Role of ancillary techniques in diagnosis, therapy and prognosis of a case of precursor B-cell acute lymphoblastic leukemia in an elderly patient

The chromosomal abnormality of Philadelphia chromosome is mostly seen in Chronic Myeloid Leukemia (CML). But it is observed that the Philadelphia chromosome (Ph), t(9,22), is the most common cytogenetic abnormality in adult patients with acute lymphoblastic leukemia (ALL), occurring in about 20% to 30 % of all cases. Patients with Ph-positive ALL have breaks in the minor breakpoint region, m?BCR (exons 1?2) lead to a short fusion proteins (p190) and is most frequently associated with Ph chromosome- positive ALL. They have an increased risk for central nervous system (CNS) involvement, an aggressive clinical course and poor prognosis. Historically, they had an inferior outcome when compared with their Ph-negative counterparts. Adult Ph+ patients achieve Complete Remission rates comparable to Ph? ALL patients with standard chemotherapy, but the remissions are short and survival poor. The addition of tyrosine kinase inhibitors (TKIs) including imatinib has dramatically improved outcomes. We are presenting this case report of t(9;22), p190 BCR-ABL1 positive ALL in an elderly female patient of south Gujarat.

Laws Related to Environmental Protection vis-a-vis Hospital Induced Environmental Toxicity

Hospitals are reservoir of infected organisms and toxins. It is must to ensure minimum exposure to patients, public and staff to avoid spread of toxicity. Hospitals are also generating solid, liquid and gaseous waste which in turn produces environmental toxicity if not dealt with properly. To manage hospital and to avoid hospital induced environmental toxicity, it is necessary to know and follow various laws of environmental protection like The Environment Protection Act, 1986; The Environment (Protection) Rules, 1986; Bio-Medical Waste Management Rules, 2016; Manufacture, Storage and Import of Hazardous Chemical Rules, 1989; Municipal Solid Waste (management and handling) Rules, 2000; Environmentally Sound Management of Mercury Waste in Healthcare Facilities Rules, 2008; Water (Prevention and Control of Pollution) Act, 1974; The Air (Prevention and Control of Pollution) Act, 1981; Manufacture, use, import export and storage of hazardous microorganisms, genetically engineered microorganisms or cells rules, 1989; etc. Brief knowledge about above laws and consequences of violating such rules are important for every health sector like clinics, nursing homes, pathology laboratory, forensic laboratories, AYUSH hospitals, camps, research laboratories etc. In this review, we just touch upon various rules and its importance in relation to hospital set up. Green and clean environment is our necessity and health sector has to comply it.

Comparison of peripheral blood smear and automated cell counter in 100 cases of anemia

Background: Hemogram/ Complete Blood Count (CBC), performed on hematology analyzers, is one the most commonly ordered blood test in clinical practice especially in patients presenting with fever. The aim of the present study was to compare accuracy of RBC histograms shown by our 5 part cell counter to that of microscopy examination of blood film stain by field stain. Materials and methods: The present observational study was conducted during June 2020 - August 2020. Samples were run on 5 part hematology analyzer. Population of both anemic and healthy individuals in the age group 0-60 years were evaluated for the study. Total 100 patients in the age group of 0- 60 years were enrolled in this study. Hematological parameters were obtained by using 5 part automated hematology cell counter. The hemoglobin concentration and red blood cell (RBC) indices, encompassed mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) and erythrocyte count. Results: We studied 100 blood samples of patients. Among them 82 cases showed correlation between histogram to that of the peripheral blood smear examination.Conclusion: The result of the study shows that the automated hematology analyzer are appropriate for screening purposes because it increases the turnaround time and reduces the labor cost. But to diagnose and differentiate different types of anemia manual scan of peripheral smear is a method of choice.

Histopathological study of dermal granuloma

INTRODUCTION:The objectives of this study were to confirm the diagnosis of clinically suspected dermal granuloma- tous diseases by histopathological examination and by routine and special stains as well as to study the incidence of various types of dermal granulomas.MATERIALS AND METHODS:This study was conducted at the Department of Pathology in collaboration with De- partment of Skin and Venereal disease. A total of 90 cases from outdoor patient department of skin and venereal disease, which were clinically diagnosed as suspected dermal granulomatous diseases, were taken as the study population.RESULTS:In our study, we found that leprosy had the highest incidence (50%), followed by cutaneous tuberculosis (30%) among all dermal granulomatous diseases like syphilis, fungal, granuloma annulare, foreign body, actino- mycosis, and sarcoidosis. Dermal granulomas were most common in middle age between 21 and 40 years of age.CONCLUSION:Histopathology played an important role in the final diagnosis of dermal granulomatous lesions. Most common dermal granulomatous disease was leprosy, followed by cutaneous tuberculosis.

Our Experience Of Metastatic Lesion Of Lymph Node Diagnosed By Fine Needle Aspiration Cytology.

Abstract: Background and Objectives: Fine needle aspiration cytology (FNAC) is a useful screening test.Diagnosis of metastatic lesion by FNAC is providing a clue to the clinicians to nature and site of primary. The aim of the present study is to highlight the role of FNAC of lymph nodes in the diagnosis of suspected and unsuspected lymph node malignancies. Methodology: Retrospective study of 80 cases of metastatic lymph nodes out of total 391 lymph nodes aspirated during the period of 1st July, 2013 to 31st June, 2014 was done. This study was carried out in cytology laboratory of Pathology Department of Dhiraj General Hospital, Piparia. FNAC of the enlarged lymph node was performed taking aseptic precautions. Results: Out of total 3070 cases of FNAC, 391 cases (12.93%) were of lymph nodes. Among these, there were a total of 80 nodes reported as “positive for metastasis” accounting for 20.46% of all lymph node FNACs and 2.60% of all FNAC cases.The most common subtype of metastatic malignant tumor was squamous cell carcinoma which includes 72.5% (58 cases) of the study population.Most common site affected by metastasis were cervical lymph nodes (77.5%) followed by supra clavicular lymph nodes (12.5%), axillary lymph nodes (7.5%), abdominal lymph nodes (1.25%), inguinal lymph nodes (1.25%) respectively. Conclusion: FNAC of lymph nodes is a very useful and simple tool in the diagnosis of lymph node malignancies.

Diagnosis of fat necrosis on FNAC – A case report.

Fine needle aspiration (FNA) of the breast has gained significant credibility in the diagnosis of breast diseases especially malignancy. Fat necrosis of the breast is a phenomenon that occurs within breast adipose tissue following exposure to trauma. It can mimic breast cancer clinically or radiologically. FNA of fat necrosis is a useful tool in directing management and treatment of the patients and avoiding unnecessary surgeries although histopathological examination is the gold standard for the final diagnosis.

Hepatoblastoma of 12 years old female - A case report.

Hepatoblastoma is the most common primary liver tumor of childhood and after neuroblastoma and nephroblastoma the third most common abdominal neoplasm in this age group. Hepatoblastoma in adolescent and adults are worse off than in childhood because they are diagnosed late. The primary treatment is surgical resection, and the use of preresection chemotherapy can increase the number of tumors that are resectable. The prognosis for patients with resectable tumors is fairly good in combination with chemotherapy.

Cystic metastatic squamous cell carcinoma – A case report.

Fine-needle aspiration cytology (FNAC) has been shown to be very useful in the preoperative evaluation of neck masses. Cystic change in metastatic lymph nodes occurs in certain types of tumors and it is an unexplained, site-specific phenomenon that mostly happens in the lymph nodes of head and neck region. It is suggested that cases of cystic squamous carcinoma metastases to cervical lymph nodes may be determined by cytological examination of fine needle aspirates. The importance of interpretation of fine needle aspiration cytology by an experienced cytologist is emphasized to avoid the possibility of excising metastatic squamous cell carcinomas, which could lead to unnecessary surgical procedures such as radical neck dissection.

Dysembryoplastic neuroepithelial tumor: A rare case report.

Dysembryoplastic neuroepithelial tumor (DNET) is a rare benign tumor generally seen in children and adolescents with intractable epilepsy. This tumor demonstrates typical histological features such as glial nodules and the so called glioneuronal element. The diagnosis of DNET cannot rely just upon imaging features but needs a multidisciplinary contribution from the clinical and diagnostic department involving the clinician, radiologist as well as the pathologist to reach a definite and conclusive diagnosis. However histopathology is the gold standard for the final diagnosis.

Adenoid cystic carcinoma of the parotid gland – A case report and review of literature.

Adenoid cystic carcinoma (ADCC) is a relatively rare malignant salivary gland tumor comprising less than 1% of all malignancies of head and neck. It can arise in any salivary gland site, but approximately 50–60% develops within the minor salivary glands. On fine needle aspiration cytology FNAC), hyaline globules surrounded by neoplastic cells forming a cell ball are the diagnostic. Adenoid cystic carcinoma, being rare, was not suspected at the first instance. The final diagnosis was made from the cytological, radiological, and histopathological reports.

Oncocytoma of parotid gland: A rare case report.

Oncocytomas are benign salivary gland tumors composed of oncocytes, cuboidal to columnar epithelial cells with abundant eosinophilic cytoplasm secondary to the accumulation of excessive number of mitochondria. In 1894, the German pathologist Hurthle first described these granular cells in normal canine thyroid glands, while the term "Oncocyte" was coined by Hamperl in 1931. Fine Needle Aspiration Cytology (FNAC) has increasingly been used as a primary screening tool for salivary gland lesions with high levels of sensitivity and specificity. However, caution should be exercised when interpreting aspirates with predominant oncocytic population. Final diagnosis is assisted by CT and/or magnetic resonance imagine (MRI) of the neck and histopathologic examination.

Lessons in medical ethics from ancient Indian teachers.

Age of medicine is as old as the age of human on the earth. The doctor today is a scientist, technologist and healer at the same time. The ethics germane to the medical profession can’t be simple and uniform. Nor is the ethics simply a matter between the doctor and the patient; the society with its entire economic and political dimension is involved in much bigger way. Certain basic traditional thoughts given by ancient Indian teachers like Hippocrates, Charaka, Sushrutha and Vagbhata are still become relevant. Medical ethics in the medical curriculum, must be included not as a normative discipline but as a practical course with its own problems and considerations. As per Indian outlook, the role of ethics is certainly vast and varied, from treating a common cold, to the controversy on euthanasia, from the simple obligations of a family doctor, to the specialist services in the high cost, high technology five star nursing homes.

Demographic profile of Aluminium phosphide poisoning in Gandhinagar, Gujarat.

Background: Poisoning is an important cause of unnatural death, next to road traffic accidents in India even today. Incidence of aluminium phosphide poisoning is increasing day by day in western region of India including Gujarat. Demographic profile of aluminium phosphide poisoning cases is very helpful to be aware of current scenario and to implement preventive steps for betterment of health services. Objectives: The present study was undertaken to know the demographic profile of aluminium phosphide poisoning cases received as indoor or outdoor patient department of Gayatri Hospital, Gandhinagar, Gujarat, India. Material and methods: History taking, complete examination and necessary investigations of all cases of aluminium phosphide poisoning cases is very helpful to be aware of current scenario and to implement preventive steps for betterment of health services. Objectives: The present study was undertaken to know the demographic profile of aluminium phosphide poisoning cases received as indoor or outdoor patient department of Gayatri Hospital, Gandhinagar, Gujarat, India. Material and methods: History taking, complete examination and necessary investigations of all cases of aluminium phosphide poisoning was done, during the period of two years from 01-01-2012 prevalence of age and sex, socio-economic status, marital status, religion, literacy status, occupational status, time of consumption, manner of poisoning, reasons for suicidal consumption etc. Results: During the study period, 40 cases were diagnosed as of aluminium phosphide poisoning. Majority of the victims were in the age group of 41-50 years (25%), 70% were married, 80% were Hindu, 65% were of lower socio economical class and 57.5% belonged to rural area. Occurrence of aluminium phosphide poisoning was more common in evening time between 5 pm to 11 pm (45%) and among housewives (27.5%). Suicidal cases (82.5%) were more common compared to others. Conclusion: Based on these finding, preventive measures like restriction of sale and availability of aluminium phosphide, good availability of investigation and treatment, promoting poison information centre etc have been put forward.

Hb Q in India: An uncommon hemoglobin variant diagnosed in two patients â Case series.

Hemoglobin Q-India (α 64 Asp→His) is an important member of the hemoglobin Q family, molecularly characterized by the replacement of aspartic acid by histidine. The first case of Hb Q India was reported by Sukumaran in 1972 in a Sindhi family with associated β-halassemia. India is known as a country with a high prevalence of α - and β-thalassemia and different types of hemoglobinopathy. Many of these variants are yet to be identified. Here, we are reporting two cases of Hb Q- India diagnosed during premarital thalassemia screening.

Study of various cardiac arrhythmias in patients of acute myocardial infarction.

Background: Myocardial infarction is one of the major causes of sudden death in present era and cardiac arrhythmias are common complications of it. Material and methods: Present study was conducted at intensive coronary care unit (I.C.C.U) of tertiary care hospital, Ahmedabad on 100 cases of acute myocardial infarction to study the incidence of arrhythmia and their nature in relation with the site of infarction and to evaluate prognostic value of arrhythmias in Acute Myocardial Infraction (AMI). Results: Incidence of various arrhythmias was 76% in present study. S. tachycardia was more common (68%) than S. bradycardia (19%). S. tachycardia and tachyarrhythmia occurred more commonly with anterior wall myocardial infarction, while S. bradycardia and bradyarrhythmia with inferior wall myocardial infarction. Conclusion: Study of incidence of various cardiac arrhythmias, their nature and relation to site of infarction as well as prognostic value in patients of acute myocardial infarction proper treatment.

Nature helps to solve the crime â Diatoms study in case of drowning death.

Nature is everywhere surrounding us in different form. It includes single cell structure to extremely complex, living or non living, substance or creature. One of the important part of nature is diatom - submersion of body into water is known since ages. Diatoms study in case of drowing death is very useful for forensic investigators. It is one of the best example in which nature helps to solve the crime. In present article, we discussed about diatoms, diagnosis of drowning death and length of submersion of body in water with help of diatoms, collection, identification and preservation of diatoms for forensic analysis.

Rare Haemoglobin Variant Hb J Meerut in 27 Years Old Female - A Case Report.

Hemoglobin has plenty of variants and fast moving hemoglobins (FMH’s) are the rare hemoglobin variants. They are having tendency to migrate anodally to hemoglobin A on alkaline gel electrophoresis. Because of the mutation in the globin genes, these hemoglobin variants have the fast moving nature. The basic pathophysiology behind it is the substitution of a negatively charged amino acid residue in either α, β or γ globin chains. Hb J Meerut is an infrequently found α-globin variant. It has previously been reported in various populations around the world. Here, we are reporting a case of Hb J meerut who came to laboratory for thalassemia screening.

Forensic onychology: An essential entity against crime.

Forensic Onychology (Greek word, Onuks = nail, Logia = study of) is the subject which deals with study of fingernails and toenails for better administration of justice in the court of law. Identification means determination of individuality of a person. Nails are important tissues for human identification. One of the major advantages of utilizing nail is that, in comparison with other tissues, sample size and sampling process can be considered relatively non invasive and non destructive and yet each nail retains a discrete record of detailed information on genetic inheritance, drug use, pathology, diet and location history as well as exposure to explosives residues or other pollutants. In contrast to soft tissues, nails survive relatively well in the decomposition environment. Furthermore, in contrast to other long lasting tissues (such as bone and teeth) nails are easy to decontaminate from external sources of DNA. Thus examination of nail is very useful in many ways against crime. In this paper, we discussed about structure and method of analysis of nail, utility of examination, drug use and nails and detection of DNA from nails.

Fine needle aspiration cytology of swellings of head and neck region.

Head and neck mass lesions are frequently found in clinical practice. A spectrum of pathological lesions ranging from simple benign lesion to highly malignant manifestation is observed. Objectives: To make clinicopathological correlation of head and neck lesions and to assess the frequency of incidences of different sites, age groups, sex, and distribution among inflammation and neoplastic lesion. Materials and Methods: A retrospective study was conducted from January 2011 to April 2012. Fine-needle aspiration diagnosis was correlated with details of relevant clinical findings and investigations. Patients aged between 1 and 70 years were included in the study. A total of 200 patients with the swellings of head and neck underwent fine-needle aspiration cytology (FNAC). Results: Out of 200 fine-needle aspiration procedures, 52% were of thyroid, 28.50% were of lymph node, 11% from salivary gland, and 4% from soft tissue and miscellaneous swellings. There were 4.5% cases in which diagnosis was not possible. In inflammatory swelling (33%), tuberculous lymph node (42.12%) involvement is common than all other sites with male preponderance (55%). Conclusion: FNAC is a simple, quick, inexpensive, and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.