Effectuation to Cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using “Milan System for Reporting Salivary Gland Cytopathology”: A 2 years retrospective study in academic institution

Background: To accost things in a particular disciple, egress related to Fine Needle Aspiration Cytology (FNAC) and to standardize reporting pattern, a framework “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC) has been sponsored. Aim: Aim of this study was to evaluate the potency of salivary gland FNAC reported under Milan guidelines, to calculate malignancy risk, and to compare the preoperative cytological diagnoses with the postoperative histopathological diagnoses. Settings and Design: This was a retrospective study over a period of 2 years (May 2016 to April 2018), which was classified according to Milan system and correlation with histopathology. Furthermore, the risk of malignancy was calculated for all the diagnostic categories. Materials and Methods: FNAC were analyzed on 105 patients with palpable salivary gland. Results were distributed into six categories. About 76 cases were surgically treated and resected tissues were submitted for histopathological examination. Statistical Analysis: The various diagnostic values of the procedure were calculated using the standard formula. Results: We reviewed 105 salivary gland FNA samples and recorded interpretations according to the proposed standardized six categories. Among them, category IV (neoplastic) had more cases (57.14%). The rates of malignancy in histology were as follows: (1) nondiagnostic, 0.0%; (2) nonneoplastic, 0.0%; (3) atypia of undermined significance, 50.00%; (4a) benign, 02.44%; (4b) uncertain malignant potential, 33.33%; (5) suspicious for malignancy, 100%; and (6) malignancy, 93.33%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Milan system came out to be 85.00%, 98.14%, 94.44%, 94.64%, and 94.59%, respectively. Conclusion: The six-tier diagnostic categories of the Milan system helps in triaging patients with salivary gland swelling and thus facilitate individualized management.

Neonatal Septicemia due to Acinetobacter species and their Antimicrobial Susceptibility Pattern.

Background and Objectives: Sepsis remains a clinical challenge in the Indian intensive care nurseries. Neonatal sepsis due to Acinetobacter species has been reported in recent years. Because of their multidrug resistance pattern, Acinetobacters pose a challenge regarding management of patients. The present study was therefore undertaken to find out the prevalence of Acinetobacter species in cases of neonatal septicemia and also to find out the antimicrobial susceptibility pattern of all Acinetobacter isolates. Methods: Eighty Acinetobacter isolates from blood culture samples from neonates with signs and symptoms of septicemia were speciated by standard biochemical tests and their antimicrobial susceptibility testing was done by Kirby Bauer Disk Diffusion (KBDD) method according to CLSI guidelines. Results: Incidence of neonatal septicemia due to Acinetobacter species was 9.18% out of total blood culture positive samples and predominant species was Acinetobacter baumanii (67.5%), followed by Acinetobacter junii (20%). Acinetobacter species showed maximum susceptibility to netilmicin (86.25%), followed by imipenem (70%). Acinetobacter junii showed greater susceptibility than Acinetobacter baumanii. Conclusion: This study indicates that neonatal sepsis due to Acinetobacter species is on the rise. Acinetobacter baumanii is multiresistant type and has direct bearing on mortality, so it highlights the importance of formulating a proper antibiotic policy in every hospital in cases of neonatal sepsis. The differences in resistant patterns among isolates emphasizes the need for differentiating A. baumanii from other Acinetobacter species by special biochemical tests.

Fatal rhino-orbito-cerebral infection caused by Saksenaea vasiformis in an immunocompetent individual: first case report from India.

A 56-year-old female patient presented with history of nasal blockage, nasal bleeding, headache, since one month. On admission the patient developed severe headache, decreased vision of eyes and blindness. Clinical diagnosis of rhino-orbital involvement was confirmed by computerized tomography of the paranasal sinuses. The diagnosis of fungal infection was confirmed by KOH examination, haematoxylin and eosin examination and Gomori's methanamine silver stain of the biopsy material. Diagnosis was confirmed by culture on Sabouraud Dextrose agar, slide culture on Czapek Dox medium and the isolate was identified as Saksenaea vasiformis. The patient was started on intravenous amphotericin B (received only one dose before succumbing), but she did not respond to the treatment, developed hemiparesis, slurred speech, diminished reflexes and ultimately died. The involvement of the brain was confirmed by computerised tomographic scan. We believe this case to be the first case of rhino-orbito-cerebral infection due to Saksenaea vasiformis and that of second case in an immunocompetent patient in the world.

Accumulation of Tc99m-DMSA-3 in the spleen in a case of multiple myeloma with associated amyloidosis.

We describe a case of a 58-year-old male with longstanding hypertension and Type 2 diabetes mellitus who developed sudden onset renal impairment. The first clue to the possible presence of amyloidosis in this case was provided by the radionuclide renal cortical scan performed with trivalent dimercapto succinic acid (Tc99m-DMSA-3), which revealed intense tracer uptake in the spleen suggesting amyloid deposit. Further workup to ascertain the cause of amyloidosis led to the diagnosis of multiple myeloma. We conclude that in cases of extra-renal or splenic accumulation of Tc99m-DMSA-3, a diagnosis of amyloidosis should be considered, in an appropriate clinical setting.