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.

A study on fluconazole resistance among candida species isolated from patients attending STD OPD in a tertiary care hospital.

Back ground: Sexually transmitted infections are a significant public health problem worldwide as they cause widespread morbidity and mortality in both male & female. In developing countries, STI are the third most common public health problem in young people of reproductive age group. Aim of the Study: This study was conducted to determine the prevalence of Candida species causing genital candidiasis in patients attending STD clinic in tertiary care hospital & to know the fluconazole resistance pattern of the isolated Candida species. Materials and methods: KOH mount is done by adding 10% KOH to the smear made with the vaginal discharge to look for the presence of yeast cells/ hyphal elements. Gram stain is done to look for the presence of gram positive budding yeast cells. Results: In this present study, Candida glabrata was the most common species causing vaginal candidiasis (47%) and fluconazole resistance is more among the Candida non-albicans isolates (62%). Candida albicans is the most common species isolated from male samples. Fluconazole resistance is also increasing among the Candida albicans isolates (32% in females and 30% in males). Conclusion: Prevalence of fluconazole resistance among Candida isolates is also increasing. This is due to the inappropriate and over the counter usage of antifungal agents. The emergence of Kavitha M, Hemalatha S, Shanmugapriya V. A study on fluconazole resistance among candida species isolated from patients attending STD OPD in a tertiary care hospital. IAIM, 2017; 4(4): 35-40. Page 36 fluconazole resistant C. albicans and non albicans species emphasises the need of species identification and antifungal susceptibility in the diagnosis and management of vaginal candidiasis.

First case report of isolated aspergillus dacryoadenitis.

We report a case of isolated Aspergillus dacryoadenitis. A 23‑year‑old male presented with dull ache, diffuse swelling in superolateral quadrant of the right orbit and proptosis for 4 months. Ocular examination showed conjunctival congestion, discharge in the fornix and palpable lacrimal gland (LG) mass. Routine hematological investigations followed by computed tomography scan of orbits were done. He did not respond to a course of systemic and topical antibiotics. Lateral orbitotomy with extended lid crease incision was performed with excision biopsy of LG. Abundant blackish material was found in the LG intraoperatively. The specimen was sent for histopathological examination (HPE). HPE report showed Aspergillus. Thorough ENT and systemic evaluation ruled out any other site with the fungus. To the best of our knowledge, this is the first case report of Aspergillus infection in LG.

Intraluminal Plexiform Unicystic Ameloblastoma: A Report of a Rarity in an 8-year-old Boy.

Unicystic ameloblastoma (UA) is a variant of ameloblastoma and this entity is more common in second to third decade of life. It is very rare in children with <2.2% under the age of 10 years. Th is odontogenic tumor is most commonly encountered in the posterior mandible and is associated with an impacted tooth. Th e term plexiform UA refers to a pattern of epithelial proliferation that has been described in cystic lesions of the jaws. Here is a report of a rare case of intraluminal plexiform UA, in the right posterior mandible of an 8-year-old boy presented to our department.

Antibacterial activity of Coccinia grandis leaf extract on selective bacterial strains.

To assess the antibacterial activities of Coccinia grandis leaf extract on selective bacterial strains under in-vitro conditions. The antibacterial activity was tested against five bacterial strains by agar well diffusion method. The crude extract showed a broad spectrum of antibacterial activity by inhibiting both the gram positive and gram negative groups. The antibacterial activity of C.grandis leaf extract using solvents such as acetone, ethanol, methanol, aqueous and hexane was evaluated against five bacterial sp. Ethanol leaf extract of C.grandis showed high antibacterial activity against S.aureus, B.cereus, E.coli, K.pneumoniae and S.pyogens. Minimal inhibitory concentration of the leaf extract against each test organism was also studied by observing their growth on Mueller Hinton Agar containing the extract at various incremental levels, equivalent to 31.25μg/ml to 1000μg/ml of the extract. The highest activity was observed in ethanol extracts against S.aureus, E.coli, and K.pneumoniae with an inhibitory concentration below 31.5μg/ml. The significance of the study was conducted to investigate the invitro antibacterial activity of folklore medicinal plant and to evaluate scientific base of their applications.

Nested polymerase chain reaction on blood clots for gene encoding 56 kDa antigen and serology for the diagnosis of scrub typhus.

Purpose : Scrub typhus is a zoonotic illness endemic in the Asia-Pacific region. Early diagnosis and appropriate management contribute significantly to preventing adverse outcomes including mortality. Serology is widely used for diagnosing scrub typhus. Recent reports suggest that polymerase chain reaction (PCR) could be a rapid and reliable alternative. This study assessed the utility of these tests for scrub typhus diagnosis. Materials and Methods : Nested PCR to detect the 56 kDa antigen gene of O. tsutsugamushi was performed on blood clots from 87 individuals with clinically suspected scrub typhus. Weil-Felix test and scrub typhus IgM ELISA were performed on serum samples from the same patients. As a gold standard reference test was not available, latent class analysis (LCA) was used to assess the performance of the three tests. Results : The LCA analysis showed the sensitivity of Weil-Felix test, IgM ELISA and PCR to be 59%, 100% and 58% respectively. The specificity of ELISA was only 73%, whereas those of the Weil-Felix test and PCR were 94% and 100% respectively. Conclusion : Nested PCR using blood clots while specific, lacked sensitivity as compared to IgM ELISA. In resource-poor settings Weil-Felix test still remains valuable despite its moderate sensitivity.

Pregnancy outcomes in pre-gestational and gestational diabetic women in comparison to non-diabetic women--A prospective study in Asian Indian mothers (CURES-35).

BACKGROUND AND OBJECTIVE: Diabetes can complicate pregnancy but it is not the major complication of pregnancy. Though prevalence of diabetes is alarmingly high among Indians there have been very few studies assessing the effect of diabetes on pregnancy outcomes, particularly comparing pre-gestational diabetes mellitus [PGDM] and gestational diabetes [GDM] with non-diabetic mothers. METHODS: Pregnant women attending the Dr. Mohan's Diabetes Specialities Centre, a tertiary care centre for diabetes in Chennai in southern India were selected for the study. PGDM and GDM were defined using standard criteria. Out of the 245 pregnant women with diabetes registered at the centre, follow up data was available for 225, which included 79 PGDM and 146 GDM subjects. Non-diabetic controls (n=30) were recruited from the ongoing population based study the Chennai Urban Rural Epidemiology Study (CURES). Details of outcome variables including abortions, mode of delivery, congenital anomalies and neonate's birth weight were documented. RESULTS: Women with PGDM had significantly higher fasting plasma glucose [p<0.001] and fructosamine [p<0.001] levels compared to GDM. Proportion of women who underwent abortions was 0% in non-diabetic controls, 10.1% in PGDM and 2.7% in GDM and the difference between PGDM and GDM was statistically significant [p = 0.04]. Prevalence of 'low birth weight' babies in the study groups were, 14.3% in non-diabetic mothers, 12.3% in PGDM and 8.2% in GDM. The prevalence of 'large babies' was higher in GDM [27.6%] and PGDM [19.2%] groups compared to non-diabetic controls [7.1%] but the differences reached statistical significance only in the GDM group [p = 0.04]. Prevalence of congenital anomalies was 0% among non-diabetic controls, 3.8% in PGDM and 1.4% in GDM but the differences did not reach statistical significance. A significant increase in frequency of abortions [trend chi square = 5.67, p = 0.017] and 'low birth weight' babies [trend chi square = 4.761,p = 0.029] was observed with increasing fructosamine levels in the diabetic mothers. CONCLUSION: Women with diabetes have worse pregnancy outcomes compared to non-diabetic mothers with and those with pre-gestational diabetes fare worse than those with gestational diabetes. The study emphasizes the fact that strict glycemic control is extremely important during pregnancy.

Gill lesions in the major carp, Labeo rohita exposed to lethal and sublethal concentrations of tannery effluent.

The major carp, Labeo rohita were exposed to (0.873%) lethal and sublethal (0.073%) concentrations of tannery effluent for 24h and 40 days respectively under static bioassay condition. The surface architecture of gill revealed severe damages such as : fusion and clumping in the middle and distal parts of the primary lamellae, swelling and deterioration of the cells. The interlamellar space was filled either with hyperplastic epithelial or mucous cells. Secondary lamellae lost their identity and appeared finger like in structure in the lethal concentration and necrosis was observed in the primary and secondary epithelium. Swelling of primary and secondary epithelial cells was evident in sublethal concentration.

Oxidative damage in intermediate syndrome of acute organophosphorous poisoning.

BACKGROUND & OBJECTIVES: The main cause of morbidity due to organophosphate poisoning is intermediate syndrome (Type II paralysis) that can occur 48-72 h after poisoning. Mechanisms that underlie the intermediate syndrome are not known. This study investigates the role of oxidative damage to muscles as a possible mechanism underlying the development of the intermediate syndrome. METHODS: Nineteen patients with acute organophosphate poisoning were evaluated from admission to discharge from intensive care for the severity of poisoning and the development and duration of the intermediate syndrome. Blood cholinesterases and parameters of oxidative stress were studied daily and their temporal profiles analysed according to the severity of poisoning and the development and duration of the intermediate syndrome. RESULTS: Fifteen patients had severe poisoning and 16 developed intermediate syndrome. There was a positive association between the severity of poisoning and the occurrence of intermediate syndrome. There was no association between the organophosphate ingested and the development of intermediate syndrome. Erythrocyte membrane acetylcholinesterase and serum butyrylcholinesterase levels at admission and over the course of poisoning were significantly (P < 0.001) reduced in patients compared to controls. There were significantly (P < 0.05) higher levels of lipid peroxidation, conjugated dienes and protein thiols in erythrocyte membranes of patients who developed the intermediate syndrome compared to healthy controls, in patients who developed intermediate syndrome compared to those who did not and in patients with long compared to short duration intermediate syndrome. INTERPRETATION & CONCLUSION: In acute organophosphate poisoning, severe and prolonged acetylcholinesterase inhibition is associated with oxidative stress, detected in erythrocyte membranes, that occurs early in the course of poisoning and may contribute to the development and severity of intermediate syndrome.

'O' set connector system in CAPD.

51 CAPD patients (age 55.5 +/- 14.5 yrs, 35 male, 16 female) on CAPD using 'O' set were studied retrospectively during the period January 1993 to April 1995. Etiology of ESRD was Diabetic nephropathy-25(49%) and the other causes-26(51%). The total duration of observation on 'O' set was 553 patient months, the mean duration was 10.8 +/- 6.1 months. 24 patients (47%) developed total of 30 episodes of peritonitis. The incidence of peritonitis was 18.4 patient months per episode of peritonitis. The organisms responsible for peritonitis were Gram positive-6(20%), Gram negative-3(10%), Fungal-1(3.3%), Mycobacterial-1(3.3%), Eosinophilic-1(3.3%), Sterile-12(40%) and unknown-6(20%) 2 patients of bacterial peritonitis and a patient with tuberculous peritonitis died while rest of the patients responded favourably to antibiotics. 13(52%) diabetic patients and 11(42%) non-diabetic patients had peritonitis (p-NS) and the peritonitis rates in diabetics and non diabetics were 18.3 and 18.6 patient months per episode respectively (p-NS). Exit site infection was seen in 5 patients (10%) (Staph aureus-4, Enterococci-1) and all responded to antibiotic therapy. 7 patients had total of 10 episodes of symptomatic accidental intraperitoneal sodium hypochlorite instillation, none had any long term adverse effects. The 'O' set procedure was done by self in 10(20%) and by others in 41(80%) cases. The peritonitis rates when performed by self and others were 18.5 and 18.4 patient months per episode respectively (p-NS). The cost of being on CAPD using 'O' set, Y-bag and twin bag were Rs. 1,50,000, 2,10,000 and 3,72,000 per annum respectively and cost of maintenance haemodialysis was 1,36,800 per annum. The cost of CAPD using 'O' set was comparable to that of maintenance haemodialysis. The 'O' set connector system in CAPD is found to be safe, cost effective and efficient.