An Unusual Case of DRESS Syndrome Presenting with Marked Leucocytosis.

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare severe drug-induced idiosyncratic hypersensitivity characterized by maculopapular and/or erythrodermic eruption, fever, peripheral lymphadenopathy, eosinophilia or atypical lymphocytosis, and visceral organ involvement. The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures. In this report, we describe a case of DRESS syndrome in a young female with a unique presentation. The DRESS syndrome can be difficult to diagnose as its clinical findings can mimic those of other systemic diseases. This case emphasizes the importance of incorporation of the patient’s clinical and medication history in the interpretation of hematological investigations.

Cytomorphometry in Oral Lesions - An Objective Approach to Cytological Diagnosis.

Objectives: The present study focusses on cytomorphological evaluation of the scrapings and cytological appearance of a spectrum of lesions of the oral cavity, Morphometric nuclear and cytoplasmic parameters were used to distinguish between benign, premalignant and malignant lesions. Material and Methods: The samples were obtained by scraping the lesion firmly till tiny pin point bleeding points were seen to ensure adequate sampling. Adequate sampling was defined as 50 cells consisting of transepithelial cytology specimen (superficial, intermediate and basal cells). Results: A total of 80 patients were evaluated with predominance in males and mean age of presentation was 45.05± 12.8 years. Cytomorphomteric analysis revealed an increasing trend in nuclear parameters as the spectrum of oral lesion moved from benign to malignant category while a decline was observed in cellular parameters. A significant p value of <0.0001 was found between cytomorphometrical parameters and histopathological subtypes. Sensitivity and specificity of conventional exfoliative cytology in conjunction with cytomorphometry was 100% and 94.74% respectively. Negative predictive value and positive predictive value of cytology for malignant lesions was 100% and 93.75% respectively. Diagnostic accuracy of cytology in predicting malignancy taking histopathology as gold standard was 97.0. Conclusion: Grading and scoring of oral cytosmears according to morphology showed a positive correlation with histopathological diagnosis. In addition, cytomorphometry increases the diagnostic accuracy of oral conventional exfoliative cytology and hence is seen to have an impact on early detection of cellular alterations and prompt treatment. Therefore, it is a sensitive and useful adjunct to monitor the cellular transformation.

Evaluation of Abnormal Hemoglobin Variants and Hemoglobinopathies on D-10 analyzer – An Institutional Experience from North India.

Background: High performance liquid chromatography (HPLC) is the most commonly used method for detection and quantitative estimation of hemoglobin variants. Hemoglobinopathies are amongst the most common genetically inherited disorders, however, the exact magnitude of different hemoglobinopathies is obscure in India. This study was done with the aim of analyzing the different findings in HPLC using D-10 analyzer and evaluating the spectrum of different hemoglobin disorders in a hospital-based population of South Delhi. Such a prevalence study would be useful to review the various strategies that can be implemented for effective control and prevention of these disorders. Methods: A hospital based descriptive observational study was conducted in which all OPD and IPD patients who were advised HPLC during their clinical workup were included. Analysis of EDTA blood samples was done by Bio Rad D10 Dual program HPLC instrument. The exact percentage of HbA, HbA2, HbF and any other variant hemoglobin was estimated. Presumptive identification of hemoglobin variants was made primarily by their percentage, retention time (RT) and peak characteristics. HPLC findings were correlated with the clinical history, family history and the CBC and peripheral smear findings in all cases. Results: On HPLC analysis, 79% of the patients had no abnormality detected and the report was within normal limits. The commonest hemoglobinopathy was Beta Thalassemia Trait followed by HbE trait. The other hemoglobinopathies detected were HbD Punjab Heterozygous (3 cases, 0.5%), Beta thalassemia homozygous (3 cases, 0.5%), Sickle cell Heterozygous (2 cases, 0.3%), HbJ Meerut Heterozygous (2 cases, 0.3%). One case each of Sickle cell Homozygous (0.15%), Compound Heterozygous HbS/beta thalassemia trait (0.15%), HbE Homozygous (0.15%), Compound Heterozygous HbE/beta thalassemia trait (0.15%), and Homozygous delta beta thalassemia (0.15%) were also diagnosed. Conclusion: This study gives an important insight to the present day scenario of hemoglobinopathies in patients in South Delhi in relation to the hematological profile. It highlights the chromatogram findings of different hemoglobinopathies on the D10 analyzer. The comprehensive data obtained by such series can help in the formulation and development of infrastructure and policies for hemoglobinopathy prevention, diagnosis and management.

Evaluation of Causes and Rate of Wastage of Blood and its Components – An Important Quality Indicator in Blood Banks.

Background: The evaluation of wastage of blood products represents an important element in the appropriate use of blood components, a critical control point in the system of blood administration. Discarding or wastage of blood can be attributed to several reasons namely time expiry, wasted import, non-usage of ordered blood, broken bags and seal with leakage, hemolytic reasons, clotted blood, returned after 30 min, and miscellaneous others.Wasting of blood and blood components are an inefficient use of resources and may be avoided. The present study was undertaken with aim of primarily to determine the frequency of blood products wasting and secondarily to determine the factors that affect blood products wastage at our institute. Methods: The present study is a retrospective cross sectional descriptive study conducted in a tertiary teaching hospital located in South Delhi catering to low socioeconomic population. Blood component wastage was defined as components that did not meet the required standards of hospitals or fractionation centres during collection, processing and storage. The main reasons included expiry date, inappropriate volume, haemolysis of red blood cells (RBCs), contamination of plasma or platelets with RBCs, blood bag leakage, reactive infectious disease tests and inappropriate temperature during storage or transportation. The required data from clinical units and blood bank were collected and analyzed for a period of 7 years. Results: A total of 13728 blood units were received during the specified period. Overall wasted factor was of 18.5% with maximum wastage of platelet concentrate units (53.7%). Analyzing the causes of blood and blood product wastage in the hospital for this study showed that blood and blood product wastage were associated with many causes of which the common causes, included the expiration of the usability period (69.2%), sero-reactivity for infectious diseases (13.7%) and Quality Control units (9.2%). Conclusion: Blood is an irreplaceable precious resource which needs to be properly utilized with minimal wastage. Although present study was limited due to its retrospective nature but it still outlines the importance to emphasize that measures should be taken into account for formulating guidelines, effective policies, and training efforts for personnel.

Video projected practical examination as an introduction to formative assessment tool for undergraduate examination in pathology

Background: Assessment of the medical students includes theory as well as practical assessment. Traditional practical examination in pathology which includes viva and spots is now increasingly being questioned because of their inherent lack of validity and reliability, time consumption, and human resource requirement. Therefore, a need was felt for another form of practical examination which can be used as formative assessment, and if found feasible, can be employed in summative assessment too. Aim: The aim of the study was to develop and implement a new method of video projected practical examination (VPPE) as a formative assessment tool for MBBS second professional students so as to improve their learning and academic performance in practical pathology and also to obtain students' perception regarding the effectiveness of VPPE. Methodology: The study was carried out with the MBBS second professional students before their end-of-semester examination in the Department of Pathology. In this new method, slide video projection was used as a formative assessment tool during practical examination. Students were randomly divided into two groups. Group I was subjected to VPPE, while simultaneously conventional practical examination was held for Group II. Assessment results of VPPE were compared with conventional practical examination. Faculty and students feedback was also taken at the end of the examination. Results: Mean marks of the students who undertook VPPE was higher than those who gave conventional practical examination. Majority (95.3%) of the students agreed that VPPE is better than conventional practical examination. Most of the faculty members also felt that it is a more valid and reliable assessment tool. Conclusions: Introducing VPPE as a formative assessment tool in practical pathology enhanced their learning and academic performance. Opinion of examiners and students also showed that VPPE has several advantages over conventional practical examination.

Chronic constipation: An unusual presentation of a Giant Serous Cystadenoma of ovary.

Benign ovarian cysts are fairly common. However, some of them may attain a large size and may prove to be malignant also. Here we report a case of 48 years old female presenting with chronic constipation due to a large ovarian cyst which was misdiagnosed on CT as mesenteric cyst. This case is being reported because of its large size, unusual presentation and missed diagnosis.

Ichthyosiform sarcoidosis following chemotherapy of Hodgkin's disease.

Acquired ichthyosis in adults may reflect internal disease, viz. internal malignancy, especially Hodgkin's lymphoma or sarcoidosis. We report a patient who developed ichthyosiform sarcoidosis over a year after completion of 6 cycles of combination chemotherapy for Hodgkin's disease. To our knowledge, the development of ichthyosiform sarcoidosis after chemotherapy for Hodgkin's disease has not been described earlier.