Screening of infants and young children with hyperbilirubinemia for sensorineural hearing impairment: an institutional study

Background: Jaundice is one of the most common problems occurring in newborns. Severe neonatal hyperbilirubinemia is a common cause of sensory neural hearing loss. It is important to identify and treat the jaundice early, to prevent complications like encephalopathy leading to hearing loss. Early detection of hearing loss is important for early intervention. The aim of the study was to evaluate the prevalence of sensorineural hearing loss (SNHL) in children with hyperbilirubinemia and to correlate the degree of hearing loss with degree of hyperbilirubinemia. Methods: The 50 cases including newborn and young children (<12 years of age) having history of hyperbilirubinemia and exchange transfusion were included in this study. After the approval and clearance from institutional ethical committee, this study was conducted from April 2021 to March 2022 in the department of ENT, govt. medical college Amritsar in co-ordination with department of pediatrics. Results: On comparing brain stem evoked response audiometry (BERA) and otoacoustic emissions (OAE) results, it was found that out of 50 patients BERA was abnormal in 8 patients while 42 had normal BERA. 18% (9) patients had abnormal OAE results out of which 7 had bilateral REFER result while 2 had unilateral REFER result. On comparing the OAE and BERA for sensitivity and specificity, the sensitivity was 92.9% in right ear while specificity was 62.5%, whereas in left ear sensitivity was 95.2% while specificity was 75%. Conclusions: According to our study the prevalence of sensorineural hearing impairment comes out to be 16% as per BERA. BERA is more sensitive and specific as compared to OAE. But still OAE can be used as screening test considering the cost factor and ease of conducting OAE test while BERA is a confirmatory test for SNHL.

Role of histopathological and microbiological investigations for a definitive diagnosis of benign sinonasal masses: a tertiary care institute study

Background: This research aimed to study the clinical presentation of various sino nasal masses (SNM), to study the importance of Histopathological and microbiological investigations in making diagnosis of SNM and to study the correlation between clinical, radiological, histopathological, and microbiological findings of SNM. Methods: In the present study 50 patients attending the ENT outpatient department with clinical evidence of nasal mass were selected based on inclusion and exclusion criteria. Patients were examined clinically and radiologically followed by surgical intervention. Histopathological and microbiological examination was done to make a definitive diagnosis. Results: Majority of cases were from 21-40 years age group (66%) with male preponderance. Nasal obstruction was most common symptom 45 (90%) followed by nasal discharge 43(86%). On histopathology highest incidence was of inflammatory polyps 22 (44%) followed by allergic polyps 14(28%) and non-invasive fungal sinusitis (NIFS) 11 (22%) respectively. Microscopically in KOH, fungal elements, yeast and hyphae were seen in total 11 (22%) cases and with SDA, Aspergillus niger was seen in 7 (14%) cases, Candida albicans in 3 (6%) and both in 1 (2%) case. Correlation of provisional diagnosis with HPE was found to be highly significant. Conclusions: It was observed that histopathological and microbiological examination is irreplaceable as both are the 揋OLD STANDARD� for making a definitive diagnosis.

A rare case of benign fibrous histiocytoma of the cornea

Fibrous histiocytoma (FH) commonly occurs in the superficial layers of the skin. Orbit and limbus are documented ophthalmic sites of involvement but isolated corneal FH has never been reported in literature. We present the first case of FH exclusively involving the cornea where a 10-year-old male child presented with a 3-month history of a painless growth on the superior cornea of the right eye with deterioration of vision. Tumor excision with therapeutic penetrating keratoplasty was done and the histopathological examination confirmed the diagnosis. There was no recurrence and the corneal graft was clear at 1 year.

Hyperthyroidism with Struma ovarii.

Struma ovarii or monodermal teratoma, is a specialized ovarian neoplasm composed entirely of mature thyroid tissue. It is a relatively rare tumor which comprises 1% of all ovarian tumors and 2.7% of all dermoid tumors. Its colour and consistency is like that of a thyroid tissue. The tissue may show any of the pathologic changes seen in a normally placed gland, including diffuse or nodular hyperplasia, thyroiditis, papillary carcinoma, follicular carcinoma and malignant lymphoma. We reported a case of hyperthyroidism with struma ovarii. A 70 year old female was operated for ovarian mass. The sign and symptoms subside after operation.

Seminogram in male partners of Infertile Couples.

Background: Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. The masculine factor as a cause of infertility is present in 40-50% of cases hence the importance of an integral evaluation of the male alterations and its fertility. Objectives: The present study aims to assess the seminal patterns of male partners of 100 infertile couples for various parameters and their possible contribution to infertility. Material and Methods: The present study was conducted on male partners of 100 infertile couples who were referred by Gynecology and Obstetric department to Pathology Department, Government Medical College, Patiala for semen examination. The semen was collected by masturbation in all cases in a clean dry detergent free container. After liquefaction and mixing, basic analysis was done which includes volume, viscosity, pH, spermatozoal concentration, motility and morphology. Data was evaluated by means of chi-square test. Results: Of 100 seminogram, 43% showed alterations in the seminal indexes; with asthenospermia in 39.5%, Oligoasthenospermia in 30.2%, Oligospermia in 16.2%, and Azoospermia in 13.9%. Conclusion: Male factors were mostly responsible as a cause of infertility. Asthenospermia was the most common type of semen defect present in these infertile males. Most of the males with semen defect were of age group >30yrs. Incidence of semen defect among males increased with duration of infertility.

Malignant mixed germ cell ovarian tumor in pregnant female.

Ovarian germ cell tumours comprise approximately 15% to 20% of all ovarian neoplasms. In pregnant females, its incidence is very low. They arise from primordial germ cells derived from the embryonal gonad. Malignant germ cell tumours comprise less than 5% of all ovarian neoplasms. Most malignant ovarian neoplasms in pregnant women are at early stages and are associated with good prognosis both for the mother and for the neonate. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy. Careful initial surgery with adequate staging biopsies followed by combination chemotherapy can greatly improve the prognosis of these patients. We present a case of malignant mixed germ cell tumor in a pregnant female who presented with abdominal mass after delivering a normal child. Histological and biochemical tumour markers confirmed it to be malignant mixed germ cell tumor.

Cytological study of palpable breast lumps with their histological correlation.

Background: FNAC is an inexpensive and highly accurate means of diagnosing both benign and malignant breast lesions. The procedure provides a rapid and non-morbid diagnosis before the operation which enables the patient and the surgeon to discuss and plan therapeutic alternatives in a rational atmosphere. Objectives: To evaluate role of fine needle aspiration cytology in the diagnosis of breast lesions and to compare the cytological findings with the histopathology wherever possible. In addition the sensitivity, specificity and accuracy of FNAC in breast lesions are carried out. Material and Methods: The present study was carried out on 200 patients who presented with palpable lump in the breast in the Department of Pathology, Government Medical College, Patiala over a period of 2 years. Cytological Diagnosis was correlated with histological findings wherever possible. Results: Cytologically, the lesions were categorized into 4 major categories, benign 143 (71.5%), malignant 37 (18.5%), suspicious or atypical 10 (5%) and unsatisfactory 10 (5%). Out of these 200 cases, 85 cases (42.5%) were available for histopathological examination. The most common benign lesion in this study was fibroadenoma 23/52 (44.2%) and the most common malignant lesion was infiltrating ductal carcinoma (28/33) Diagnostic accuracy of FNAC for benign lesion was 94.2% while for malignant lesion, it was 96.7%. The sensitivity, specificity and overall diagnostic accuracy of FNAC came out to be 93.7%, 98.1% and 96.4% respectively. Conclusion: FNAC is a simple and reliable method for diagnosis of both benign and malignant lesions quite accurately thus reducing unnecessary surgeries. The present study proved that the procedure has high sensitivity, specificity and diagnostic accuracy. Though it cannot categorize the lesion in some cases but it can rule out malignancy in most of the cases. Considering its low cost and quick results, it can be a potential tool for screening of breast cancers.

Allergic bronchopulmonary aspergillosis with aspergilloma mimicking fibrocavitary pulmonary tuberculosis.

A 47-year-old male, who presented with chronic fibrocavitary pulmonary disease, had received three courses of antituberculous therapy over a period of 17 years without relief. Four years prior to referred he had developed hemoptysis and rhinitis. Evaluation of the patient led to the diagnosis of allergic bronchopulmonary aspergillosis with coexistent aspergilloma, a rather uncommon association. Both his pulmonary and nasal symptoms showed a remarkable response to treatment with oral prednisolone. However, the possibility of concomitant allergic Aspergillus sinusitis remained open as the patient refused to undergo any invasive procedure.

Growth response of Pseudomonas stutzeri RS34 to ethylenediaminetetraacetic acid (EDTA) and its interaction with zinc.

Pseudomonas stutzeri RS34 is a less sensitive member of pseudomonads to toxic effect of EDTA, the effect of EDTA is more bacteristatic than bactericidal, and can be reversed by divalent cations. Zn2+ provides more specific protection than Mg2+. EDTA-treated cells show higher sensitivity to lysozyme confirming the chelating mode of action of EDTA that leads to destabilization of the outer membrane. Such metal resistant bacteria can be profitably employed in the removal of metals from polluted ecosystems.

Digital clubbing in sarcoidosis.

We present two cases with a rare association of sarcoidosis and clubbing. Therapy with prednisolone could not control the progress of interstitial fibrosis nor could clubbing be reversed. Both patients expired 5-1/2 years after diagnosis which suggests that clubbing, when present in sarcoidosis, may signify an unfavourable prognosis.

Clindamycin in the treatment of anaerobic lung abscess.

A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.

Allergic bronchopulmonary aspergillosis and Candida albicans colonization of the respiratory tract in corticosteroid-dependent asthma.

Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 asthmatics who had never received prednisolone. Candida albicans was repeatedly cultured from the sputa of 12 patients with CSDA. Isolation was more frequent in those patients who were receiving more than 10 mg prednisolone for more than six months. Nearly half of these patients demonstrated a positive immediate cutaneous reaction and precipitating antibodies against C. albicans. Although no pathological significance, beside colonization, could be attributed to this finding, it was felt that it would be prudent to restrict the daily dose of prednisolone to less than 10 mg, when administered for more than six moths. Two patients with allergic bronchopulmonary aspergillosis (ABPA), were identified, one from each group. The possibility of ABPA, however, remained open in two other patients with CSDA. It is probable that some patients with CSDA may be suffering from ABPA but characteristic features of the disease are masked by costicosteroid therapy, making it difficult to diagnose.

Fibrebronchoscopy in pulmonary sarcoidosis--an Indian experience.

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the yield of fibrebronchoscopy. Fibrebronchoscopy confirmed the diagnosis of tuberculosis in 2 patients with an atypical radiological picture, thereby differentiating the two conditions which occasionally mimic each other.

Primary carcinoid tumour of trachea.

Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated as a case of bronchial asthma for over a decade, is presented.

Chronic anaerobic pneumonitis.

A case of chronic anaerobic pneumonitis, without any predisposing factors, nor the classical features often associated with it, which masqueraded as pulmonary tuberculosis is described. Therapy with metronidazole resulted in striking improvement.