is also higher than similar studies conducted in other parts of India.

300,000 IU or 600,000 IU of Oral Vitamin D3 for Treatment of Nutritional Rickets: A Randomized Controlled Trial.

Objective: To evaluate the non-inferiority of a lower therapeutic dose (300,000 IU) in comparison to standard dose (600,000) IU of Vitamin D for increasing serum 25(OH) D levels and achieving radiological recovery in nutritional rickets. Design: Randomized, open-labeled, controlled trial. Setting: Tertiary care hospital. Participants: 76 children (median age 12 mo) with clinical and radiologically confirmed rickets. Intervention: Oral vitamin D3 as 300,000 IU (Group 1; n=38) or 600,000 IU (Group 2; n=38) in a single day. Outcome variables: Primary: Serum 25(OH)D, 12 weeks after administration of vitamin D3; Secondary: Radiological healing and serum parathormone at 12 weeks; and clinical and biochemical adverse effects. Results: Serum 25(OH)D levels [geometric mean (95% CI)] increased significantly from baseline to 12 weeks after therapy in both the groups [Group 1: 7.58 (5.50–10.44) to 16.06 (12.71– 20.29) ng/mL, P<0.001]; Group 2: 6.57 (4.66–9.25) to 17.60 (13.71–22.60, P<0.001]. The adjusted ratio of geometric mean serum 25(OH)D levels at 12 weeks between the groups (taking baseline value as co-variate) was 0.91 (95% CI: 0.65–1.29). Radiological healing occurred in all children by 12 weeks. Both groups demonstrated significant (P<0.05) and comparable fall in the serum parathormone and alkaline phosphatase levels at 12 weeks. Relative change [ratio of geometric mean (95% CI)] in serum PTH and alkaline phosphatase, 12 weeks after therapy, were 0.98 (0.7–1.47) and 0.92 (0.72–1.19), respectively. The serum 25(OH)D levels were deficient (<20 ng/mL) in 63% (38/60) children after 12 weeks of intervention [Group 1: 20/32 (62.5%); Group 2: 18/28 (64.3%)]. No major clinical adverse effects were noticed in any of the children. Hypercalcemia was documented in 2 children at 4 weeks (1 in each Group) and 3 children at 12 weeks (1 in Group 1 and 2 in Group 2). None of the participants had hypercalciuria or hypervitaminosis D. Conclusion: A dose of 300,000 IU of vitamin D3 is comparable to 600,000 IU, administered orally, over a single day, for treating rickets in under-five children although there is an unacceptably high risk of hypercalcemia in both groups. None of the regime is effective in normalization of vitamin D status in majority of patients, 3 months after administering the therapeutic dose.

Incidence of Rh Antigens, Phenotype & Probable Genotype in the Population of Gwalior and Chambal Region, Central India.

Introduction: Rhesus (Rh) antigen was discovered in 1940 by Karl Landsteiner and Wiener. In later years, because of its immunogenecity along with ABO grouping, RhD antigen testing was made mandatory before issuing a compatible blood. Presently there are five major antigens i.e. D, C, E, c and e in Rh blood group system. Aims: To know the distribution of major Rh antigens, its phenotype and most probable genotype in the population of Gwalior region i.e. Central India. Place and Duration of Study: This study was carried out at Blood Bank, Department of Pathology, Gajra Raja Medical College, Gwalior, India from 1st October 2008 to 30th September 2010. Methodology: The distribution of Rh antigens, its phenotype and most probable genotype was studied in 1000 samples collected from blood donors, blood recipients and other patients. Samples were tested for ABO blood group and five major antigens of Rh system by tube agglutination method /or by gel technology. Results: Out of 1000 samples studied, the incidence of RhD was 91.6% and only 8.4% samples were negative for D antigen (p=.000005). The Incidence of other Rh antigens i.e. C, E, c and e was 84%, 25.6%, 58.3% & 78.5% respectively (p=.000005) Most common phenotype in RhD positive samples were DCCee (41%) and in RhD negative it was dccee (5.6%) (p= .000005). Eleven samples (1.1%) were negative for antithetical antigens E & e. Most probable genotype in order of frequency was DCe/DCe (R1R1)-41%, DCe/Dce (R1R0)-25.5% & dce/dce (rr)-5.6% (p= .000005). Conclusion: Like previous studies, our study also concluded that there is a wide range of racial and geographical variation in the distribution of Rh phenotype and genotype. The Rh blood group system has vital role in population genetic study, in resolving medico legal issues and more importantly in transfusion practice.

Clinicopathological Study of Renal Amyloidosis

Study included 13 cases of renal amyloidosis.Oedema, feet and face was the commonest manifestation (100%), two patients (18.18%) also presented with loose motions, ascites and pain in abdomen and one patient had ankylosing spondylitis and cervical spondylitis. On clinical grounds only one case was diagnosed as primary amyloidosis of light chain type, who presented initially with cervical lymphadenopathy and 4 years later with nephrotic syndrome. About 72.72% cases had some chronic disease in the terms of tuberculosis, ankylosing spondylitis, chronic ulcerative colitis, lepromatous leprosy, rheumatoid arthritis and one patient had carcinoma caecum. Congo red stain was positive in both, light chain deposit disease (LCDD) and amyloidosis but polarizing microscope showed mixed birefringence (red, green, yellow) only in amyloidosis. In AFOG and PAS stain, amyloid appeared negative, only peripheral portion revealed blue and pink staining and central area appeared as cutout spaces. Congo red and methyl violet stains and potassium permanganate treatment was not helpful in distinguishing AL amyloidosis from secondary amyloidosis. Hence immunohistochemistry and myeloma profile is a must. It might be possible that in light chain amyloidosis, treatment with methotrexate and prednisolone may improve survival.

Acute megakaryoblastic leukaemia: a clinico-haematological profile of five cases.

Herein we are presenting the clinical, morphological and cytochemical characteristics of five cases of acute megakaryoblastic leukaemia (AML-M7) seen by us over a period of five years (Jan 1996-Dec 2000). Morphological assessment revealed marked polymorphism of blast cells and platelets both in the peripheral blood and bone marrow smears in all cases. Size of the blast cells ranged from very small to very large multinucleated cells, with variable chromatin pattern and number of nucleoli. More differentiated megakaryocytic cells showing cytoplasmic blebs, protrusions and platelet budding with bizarre platelet morphology were characteristic features suggesting the diagnosis. Cytochemical stains like myeloperoxidase, sudan black and PAS were positive in 5-15% of blast cell. Coagulation studies revealed a normal coagulation profile, whereas platelet studies showed marked impairment in aggregation of platelets with ADP and adrenalin with a normal PF-3 availability.