Peripheral T cell lymphoma: Clinico-pathological characteristics & outcome from a tertiary care centre in south India

Background & objectives: Peripheral T cell lymphomas (PTCLs) are a heterogeneous group of non-Hodgkin's lymphomas (NHLs), with universally poor outcome. This study was undertaken to provide data on demographics and outcomes of patients with PTCL who underwent treatment in a single tertiary care centre in southern India. Methods: Retrospective study was done on all patients (age ?18 yr) diagnosed with PTCL from January 2007 to December 2012. The diagnosis of PTCL was made according to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Results: A total of 244 adult patients were diagnosed with PTCL (non-cutaneous). The most common subtype was PTCL-not otherwise specified (35.7%), followed by anaplastic large cell lymphoma (ALCL), ALK negative (21.3%), natural killer/T cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), ALCL, ALK positive, hepatosplenic T cell lymphoma (HSTCL) and adult T cell leukaemia/lymphoma followed in frequency with 13.1, 11.5, 8.6, 8.2 and 1.6 per cent cases, respectively. The three-year Kaplan-Meier overall survival (OS) and event-free survival (EFS) for the patients who received chemotherapy (n=122) were 33.8�0 and 29.3�7 per cent, respectively. Various prognostic indices developed for T cell lymphomas were found to be useful. Interpretation & conclusions: Except for ALCL, ALK positive, all other PTCLs showed poor long-term outcome with CHOP-based chemotherapy. Novel therapies are needed to improve the outcome.

Placental Thickness- A Sonographic Evaluation of Gestational Age

Background: Ultrasound is being used in obstetrics for assessment of fetal well-being and for accurate assessment of gestational age. The various parameters used in ultrasonography are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), crown-rump length (CRL) etc. The present study is conducted to assess the relationship of placental thickness with gestational age.Methods: A total of 100 normal pregnant cases were subjected to ultrasonographic examination and gestational age was calculated by measuring biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) by ultrasonography. Placental thickness was measured at the level of cord insertion with 3 Mhz sector probe. Symphysio-fundal height was also measured and gestational age was calculated by comparing with the standard chart. Results: A high degree of correlation is found between the gestational age and the fundal height (r=0.991, p< 0.001), bi-parietal diameter(r=0.964, p< 0.001), head circumference (r=0.979, p<0.001), femur length (r=0.99, p< 0.001), abdominal circumference (r=0.975, p<0.001). Conclusion: In this work placental thickness was taken as a new parameter for predicting gestational age and a good correlation between them was marked (r=0.993, p<0.001).

Bone turnover markers in women can predict low bone mineral density.

Background: Morbidity and mortality associated with osteoporosis continues to be high in India due to late diagnosis. This study aims to find the difference in the levels of bone turn over markers in premenopausal and postmenopausal women, in order to assess whether these markers can be used as predictors of low bone mineral density which can develop in later life. Methods: Study was conducted on 350 women aged 30-65 years. Women were classified into premenopausal and postmenopausal groups based on their menstrual history. Serum samples were analyzed for osteocalcin and telopeptide-C. Student’s t-test and logistic regression are used for statistical confirmations. Results: Levels of these markers (ng/ml) were found to be lower in premenopausal women (Osteocalcin = 9.0 ± 1.0; telopeptide-C = 0.270 ± 0.099) than in postmenopausal women (Osteocalcin = 9.8 ± 1.7; telopeptide-C = 0.490 ± 0.135) and this difference was found to be significant (P <0.001) for both the markers. In both the groups, telopeptide-C made significant contribution to prediction of low BMD [(Premenopausal group - odds ratio (OR) = 2.9; 95% confidence interval (95%CI) = 1.3-6.5 and postmenopausal group - OR = 9.6; 95%CI = 6.0-13.23) but osteocalcin could not (premenopausal group - OR = 0.91; 95%CI = 0.58-1.42 and postmenopausal group - OR = 0.87; 95%CI = 0.54-1.4)]. In premenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 2.9 times while in postmenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 9.6 times. Conclusion: Women with higher levels of telopeptide-C need to be identified at an early stage as it provides with an early warning of the possibility of future development of osteoporosis so that preventive measures can be taken timely.

Correlation Of Bone Turnover Markers With Age, BMI And Serum Oestradiol In Pre And Postmenopausal Urban Women.

Abstracts: Background: Rapid bone loss occurs in women after menopause due to hormonal factors that lead to an increased susceptibility to fractures. This study was done to find out the correlation of osteocalcin and telopeptide-C with age, body mass index (BMI) and oestradiol in premenopausal and postmenopausal women. Methodology: Study was conducted on 350 women aged 30–65 years who were classified into premenopausal and postmenopausal groups. Serum samples were analysed for oestradiol, osteocalcin and telopeptide-C. Pearsons correlation was used for statistical confirmations. Results: Osteocalcin was found to be correlated with age (r= +0.56, p<0.001), BMI (r= -0.39, p<0.001), oestradiol (r= -0.21, p<0.01) and telopeptide-C (r= +0.18, p<0.05) in postmenopausal women but no correlation was found in premenopausal women. Telopeptide-C was found to be correlated with age (r= +0.39,p<0.001), BMI (r= -0.29,p<0.001) and oestradiol (r= -0.48,p<0.001) in postmenopausal women; in premenopausal women it was found to be correlated with BMI (r= -0.30,p<0.001) and oestradiol (r= -0.29,p<0.001). Conclusion: Inverse correlation of Telopeptide-C with BMI and serum oestradiol in premenopausal and postmenopausal women suggests that their increased bone turnover was linked to low BMI and oestrogen deficiency.

Effect of long term supplementation of tomatoes (cooked) on levels of antioxidant enzymes, lipid peroxidation rate, lipid profile and glycated haemoglobin in Type 2 diabetes mellitus / Efectos de la suplementación a largo plazo con tomates (cocidos) en los niveles de enzimas antioxidantes, el indice de peroxidación lipídica, el perfil lipídico, y la hemoglobina glicada en la diabetes de tipo 2

The objective of the present study is to evaluate the beneficial effect of tomatoes, which are a rich source of lycopene, a relatively new carotenoid known to play an important role in human health. In this study, the lipid peroxidation rate was investigated by estimating malondialdehyde (TBARS) levels of antioxidant enzymes like SOD, GSH-Px, GR, GSH, lipid profile, which includes total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, very low density lipoprotein, and glycated haemoglobin HbA1c in (n = 40) the Type 2 diabetic group (n = 40) and an age-matched control group (n = 50). Significantly lower levels of antioxidant enzymes and very high lipid peroxidation rate in the Type 2 diabetic group were observed when compared to controls (p 0.10). These findings suggest that tomato lycopene may have considerable therapeutic potential as an antioxidant but there was no significant lipid lowering effect in Type 2 diabetes mellitus.

El objetivo del presente estudio es evaluar el efecto beneficioso del tomate como fuente rica en licopeno – un carotenoide relativamente nuevo, del cual se sabe que juega un importante papel en la salud humana. En este estudio, investigamos el índice de peroxidación lipídica, estimando los niveles MDA (TBARS) de las enzimas antioxidantes como SOD, GSH-Px, GR, GSH, el perfil lipídico, que incluye el colesterol total, los triglicéridos, los HDL, LDL, VLDL, y la hemoglobina glicada (HbA1c) en (n = 40) en el grupo diabético tipo 2 (n = 40) y el grupo de control pareado por edad (n = 50). En este estudio, observamos niveles significativamente más bajos de enzimas antioxidantes e índices de peroxidación lipídica muy altos en el grupo diabético tipo 2, en comparación con el grupo control (p < 0.001). Asimismo observamos niveles significativamente más altos de perfil lipídico y hemoglobina glicada (HbA1c) en el grupo diabético al comparársele con el grupo control (p < 0.001).

Percutaneous dilational tracheostomy: an initial experience in community based teaching hospital.

Percutaneous dilational tracheostomy (PDT) is frequently performed in the intensive care unit to prevent the long term complications associated with prolonged endotracheal intubation. OBJECTIVE: To report the analysis of our experience with percutaneous dilation tracheostomy. STUDY DESIGN: A prospective documentation of 40 patients who received percutaneous dilational tracheostomy in a multidisciplinary intensive care unit during a 12-month period. METHOD: The patients demographic, indications of intubation and PDT, time required to perform the procedure, complications and the outcome of these patients in the intensive care unit were noted. RESULT: Among 425 patients, 40 underwent percutaneous dilational tracheostomy that included 22 females and 18 males with the median age of 35 years. Prolonged ventilatory support was the most common indication for tracheostomy. The average duration of intubation before PDT was 5 days. Median procedure time was 20 minutes. Complications included minor bleeding in two (5%), subcutaneous emphysema with pneumothorax in two patients (5%), tracheal stenosis in three (7.5%), tracheo-esophageal fistula and glottic granuloma in one patient each (2.5%). Among forty patients, 28 (70%) were discharged to the ward, 8 died in intensive care unit and 4 left hospital against medical advice. CONCLUSION: Percutaneous dilational tracheostomy is a safe, quick and effective way for long term airway management in critically ill patients.

Study of fifty human tali for calcaneal articular facets.

Fifty adult dry human tali from the Department of anatomy, Nepalgunj Medical College Chisapani, were studied. Observations were made on different types of articular facets of calcaneus for the tali. They were classified into four groups and their percentages of incidences were calculated. These findings were well correlated and compared with the literatures available.

A study of metopic sutures in human skulls.

The present study has been carried out in fifty-one adult human skulls for metopic sutures in the department of anatomy, Nepalgunj Medical College, Chisapani. Metopic sutures were found in six skulls (11.46%) This study showed higher incidences of incomplete metopic sutures (7.84%). One skull showed double incomplete sutures (one to right of bregma and other in the middle of the frontal bone in the mid line), which was of, a very rare variety seen in frontal bone of (1.96%), three skulls showed incomplete sutures (3.92%). Though the number of the skulls was small, the study showed a rare morphological variety, which was well correlated with earlier workers.

Role of non-H2O2 producing lactobacilli and anaerobes in normal and complicated pregnancy.

Lactobacilli (Doederlein's bacilli) are the most important predominant protective agents of the vaginal microbial ecosystem and alteration in vaginal pH directly speculates the concentration of lactobacilli. Currently, recognition of anaerobic lactobacilli (non-H2O2 producing lactobacilli) had further raised its significance. Therefore, the present study was aimed to explore the role of non-H2O2 lactobacilli and its association with other anaerobes in 100 cases of complicated pregnancy, 75 cases of normal pregnancy and 35 cases in non-pregnant women. Vaginal and cervical swabs were obtained and were inoculated in special and suitable media. Anaerobic lactobacilli (non-H2O2 producing) were more common genital microbes in women of complicated pregnancy (56.0%) than in normal pregnancy (34.7%) and in control group (14.2%). Rate of recovery of non-H2O2 producing lactobacilli increased when pathogenic bacteria especially anaerobes dominate the genital microflora. Anaerobic lactobacilli were seen in higher numbers when they were associated with bacteroides sp and other anaerobes. They were significantly reduced when aerobes predominated in flora; the correlation have been discussed.

Aplasia cutis congenita.

Two cases of aplasia cutis congenita are reported here. One of the cases also had pre- and postaxial polydactyly and other digital anomalies.

Triple-drug therapy of Helicobacter pylori infection in duodenal ulcer disease.

OBJECTIVE: To evaluate the efficacy of triple-drug therapy for Helicobacter pylori infection and the effect of its eradication on relapse of ulcer in patients with duodenal ulcer (DU) disease. METHODS: Patients with uncomplicated DU who were H. pylori-positive on urease test or histology were given triple-drug therapy (metronidazole, tetracycline, colloidal bismuth subcitrate). Ulcer healing and H. pylori status were assessed one month after completion of therapy. Those with healed ulcers were followed up endoscopically for ulcer recurrence at 3-month intervals for one year or more. RESULTS: Fifty seven of 60 consecutive DU patients (95%) who were H. pylori-positive were taken up for the study; 46 patients (36 men; median age 40 years, range 13-70) completed the study. Thirty one of them (67%) eradicated H. pylori and had healed ulcers at one month post therapy; of 15 patients with persistent H. pylori infection, ulcers healed in 12 (p = ns). After an average follow up of 11 months, 8 of 12 H. pylori-positive patients had relapse of DU compared to 5 of 31 (16%) H. pylori-negative patients (p < 0.01). CONCLUSIONS: Triple-drug therapy was effective and safe for H. pylori infection, the lower rate of eradication observed compared to results elsewhere probably being related to bacterial resistance. Eradication of H. pylori was associated with healing of ulcers, resolution of antral gastritis and a significant fall in the rate of ulcer relapse.

Inflammatory pseudotumour of liver--a case report.

A rare case of inflammatory pseudotumour of liver in a child is reported. The child presented with obstructive jaundice and was considered to have malignant tumour of liver clinically and by imaging modalities. Resection of left hepatic lobe with the mass was done. Histologically, the lesion consisted of an admixture of proliferation of lymphocytes, plasma cells and fibroblasts along with vasculitis and variable amount of hyaline fibrosis. Adjacent liver showed evidence of biliary cirrhosis and multiple microabscesses. Many of the previously reported cases were also diagnosed clinically and radiologically to be malignant tumours of liver. The case is reported to create awareness of this rare entity.

Comparative study of immunoglobulin G and immunoglobulin M among neonates in caesarean section and vaginal delivery.

The present study comprised 50 cases of normal vaginal delivery and 50 cases of caesarean section. The cord blood level of immunoglobulin G was significantly higher in normal vaginal delivery cases than in caesarean section cases (mean level is 1653.2 +/- 443.1 mg/dl and 898.3 +/- 415.6 mg/dl respectively). The immunoglobulin G was low in cord blood but had higher concentration in all the 7 cases in study group who had fever with rigor in antenatal period. Thus the babies delivered with caesarean section had lower immunoglobulin level than normal vaginal delivery.

Bifid pancreas: an endoscopic retrograde pancreaticographic curiosity.

Bifid pancreas, representing a major bifurcation of the main pancreatic duct, has rarely been reported. We report four such cases where this condition was picked up incidentally.

Combination of anticholinergic agent and H2 receptor antagonist in duodenal ulcer treatment--a randomized, double blind multicenter study.

BACKGROUND: The acid suppressive abilities of H2 receptor antagonists and anticholinergics have been claimed to be additive. METHODS: A multicenter, double-blind, randomized trial comparing ranitidine (150 mg) plus propantheline bromide 15 mg at bedtime to ranitidine 300 mg alone at bedtime was conducted in 161 patients with endoscopically confirmed uncomplicated duodenal ulcer. RESULTS: After six weeks of therapy, ulcer healing rates in the two groups were comparable ie 80% in the combination group (ranitidine + propantheline) and 79.4% in the ranitidine group. Pain relief after one, two and four weeks of treatment was also comparable in the two groups. Side effects to drugs were minor and comparable in both the groups. CONCLUSION: A combination of 150 mg ranitidine and 15 mg propantheline bromide is as efficacious as 300 mg ranitidine in inducing healing of uncomplicated duodenal ulcers, with similar side-effects but at greatly reduced cost.

End point for sclerosis of esophageal varices.

BACKGROUND: Small esophageal varices are difficult to inject intravariceally and complete eradication of varices may not be therapeutically necessary. METHODS: A prospective study designed to compare the use of different end points of sclerotherapy ie (i) total eradication (grade 0) (ii) grade I varices or (iii) grade II white (IIw) varices, by stopping variceal injection when one of these was reached. The patients were followed endoscopically and clinically at 3-4 mo intervals. OUTCOME MEASURES: Variceal recurrence and rebleeding rates. RESULTS: Of 266 patients with portal hypertension (147 cirrhosis, 51 non-cirrhotic portal fibrosis, 68 extra-hepatic portal venous obstruction), 232 (87.2%) reached one of the three end points--six to grade 0, 96 to grade I and 130 to grade IIw. Among 212 patients followed up for a mean post-sclerotherapy period of 12.2 mo (range 3-48 mo), variceal recurrence rates, time intervals to recurrence and rebleed rates were comparable in patients with endpoints of grade I and grade II (white) varices (28.5% vs 38.9%, 10.8 mo vs 9.2 mo, and 7.7% vs 7.8%, respectively; all p = ns). Overall, 51 patients had interval bleed before reaching the end point--50 (98%) of them bled from grade III and IV varices while only one patient (2%) bled with grade IIw varices. CONCLUSION: Grade I or grade IIw varices should be acceptable as the end points for endoscopic sclerotherapy of esophageal varices.

Endoscopic removal of ascaris from biliary tree.

Hepatobiliary ascariasis is an uncommon condition outside the Kashmir valley. We report here a patient with this disease from the eastern part of India.

Correlation between inhibitory effect of quinolones and mycolic acid metabolism in mycobacteria.

Mycolic acids are important components having a significant role in maintaining the rigidity of mycobacterial cell wall. They could also be the barrier for penetration of certain drugs into the bacterial cell. A novel in vitro model system was established for assessing the effect of Ciproflaxacin on mycolic acid metabolism in pathogenic mycobacteria M. Kansasii (which has similar mycolic acid pattern to that from M. leprae) and the effect of norfloxacin in M. intracellulare. These test mycobacteria were exposed in their midlogarithmic phase of growth to 0.5, 1, 2, 3, 4, 5 and 6 micrograms ml of ciprofloxacin and norfloxacin respectively for 1, 2 and 24 hours. Ciprofloxacin completely inhibited the synthesis of mycolates in M. kansasii at 3, 4 and 5 micrograms/ml; whereas norfloxacin exhibited its maximum inhibitory action on mycolic acids in M. intracellulare at 6 micrograms/ml for all the durations of exposure. Inhibition of mycolates directly correlated with bacterial viability which was estimated by colony forming units. The effect of quinolones on mycolic acid metabolism appears to be direct and not secondary to DNA gyrase. The results obtained from this study and our previous findings show that mycolic acid metabolism is affected by various groups of drugs, whose primary sites of activity may be different. The findings of the present study may have significant therapeutic implications in leprosy and other mycobacterial diseases.