Histopathologic diagnosis of lymph node biopsies.

This is a retrospective study of biopsies of lymph nodes received in the department of pathology, Nepal Medical College (NMC), from January 2004 to December 2005. Total number of lymph node biopsies during the two year period was 55, out of which 56.0% cases were females and 44.0% were males with M:F 1:1.29. Most common cause of lymphadenopathy was tuberculosis and most common group of lymph node was cervical lymph nodes. Metastatic deposits were seen in only six cases. So, like other developing countries, in our country also, tuberculosis is the leading cause for lymphadenopathy.

Rapid detection of helicobacter pylori by endoscopic brush cytology and comparison with histopathology.

OBJECTIVES: The main objective of this study was to assess antral brush cytology as an alternate approach for the diagnosis of H. pylori infection as compared to histopathology. METHODS: 75 cases with diagnosis of antral gastritis underwent endoscopic antral biopsy as well as antral brushing cytology was included irrespective of age and sex. Cytological slides were stained with Giemsa stain & biopsy slides were stained with H&E and Giemsa stain. Correlation was done between cytological smear slides and biopsy slides. RESULTS: Among 75 cases, H. pylori were positive in 55 (73.4%) cases of biopsy specimens while in brush cytology it was positive in 48 (64%) cases. In 45 (60%) of 75 cases, H. pylori was seen in both biopsy and brush cytology. CONCLUSION: Endoscopic brush cytology provides an accurate, inexpensive and easy technique in the rapid detection of H.pylori infection.

Study of effusion cytology in patients with simultaneous malignancy and ascites.

OBJECTIVE: To evaluate sensitivity of effusion cytology in detecting malignancy. MATERIALS AND METHODS: Effusion cytology was studied from 37 malignancy associated and 28 non malignancy associated ascitic fluid samples. RESULTS: Out of 65 cases, 44 (67.7%) effusions were reported negative, 15 (23.1%) were positive and 6 (9.2%) were suspicious for malignancy. Thus total 21 effusions (32.3%) were tumour cell positive. All 21 (100%) were true positive, none (0%) was false positive, 28 (63.6%) were true negative and 16 (36.4%) were false negative. Thus ascitic fluid cytology had sensitivity of 56.7% and specificity of 100%. Predictive value of positive test and negative test was 100% and 63.6% respectively. Stomach was the most common primary site of malignancy associated with ascites (11/37 i.e. 29.7%) where as adenocarcinoma was the most common type of malignancy (11/15 i.e.73.3%) in ascitic fluid cytology. CONCLUSION: Ascitic fluid cytology is a simple and useful procedure with sensitivity of 56.7% and should be routinely requested.

Malignant teratoid medulloepithelioma in eye.

Malignant teratoid medulloepithelioma is an extremely rare tumor occurring in children younger than 5 years of age, arising from ciliary body epithelium or iris but few arise from optic nerve and retina. This report concerns a 5 years old boy who presented with pain, redness and protrusion of right eye. Histopathologically, the tumor was composed of epithelial and sarcomatoid component. The pseudostratified primitive appearing epithelial cells were arranged mainly in diffuse pattern, nests cords and tubules. At places, pseudo rosette and true rosette were seen. Mitoses were frequent consisting of 7-10/ HPF. The sarcomatoid component consisting of spindle shaped cells arranged in interlacing bundle were also seen. Mitoses counted 5-7/HPF. Massive areas of necrosis and hemorrhage along with calcification, focal area of mature cartilage were present. Vascular and optic nerve invasions were seen. This case of malignant teratoid medulloepithelioma is the second case diagnosed in TU Teaching Hospital within the period of 10 years and reported because of its rarity. The differentiations from other tumors of the orbit such as small cell tumor were discussed.

Seasonal distribution of enteropathogens detected from diarrheal stool and water samples collected in Kathmandu, Nepal.

A total of 334 diarrheal fecal samples (from 210 males and 124 females) collected in Kathmandu, Nepal, were studied for various kinds of enteropathogens. Overall, 33% (111/334) fecal samples were positive for one or more enteropathogens. There was no difference in detection rates between males and females. Enteropathogen detection rates in summer, winter, spring, and autumn were 61% (40/66), 52% (45/87), 31% (25/81), and 25% (25/100), respectively. Altogether eight species of bacteria, three genera of viruses, and five species of protozoan parasites were detected with considerable seasonal variations. Among the bacterial isolates, enteropathogenic Escherichia coli topped the list followed by Vibrio sp. Only one sample had Shigella (S. sonnei). Rotavirus type A was the most frequently detected among the enteric viruses, followed by human enterovirus and human adenovirus, respectively. Among the enteric protozoan parasites, Giardia intestinalis was the most frequently detected followed by Cryptosporidium parvum. Detection of bacterial and protozoan pathogens showed a slightly high tendency in the summer season compared with that in the other seasons (p>0.05), whereas the detection of viruses was significantly high in the winter season (p<0.05). Of the total 57 water samples, 43 (75%) showed one or more bacterial species out of which 51% (22/43) were E. coli. Among the E. coli isolates, 68% were EPEC. Enterohemorrhagic E. coli (O157) was not detected.

Toxoplasma antibody prevalence in Nepalese pregnant women and women with bad obstetric history.

Sera from randomly selected 345 pregnant Nepalese women aged 16-36 years and 13 women with bad obstetric history (BOH) were tested for the presence of Toxoplasma antibodies using microlatex agglutination (MLA) and ELISA methods. The overall prevalence was 55.4% (191/345). Prevalence was slightly higher (59.0%) in older age-group (27-36 years) compared with younger age-group (16-26 years) (52.2%). No significant difference in antibody prevalence in women belonging to two different ethnic-groups (Tibeto-Burmans 57.8%, Indo-Aryans 52.7%) was observed (p>0.05). MLA antibody titer ranged from 1:16 to 1:2,048. Over three-fourth of the women showed either high (1:510 or over) or low (1:16 or 1:32) antibody titer. Three percent (6/191) of MLA antibody positive subjects had Toxoplasma IgM antibodies by IgM-ELISA. All six IgM antibody positive pregnant women had MLA antibody titer of over 1:510. Of the total 13 women with BOH, 5 (38.5%) had Toxoplasma antibodies of which 2 (40.0%) were positive for Toxoplasma-IgM antibodies.

Seroepidemiological study of Toxoplasma infection in central and western regions in Nepal.

The present study was carried out to ascertain the seroprevalence rate in different geographical areas in Central and Western Regions in Nepal. A total of 1,237 serum samples collected from Nuwakot (217), Kathmandu valley (402) and Chitawan (159) districts in Central Region, and Mustang (143), Surkhet (64) and Banke (252) districts in Western Region in Nepal were included in this study. Toxoplasma antibodies were detected by micro-latex agglutination (MLA) and enzyme linked immunosorbent assay (IgM-ELISA) methods. The seropositive rate in Central and Western Regions were found to be 48% and 49%, respectively; with an overall positive rate of 48 percent. Districtwise, the seropositive rate in Nuwakot, Kathmandu valley, Chitawan, Mustang, Surkhet and Banke districts were 38, 46, 64, 51, 67 and 44%, respectively. Interestingly, the relatively newly inhabited Surkhet district in Western Region and Chitawan district in Central Region showed significantly higher seropositive rate compared with those of two other districts in the respective Regions (p < 0.05). Ethnically, Tibeto-Burmans showed higher seropositive rates in Central Region (p > 0.05). In contrast, Indo-Aryans showed higher seropositive rate in Western Region (p > 0.05). Age related increase in seropositivity was observed only in Central Region. One percent of Toxoplasma antibody positive samples also showed Toxoplasma IgM antibody positivity.

Seroepidemiological study of Toxocara infection in Nepal.

Seroepidemiological study of Toxocara infection in Nepalese people aged more than fourteen years was carried out by enzyme linked immunosorbent assay (ELISA) using T. canis soluble embryonated egg antigen. Of the total 200 subjects included in this study, 162 (81%) were found to possess antibodies to Toxocara spp. Males showed higher (85%) antibody positive rates than females (77%). Inhabitants of Kathmandu valley showed higher antibody positive rates (84%) compared with those living outside of the valley (78%). These differences, however, were not significant statistically (p > 0.05). Ethnically, Newar, Rai/Limbu, Tamang/Sherpa, Brahmin/Chhetri, Jha/Yadavs, and others (Kami, Damai) showed Toxocara antibody positive rates of 85, 85, 83, 70, 77 and 100%, respectively. Half of the Toxocara antibody positive subjects (49%) showed an elevated level (two plus) of antibody.

Seroepidemiological study of toxoplasmosis in two different geographical areas in Nepal.

A total of 302 serum samples collected from Chitawan (159) and Mustang (143) districts of Nepal were included in this study. Anti-toxoplasma antibody was detected using micro-latex agglutination (MLA) and ELISA methods. An overall positive rate was found to be 57.9%. The positive rate in Chitawan was significantly higher (64.1%) (less than 1,000 m altitude) compared to that in Mustang (51.0%) (more than 3,000 m altitude) (p < 0.05). Females in Chitawan showed significantly higher positive rate (71.2%) compared to males (56.9%) (p < 0.05). On the contrary, though insignificantly, males showed higher positive rate (57.9%) compared to that of females (43.3%) in Mustang. Almost equal positive rate was observed among males in both study area. Females in Chitawan showed significantly higher (71.2%) positive rate compared to their counterparts in Mustang (43.3%) (p < 0.001). A slight increase in positive rate with age was observed in Chitawan while in Mustang a decreasing trend was noticed. Ethnically though statistically not significant, Indo-Aryans showed a higher positive rate (69.2%) compared to the positive rate shown by Tibeto-Burmans (63.1%) in Chitawan while the reverse was true in Mustang (Tibeto-Burmans: 53.8% and Indo-Aryans: 38.4%). Interestingly, 2.9% and 1.3% of MLA positive samples showed toxoplasma IgM antibody. None of the IgM positive samples were positive for toxoplasmic antigens.