Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients – A consensus document

In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.

Role of FNAC in cytological diagnosis of metastatic lymph node.

Background: FNAC not only confirms the presence of metastatic disease, but also gives the clue regarding the nature and origin of primary malignancy Aim and objective: To Assess the usefulness of FNAC in diagnosis of metastatic lymph node. Data were arranged according to lymph node involved and morphological diagnosis. Study design: Study material comprises of 56 lymph node aspirate diagnosed metastatic carcinoma in cytology out of total 383 cases of Lymphnode aspiration in a one year. Method: All FNACs were performed using a 22 gauge needle. An average minimum of 4 slides were made, Slides were routinely stained with both leishmann, Giemsa and Papanicolaou (PAP) stains. Results: Out of total 383 lymph node aspirate 56 cases showed metastasis Lymphnode while 327 cases showed other lesion of lymph node. Cervical lymph node was the commonest group involved. Metastasis from squamous cell carcinoma was the most common diagnosis made on cytology. Conclusion: In our study we feel that FNAC of lymph nodes as a first line of investigation in developing countries. It is not only useful in the diagnosis of suspected or unsuspected metastatic neck nodes, but can also help in starting the specific therapy in time thus reducing mortality and morbidity.

Atypical contents of inguinal hernial sac: A surgical dilemma.

Unusual contents in inguinal hernial sac are uncommon. Appendix, ovary or urinary bladder is more frequent than other abdominal organs. To deal with an unexpected organ during surgery is a surgical dilemma. We present two cases of appendix (Amyand’s Hernia) and third one with ovary in inguinal sac.

Histiocytic necrotising lymphadenitis (kikuchi's disease) [a 5 year histomorphological study].

Background: Kikuchi’s disease is a rare, benign, self-limiting disease, mainly involving the lymph nodes of young people. The disease has unknown etiology. Clinical symptoms and basic investigations in a patient often leads to a misdiagnosis, due to similar findings in other lesions like, lymphomas and chronic granulomatous inflammations of lymph nodes like tuberculosis. Lymph node biopsy shows characteristic diagnostic features. Methods: We studied all lymph node biopsies received in department of pathology & from other private laboratories in Rural and Urban areas, in & around Bareilly region of North India, in 5 years (2006-2010). Relevant clinical data was collected. Findings were correlated with previous studies. A total number of 1015 cases were examined. Results: A total of 15 cases showed histopathological features of Kikuchi’s disease. Most number of cases was seen in females, in the age group of 20-25 years. Patients presented with fever and lymphadenopathy, with a clinical provisional diagnosis of tuberculosis in maximum number of cases.Conclusion: Necrotising lymphadenitis has a striking predilection for cervical lymph nodes of females and is usually accompanied by fever. Most commonly, this disease is mistaken for tuberculosis or Lupus Lymphadenitis. Detailed clinical examination and characteristic histopathological findings help in diagnosing these lesions.

A histomorphological study of resected mediastinal tumors.

Background: The numerous structures within the mediastinum, make it prone for development of various congenital cysts, benign & malignant neoplasms. Cystic lesions and small tumors are asymptomatic in half of the patients and symptoms develop as a result of compression or invasion. These tumors are thus discovered at very late stages, which proves fatal, or, are diagnosed incidently. Methods: We analysed all resected mediastinal tumor specimens received in Department of Pathology & from few other private laboratories in Rural and Urban areas, in & around Bareilly region of North India. In 10 years duration, a total number of 38 cases were examined. Information was collected from detailed gross & microscopic examination and correlated with that of previous studies. Results: Mediastinal tumors occur more in males, with higher frequency of malignant lesions than benign. Predominant tumors are thymomas occurring in middle age group(20-29yrs), followed closely by neurogenic tumors. Conclusion: This study stresses upon the importance of early screening of all patients with suspicion, with help of radiological modalities along with FNAC & mediastinoscopy. Possible causes of increasing incidence of thymomas in children younger than 16yrs age should be further evaluated.

Wilson's disease in Eastern India.

INTRODUCTION: Wilson's disease is an inherited autosomal recessive (AR) disorder of copper metabolism transmitted by a mutant gene on chromosome 13q14-21 and results in abnormal accumulation of copper giving rise to protean manifestations. AIM: The aim is to study the clinical features, biochemical and radiological abnormalities of this disorder in Eastern India and the effect of treatment. RESULTS: Forty nine (n = 49) cases were studied over a period of 10 years. Majority of patients were male with mean age of onset being 11.13 years. They commonly presented with dysarthria, dystonia or drooling. The clinical features were dystonia (96%), silly smile (92%), dysarthria (80%), cognitive decline (71%), tremors (47%), bradykinesia (45%), etc. Family history suggested an autosomal recessive pattern. Sibling screening revealed that 4/8 (50%) were presymptomatic. All but one had presence of Keyser Fleischer (KF) ring in their cornea. Serum copper was reduced in 77% while ceruloplasmin was less in 94% of cases. The commonest abnormality seen in CT/MRI were in basal ganglia (74%) followed by white matter changes (59%) and brain stem changes (20.5%). The response to treatment was not as good and there was an initial deterioration in 50% of cases. Only five patients could go back to their school. CONCLUSION: Wilson's disease have protean manifestations. All children with slowly progressive extrapyramidal syndrome should be investigated for it. Screening of all asymptomatic siblings for Wilson's disease must be carried out. Early institution of proper treatment and life long continuation is indicated in all. In the present series, an earlier age of onset of neurological signs and symptoms were seen; there was initial deterioration in 50% of cases and the response to treatment was not as good.

Inhibition of aflatoxin production & growth of Aspergillus flavus by eugenol & onion & garlic extracts.

Efficacy of natural non-toxic materials including extracts of onion and garlic as well as eugenol was tested against aflatoxin production by A. flavus in liquid SMKY medium and in maize grains. Maximum inhibition in the mycelial growth occurred with garlic extract (61.94%), whereas inhibition of aflatoxin production was highest (60.44%) due to onion extract. Eugenol was most suitable for inhibiting aflatoxin production (60.35%) on maize grains.

Vitamin C status, glutathione and histamine in gastric carcinoma, tuberculous enteritis and non-specific ulcerative colitis.

Studies were conducted to evaluate the blood levels of ascorbic acid, dehydroascorbic acid, glutathione, and histamine in patients with gastric carcinoma, tuberculous enteritis and non-specific ulcerative colitis. Leucocyte ascorbic acid, urinary excretion of total ascorbic acid and ascorbic acid saturation test were also carried out in order to assess the ascorbic acid status of these patients. It was observed that the plasma and leucocyte content of ascorbic acid was significantly lower with markedly decreased urinary excretion in these patients. Further urinary excretion of ascorbic acid after a test dose was also found to be subnormal. Decreased levels of glutathione and significantly higher levels of histamine reflect an overall reducing status of the body is markedly deranged.