Breast Tuberculosis - Experience of Cases in a Tertiary Care Institute.

Aim: The study was conducted with an aim to suspect and diagnose “breast tuberculosis (TB)” cases early to avoid unnecessary delay in their treatment. Materials and Methods: For this purpose, the cases of breast complaints presenting in the Department of Surgery were clinically examined, investigated with fine-needle aspiration cytology (FNAC) or biopsy along with other relevant investigations. FNAC or biopsy positive for breast TB cases were further investigated by chest X-ray and/or sputum acid-fast bacilli for any evidence of pulmonary TB. Results: A total of 9 cases of breast TB were collected. Out of these 9 cases, 7 cases were adult females in the age group of 24-40 years. Cases 1, 2, 5, 6, and 9 were non-lactating, while Cases 3 and 7 were lactating. Case 4 was a 12-year-old girl and Case 8 was 25-year-old male. All the cases were involving the right breast except Case 5, which was involving both breasts, and Case 6, which was involving left breast. Case 5 was also having active pulmonary TB. Case 7 was showing Ziehl-Neelsen staining positive for AFB in breast tissue sample. We treated all cases with first-line four drugs (HRZE) for initial 2 months and two drugs (HR) for another 4 months except in Cases 1 and 5 where the continuation phase was extended to 6 months. Conclusion: Histopathological diagnosis is a more reliable and accurate as compared to the bacteriological diagnosis of tubercular mastitis. Four drugs therapy for 6 months is adequate. The majority of the cases will heal without major surgery, and mastectomy should be reserved for extensive breast destruction and unresponsive cases.

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.

Non-surgical Management of oral Hemangioma.

Background: Hemangiomas are solitary or sometimes multiple flat or raised reddish blue lesions. These are benign, vascular tumours that can lead to disfigurement or may become life threatening. Oral mucosa and skin are most commonly affected. Many modes of therapy have been advised for hemangiomas, which include cautery, cryotherapy, radiotherapy and sclerosing agents. Aims & Objective: Present study was undertaken to study the non-surgical management of oral hemangioma. Material and Methods: A prospective study of all clinically diagnosed cases of oral hemangioma at a tertiary care hospital was carried out. Surface anaesthesia was given by 15% xylocaine spray. 3% sodium tetradecyl sulphate was given as intralesional injection at multiple sites with insulin syringe. 0.1 to 1ml of STS was injected depending upon the size of lesion. Follow up examination of all cases was done. Results: A total of 15 cases were included in the study, in a period of 5 years. Hemangioma regressed in all cases with relief of symptoms. All patients complaining of bleeding, inflammation and pain were given analgesic and anti-inflammatory drugs. Complete remission was seen in 86.67% of the patients. 13.33% showed partial regression with ulceration and sloughing, which subsided with subsequent treatment. Conclusion: Various treatment modalities are recognised in the management of oral hemangiomas. Use of 3% sodium tetradecyl sulfate is cheap, very effective and easy treatment modality. However, judicial use of dose, number and site of injections is advised to prevent further complications.

Anti-microbial properties of human wax.

Background: Human wax is a mixture of desquamated keratinocytes secreted in outer third of the wall of external auditory canal. The wax produced forms a physiological barrier between the external environment and deep external auditory canal. The antibacterial and antifungal properties of human wax due to its chemical composition have raised considerable debate. Different authors have different views regarding the antimicrobial property of human wax. Aims & Objective: Present study was undertaken to study the antimicrobial property of human wax and to assess its preventive actions against some common flora. Material and Methods: A prospective study of healthy individuals, both males and females, of all age groups, without any pathology in the external and middle auditory canal who presented at outpatient department of a tertiary care hospital in this region and few other private hospitals. Samples were collected from patients and studied for their antimicrobial effect. Results were recorded and analysed. Results: A total of 100 cases were included in the study, of which 52 sterile samples were tested with some common microbial flora. Data obtained was analysed. Conclusion: Variable results have been observed by different authors regarding antimicrobial properties of human wax. Our study highlights the antimicrobial property of human wax and signifies the role of further studies for antibacterial and antifungal role of human wax in diseased auditory canals.

Tympanosclerosis causing blockage of Middle Ear Cleft.

Background: Middle ear cleft space starts from Eustachian tube, and includes middle ear, aditus & mastoid antrum. It develops from 1st visceral pouch. Blockage of middle ear cleft, particularly the aditus can result from a number of reasons. Tympanosclerosis creates obstruction in aeration of middle ear and mastoid antrum. Aims & Objective: To study effect of tympanosclerosis on blockage of middle ear cleft. Material and Methods: A retrospective study of all cases of cortical mastoidectomy surgeries done in a Tertiary care centre in Western U.P. was carried out. Relevant clinical data and histopathology reports were obtained from hospital records and the data was analysed. A total of 20 cases of cortical mastoidectomy were included in the study. Results: A total of 20 cases were included in the study, in the age group of 16 to 58 years. Tympanosclerosis was seen in 13 cases. In tympanosclerosis positive group, the mean age was 25-32years. The aditus was not patent in 10(50%) of patients in this group. Conclusion: Tympanosclerosis is a non-specific result of chronic inflammatory process and causes an increased risk for blockage of aditus through plaque formation. Clearance of these plaques and cortical mastoidectomy prevents recurrences.

A study of seroprevalence and determinants of HIV and HBsAg among antenatal mothers in tertiary and secondary care hospital at Bareilly.

Background: HIV and Hepatitis B are devastating diseases causing serious global public health problems and are rampant in this part of the country. Risk of vertical transmission occurs in a large number of cases in the absence of immunoprophylaxis. About 30% of world’s population has serological evidence of current or past infection with HBV. Detection of carriers is important in control of infections of this magnitude, failure of which may result in serious complications. Aims & Objective: To study of seroprevalence & determinants of HIV and HBsAg among antenatal mothers in tertiary & secondary care hospitals at Bareilly. Material and Methods: The study was conducted at the Department of Pathology & Microbiology, Rohilkhand Medical College and Hospital, Bareilly. All patients attending Antenatal OPD of a Tertiary and secondary care hospitals, over a period of three years were assessed by subjecting them to serological tests for detection of HIV & HBsAg. Data was extensively analyzed and compared. Results: A total of 30,162 patients attended antenatal OPD during the study period, of which 20,699 were tested for HIV and 20,941 were tested for HBsAg. Of these, 12 (0.058%) were positive for HIV and 37 (0.18%) were positive for HBsAg. Conclusion: We studied the dynamics of HIV and Hepatitis B Virus transmission among pregnant women and the factors responsible for its spread to help us take plausible interventions to prevent vertical transmission. The seroprevalence of HIV & HBsAg was low, nonetheless posing a major cause of morbidity and mortality. Prevalence of HIV is found to be low, but it cannot actually be determined due to a very high refusal rate.

Bacterial and fungal causes of hemoptysis in patients of a tertiary care center in Western Uttar Pradesh.

Objective: To study the various bacterial, fungal and neoplastic causes of hemoptysis in patients of different age groups in a teaching hospital in western Uttar Pradesh (U.P) Materials & Methods: One hundred & Eighty patients who were admitted to the Department of Chest & T.B and in the Department of Medicine from Jan 2010 to Jan 2012 were included in this study. The patients were characterized on the basis of Clinical signs & symptoms, physical examination, complete blood count with platelets, bleeding time, clotting time, prothrombin time [clotting profile] chest radiography, CT scan, bronchoscopy, histopathological examination and microbial examination including culture of sputum & Bronchoalveolar Lavage. Results: Out of 180 patients admitted, 114 were males & 66 were females. The cause has been identified in 55 patients (32 males & 23 females) while in remaining cases the cause was undiscovered. Pulmonary tuberculosis was identified as the most leading cause of hemoptysis (38.16%) [Mycobacterium tuberculosis alone and M. tuberculosis with other bacteria in case of coinfection], followed by bacterial agents [Staphylococcus aureus (9.09%), Klebsiella spp (9.09%), Pseudomonas aeruginosa (5.45%) and Streptococcus pneumoniae (1.81%). Among the fungal agent we have found Aspergillus spp (10.9%) and Mucor in 1 case (1.81%). The other group of patients include the neoplasms (20.0%). Coinfection was seen among (14.54%) patients and the agents were [Mycobacterium tuberculosis & Pseudomonas aeruginosa] (5.45%), [M. tuberculosis & S. aureus] (3.63%), [M.tuberculosis & klebsiella spp] (1.81%), [Klebsiella & S.aureus] (3.63 %) Conclusion: In developing countries like India with such an increasing population, hemoptysis is one of the potentially life threatening symptom of underlying respiratory tract infection. An adequate & efficient evaluation of the etiological agents causing hemoptysis plays a pivotal role in management of such patients. The purpose of this study was to identify the different etiological agents along with the other causes of hemoptysis.

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.