Biliary adenofibroma: a precursor lesion of intrahepatic cholangiocarcinoma

ABSTRACT Biliary adenofibroma (BAF) is an uncommon liver tumor with a high propensity for malignant transformation. The histomorphology of BAF with malignant transformation can show a spectrum of changes ranging from benign, dysplastic to frank malignancy. Thus, the diagnosis of BAF imposes the pursuit of dysplasia/ malignancy focus. We presented a case of intrahepatic cholangiocarcinoma arising from BAF in a 49-year-old woman with detailed histomorphology. We also performed a PubMed database search and tabulated all previously reported cases of BAF with dysplasia/ malignant transformation. A statistic comparison of age, sex ratio, size of the tumor, and survival following complete resection between BAFs with and without dysplasia/ malignancy from the retrieved data is presented. Our analysis did not highlight any statistically significant difference between BAFs with and without dysplasia/ malignancy in age, sex ratio, tumor size, and survival following complete surgical resection. Our study highlights the histopathology and immunohistochemistry of a case of BAF with malignant transformation and highlights the importance of this diagnosis in management. Further longitudinal studies on a larger cohort of patients are required to validate our findings.

Consequences of antepartum hemorrhage and its maternal and perinatal outcome

Background: Antepartum haemorrhage, a life-threatening event, is defined as bleeding per vaginum occurring after the fetus has reached the period of viability, considered to be 20 weeks in developed countries and 28 weeks in countries with low resource settings. We evaluated the consequences of antepartum haemorrhage, their maternal and perinatal outcome so as to outline the proper management of patient in order to improve both maternal and perinatal morbidity and mortality.Methods: This one-year prospective study totaled 133 cases of APH fulfilling the inclusion criteria were studied. Data was recorded on the MS excel sheet for further analysis and processing.Results: Total 6693 deliveries were conducted out of which 133 presented as APH and incidence of APH was found out to be 1.98%. Placenta previa was most common. APH was commonly associated with multigravida and most cases were in age group of 26-30 years. Most of the PP and abruption cases were admitted at 34-37 weeks and 31-33 weeks respectively. High risk factors included previous LSCS and D and C, hypertension, multiple pregnancies and malpresentations. Most of the patients underwent preterm LSCS. Most fetal complications were due to prematurity. 58.6% patients were transfused blood. Overall perinatal mortality was 20.1% and maternal mortality was zero.Conclusions: Early diagnoses, timely referrals and transfusion facilities along with trained team of doctors with well-equipped ICU facility goes a long way in avoiding APH related maternak and fetal complications.

Platelet count and MPV in women with PIH in their third trimester

Background: One of the most common and potential life-threatening complications of pregnancy is pregnancy induced hypertension. Though platelet count during pregnancy is within the normal non-pregnant reference values, there is a tendency for the platelet count to fall in late pregnancy. The frequency and intensity of maternal thrombocytopenia varies and is dependent on the intensity and severity of PIH.Methods: This prospective study was conducted in the Department of obstetrics and gynecology in Jhalawar medical college from January 2018 to April 2018.Total 120 pregnant women during third trimester (32-40 weeks) aged 18 to 35 years were selected. Among them 63 were preeclamptic patients and 63 were healthy normotensive control. Subjects and healthy pregnant women (control) visiting the Obstetrics and Gynecology department of Jhalawar Medical College were registered in the study and followed during their pregnancy. Both, subjects and control participants were subject to platelet count manually and MPV was determined by an automated analyser (sysmex XN-1000™) performed using standard methods on.Results: The mean platelet count of the subject group (131.4937±62.05999 lakh/mm3) was significantly lower than that of the control group (324.9683±230.78764 lakh/mm3). This shows that there is thrombocytopenia found in patients with P.I.H in their third trimester. On the other hand, the p value of “mean platelet volume” in patients with preeclampsia was (p<0.0001) which shows that there is no significant difference in MPV of cases (7.1438±2.62 femtolitre) and control (7.8976±3.08 femtolitre) (p>0.142), regular monitoring of platelet counts in women with Pregnancy Induced Hypertension must be subject of the management protocols.Conclusions: In present study we observed that the number of thrombocytopenic subjects was higher in cases of preeclampsia as compared to the control group. These extrapolations indicate that there might be some important mechanism which interferes with platelets life span thus reducing the number of functional platelets in circulation. The platelet count has an association at prediction of increasing grade of PIH. There is an inverse relationship between the severity of PIH and platelet count. The depleted platelet counts are concluded to be consistently associated with clinical groups of severe preeclampsia and the risk of consumptive coagulopathy.

Comparative Evaluation of Oral Stereognostic Ability of Dentulous and Edentulous Population

Background: The aim of the study was to determine the oral stereognostic ability of completely edentulous individuals through identification of different forms. Methods: Twenty edentulous subjects were selected for the study, 5 large and 5 small geometrical forms were selected and placed intraorally and percentage identification was tabulated. Results:The mean percentage of the correct identification of large forms (91.64±8.71) and the mean percentage of correct identification of the small forms (76.27±11.58), using Student independent ‘t’ test, statistically significant difference was found between the two values (p<0.05). Conclusion: the discriminating ability of edentulous and dentulous was not statistically different, although the differences between large and small forms were significant.

Evaluation of Bond Strength of Silicone and Acrylic Resin Based Resilient Denture Liners Over A Period of Storage in Water

Background: Two potential problems commonly identified with a denture base incorporating a resilient liner are afailure of the bond between the acrylic resin and resilient liner material and a loss of resiliency of the resilient liner material over time. Methods: The current study was performed to assess the bond strength and hardness of acrylic resilient liner in both auto-polymerized and heat-polymerized forms and silicone resilient liner in auto-polymerized form to a processed denture base resin over a period of water storage for 1 day, 1 week and 1 month. The denture liners investigated were acrylic resin-based heat-polymerized (Super-soft), acrylic resin-based autopolymerized (Coe-Soft) and silicone based autopolymerized (GC-reline) resilient liner. The resilient liners were processed according to manufacturer’s instructions. Tensile bond strength was measured in ASI Instron universal testing machine at a crosshead speed of 20 mm/min, and hardness was measured using a Shore-A durometer. Results: Two-way ANOVA and Tukey HSD tests were used to analyze the data (α=0.05). The results indicated that there were significant differences both in the hardness and bond strength values of resilient liner materials. Conclusion: Autopolymerized silicone resilient liner has increased bond strength and hardness values than autopolymerized acrylic liner but the bond strength and hardness values of autopolymerized silicone liner was less than heat cure acrylic resilient liner.

Study of the Serum Levels of C-Reactive Proteins as an Indicator of Disease Activity in Pulmonary Tuberculosis and Monitoring Response to Treatment.

Background: Pulmonary Tuberculosis is caused by mycobacterium tuberculosis. C-reactive proteins (CRP) are produced in the body by liver in response to inflammation caused by Mycobacterial infection. Insufficient information is available in medical literature, correlating serum CRP levels to the severity of pulmonary tuberculosis. The present study was undertaken to correlate the validity of serum CRP levels to clinical findings. Severity of pulmonary tuberculosis, need for ventilator support, response to anti-tubercular therapy and mortality. Objectives: To correlate the serum CRP levels with clinical findings, mortality, radiological severity and response to anti-tubercular treatment in patients suffering from pulmonary tuberculosis. Methods: The present study was conducted in 50 new sputum positive pulmonary TB patients and 50 healthy individuals. The patients were evaluated for clinical and radiological findings, which were correlated to baseline CRP levels. CRP levels were measured at 2 months and after completion of treatment and correlated to treatment end results. Results: Mean baseline CRP levels in pulmonary tuberculosis patients were 55.32mg/L (range 16- 144mg/L).CRP levels among normal healthy individuals were 4.46 mg/L (range 2-8mg/L). CRP levels were significantly higher in TB patients with fever, tachycardia, tachypnea, hypotension, respiratory distress and the need for ventilatory support when compared to patients without these features. The study showed significant correlation between CRP levels and radiological extent of disease. Baseline CRP levels were significantly higher in mortality group when compared to survivor group.CRP levels showed progressive decline in patients who were cured. Conclusion: The CRP levels in pulmonary tuberculosis patients before initiating anti-tubercular therapy showed a positive correlation with features like presence of fever, tachycardia, tachypnea, hypotension, respiratory distress, need for ventilator support, radiological severity and in patients who died. Thus, serum CRP levels can be used as a surrogate marker for severity of pulmonary tuberculosis in the patients. This is probably the first study conducted in North India correlating CRP levels and disease severity of pulmonary Tuberculosis to the best of our knowledge.