Study of Correlation of High-Resolution Ultrasonography and Ultrasonography Guided Fine Needle Aspiration Cytology in Diagnosis of Pure Neuritic Leprosy in a Tertiary Care Hospital

This study assesses the features of high-resolution ultrasonographic and ultrasound-guided FNAC of peripheral nerves and correlates the findings in clinically suspected cases of pure neuritic leprosy (PNL). As per the study protocol, clinically screened pure neuritic leprosy cases from January 2017 to June 2018 were subjected to high resonance ultrasonography and ultrasonography-guided FNAC. The aspirated material was stained with modified ZN stain for AFB. Nerves showed hypoechogenicity, loss or distorted echogenic rim, and fibrillary echotextures in ultrasonography. Epithelioid cells, epithelioid cell granuloma was found in the histopathology sections of FNAC specimens with the presence of AFB in some cases. From these findings it may be concluded that HRUS and ultrasound-guided FNAC could be incorporated as rapid and reliable diagnostic tools for PNL. It may enlighten the future path as an early indicator of neural damage and be critical and useful to prevent the disabilities.

A novel approach to decalcification in histopathology laboratory: An adaptation from the Hammersmith protocol

Aim: Utility of modified Hammersmith protocol in the deacalcification and/or softening of tissues and samples in a histopathology laboratory were studied. The object of the study was to prepare a novel method for softening/decalcifying tissue for histopathology. Materials and Methods: All the hard tissues received in the histopathology section were received in 10% neutral buffered formalin and then placed in freshly prepared combination of 10 mL of concentrated formaldehyde and 5 mL of 10% formic acid in 85 mL distilled water was used for decalcification. The tissue was checked for evidence of adequate decalcification/softening every 6 hours. Those which were decalcified/softened were sent for routine tissue processing and staining, while those which were not, were again placed in formalin. The process was repeated until the tissue was ready for further processing. The routine sections of these slides were reviewed for morphology and stain quality along with special stains and immunohistochemistry performed. The time taken for decalcification, the variables most likely to affect decalcification, the morphology and staining characteristics were documented. Statistical analysis was done to determine the effect of softening/decalcification process on each variable. Results: A total of 201 blocks in 119 specimens from humans including 61 males and 58 females were studied. Time taken was found to have a significant correlation only with the nature of the tissue (bone vs nonbone) and not with any other parameter viz. age, gender, specimen size, type of bone, and nature of pathology. Conclusion: This novel and modified method has circumvented the common problems of overdecalcification, preserved morphology, and produced consistent results without interfering with special stains and immunohistochemistry.

Histological studies on ontogenic development of lymphoid organs in Indian major carp, Catla catla

Aim: Immunostimulation, before the fish is able to mount an effective immune response, can induce tolerance. Therefore, present study was carried out to investigate the structural development of lymphoid organs, namely thymus, kidney and spleen of Indian major carp, Catla (Catla catla), which will help in deciding the appropriate age, when immunocompetence is established. Methodology: In this study, ontogeny of the lymphoid organs of catla was studied from hatching up to 54 days post hatch (dph). For this, whole fish were fixed, processed and embedded in paraffin wax. Further, serial sections were cut, stained and observed under microscope. Results: The thymus anlage appeared in the dorso-anterior part of the gill cavity at 1 dph. At 5 dph, an undifferentiated mass of stem cells was observed and by 8 dph, it appeared lymphoid. At 11 dph, clear dark and light zones of cells were observed. At 26 dph, Hassall’s corpuscles were observed and no further changes were observed except increase in number of lymphoid cells till end of the sampling period. Kidney was observed as an undifferentiated mass of stem cells at 1 dph with few renal tubules. At 5 dph, undifferentiated stem cells increased in number, and by 8 dph, few erythropoietic cells were observed. At 11 dph, lymphoid cells were present and by 17 dph, renal tubules started degenerating. At 26 dph, anterior kidney completely lacked excretory tissue and appeared lymphoid. Spleen was observed at 3 dph as an undifferentiated mass of stem cells, and at 8 dph, erythrocytes were seen. At 11 dph, spleen was heavily packed with erythrocytes, whereas at 20 dph, the number of erythrocytes decreased and lymphocytes were observed. Fully developed spleen was observed at 33 dph with presence of red and white pulp.

Transmission Blocking of Year Round Resistant Malaria in Koraput (India) by OMARIA – A New Antimalarial Phytotherapy.

Background: Globally, in resistant malaria endemic zones, even the latest lines of MDTs (multi drug therapes) are yielding chaotic results. These include unacceptable side effects/contraindications, with poor prognosis in juveniles/adolescents. Juvenile stage is intensely humoral and up-regulate infestation. MDTs are more unpredictable in the juveniles, and fail in the geriatric group. Pharmacies are also failing. Tropical-equatorial conditions necessitate frugal body cover cum bare foot life style. Typical geomorphology, orography, meteorology, flora and fauna provide year round conducive conditions for vector bionomics and for other types of infections. OMARIA (Orissa Malaria Research Indigenous Attempt) is a new anti-malaria phytotherapy that has been in mono station use (Koraput, India) since 1998 in drug resistant core endemic regions, also well known for tertian type. It transpired out of Koraput Model to Fight Malaria at Home with OMARIA. Materials and Methods: OMARIA is composed of the dry rind of the Indo-year round fruiting Punica granatum (Dalimba). Principal drug moieties are: (i) ellagic acid; (ii)punicalagin (iii) punicalin and (iv) potassium (K+). Are physiologically compatible and has never been used before. All the moieties being non alkaloids offer a paradigm shift among anti-malarials. Results: OMARIA kills and clears hemoprotozoas of all spp., at all stages (including gametocytes) in patients of all ages and chronicity. Is potently anti-inflammatory vis-a-vis WBCs; blocks transmission; prevents relapse and non- recrudescence; and is very useful in severe/acute/complicated/refractory malaria and in sickle cell patients. No development of resistance. Potassium (K+) probably acts as the drug’s efficacy upregulator. Conclusion: OMARIA is prophylactic and therapeutic in target groups. Is useful in numerous forms of malaria, being active against key stages of the parasite (complicated or systemic status); and in patients having multiple infections. It has synergistic and possibly buffering roles. Koraput Model has been of much help to the afflicted communities and to the administrations.

Coexistence of carcinoma breast and Paget's disease of bone.

We report a case of a patient with carcinoma breast who was incidentally diagnosed to be also suffering from Paget's disease of bone on a routine radionuclide bone scan. CT-guided biopsy and histopathology later confirmed the diagnosis.

Pattern of cerebellar perfusion on single photon emission computed tomography in subcortical hematoma: A clinical and computed tomography correlation.

Background: There is paucity of studies evaluating the role of asymmetry index (AI) on single photon emission computed tomography (SPECT) studies in patients with intracerebral hemorrhage (ICH). Aim: To evaluate cerebellar perfusion in ICH employing SPECT study and correlate with clinical and CT scan findings. Setting and Design: Tertiary care teaching hospital. Materials and Methods: A total of 29 patients with ICH were subjected to neurological examination including Glasgow Coma Scale (GCS) and Canadian Neurological Stroke Scale (CNS). Clinical features of raised intracranial pressure and herniation were noted. On CT scan, ICH location, volume, ventricular extension and midline (ML) shift were noted. On SPECT, cerebral and cerebellar perfusion was measured semiquantitatively and AI calculated. Outcome was defined at 3 months into poor and good. Results: Fourteen patients had putaminal and 15 thalamic hemorrhages. Their mean age was 59 years. The mean GCS score was 10 and CNS score 2.8. Hematoma was large in five, medium in 16 and small in eight patients. ML shift was present in 15 and hematoma extended to ventricule in 16 patients. On SPECT, cerebellar AI significantly related to ML shift but not with size of hematoma. AI was low in patients with ML shift. Outcome was related to GCS score, ML shift, size of hematoma and cerebellar AI. Conclusion: In acute stage of ICH, cerebellar AI is lower in patients with more severe stroke having ML shift.

Prevalence of anti HCV, HBsAg and HIV antibodies in high risk recipients of blood and blood products.

Along with hepatitis B virus (HBV) and human immunodeficiency virus (HIV), Hepatitis C virus (HCV) is emerging as a major transfusion hazard. 22 cases of haemophilia (A 19, B 3) and 20 cases of thalassaemia (2 16, E(2) 4) constituted the study group. Patients tested for anti HCV (using third generation ELISA), HBsAg and antibodies to HIV I and II. Prevalence of anti HCV was 54.5% in haemophilics and 5% in thalassaemics. HBsAg was detected in 9.09% haemophilics and 5% thalassaemics. No anti HIV was detected in this cohort. Anti HCV seropositivity in haemophilics has increased compare to previous studies.

Socio-economic factors associated with malaria in a tribal area of Orissa, India.

Study on the socio-economic factors and human behaviour in a cross-section of tribal communities in Sundargarh district, Orissa revealed that poor socioeconomic status and socio-cultural factors play important role in maintaining high degree of malaria transmission. Human behaviour such as location of hamlets, type of housing, sleeping habits, outdoor activities after dusk, poor knowledge about the disease and treatment seeking behaviour are of great significance as determinants of malaria transmission. All these factors need to be considered before planning community health programme. Estimation of economic loss due to malaria showed an average loss of 8.96 mandays per malaria patient with an average loss of 3.84 mandays to other family members. Mean total loss per malaria episode comes to Rs.334.91. The study showed that malaria is one of the major disease affecting the tribals to the greatest extent and putting a lot of burden on the economic upliftment of these communities.

Delusional parasitosis--study of 3 cases.

Delusional disorder-somatic (parasitosis) type is a rare psychiatric disorder which poses a challenge to diagnostic and therapeutic skills. Pimozide, a highly specific dopamine blocker has shown promising results in the 3 cases illustrated here. These cases were seen over a period of 3 years. All the three patients believed that an insect has entered through the ear and is burrowing tracts/laying multiple eggs. They approached the ENT surgeons or neurosurgeon with a fear that their brain will be invaded. On psychiatric evaluation, no past or present history of major psychiatric illness was found. Premorbid personalities were well adjusted. Only for two patients, acute moderate stressors were detected. Delusions disappeared by the end of 2 wks but therapy was continued for 5 months.