ABSTRACT
BACKGROUND: To achieve the standardization of the thyroid FNA reporting, the National Cancer Institute (NCI) hosted the "NCI Thyroid Fine Needle Aspiration State of the Science Conference", which led to the formation of 'The Bethesda System for Reporting Thyroid Cytopathology' (TBSRTC). MATERIAL AND METHODS: The present study was undertaken by 2 experts in thyroid FNA, who in a double blinded fashion, examined and re-classified 80 random FNA cases according to the 6 levels of TBSRTC for an inter-observer review, to study and assess the new terminology for ease of reproducibility and to note the rate of disagreement overall or in any particular category. The FNAs were reclassified in a double blinded fashion according to the 6 levels of TBSRTC which are: non diagnostic (ND); benign; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), Hurthle cell type/suspicious for a follicular neoplasm, Hurthle cell type (FNHCT/SFNHCT); suspicious (SUS), and malignant. RESULTS: In the present study, the maximum number of cases was reclassified under the benign category (61.25% cases), followed by the FN/ SFN category and the AUS/FLUS category (11.25% and 10.00% respectively). An agreement was reached in 66 cases (82.5%); the experts disagreed in 14 cases-17.5% (where 1 expert did not agree with the other). Individually; a 93.87% agreement was noted for the lesions in the benign category, for 50% lesions in the AUS/FLUS category, for 66.66% lesions in the FN/SFN and the SUS categories, for 71.42% lesions in the FNHCT/ SFNHCT categories and for 100% lesions in the ND and the malignant categories. Thus, the maximum disagreement was noted in the AUS/FLUS category. CONCLUSION: The implementation of TBSTRC which stands for a unique, international and a universal terminology for reporting the thyroid cytology; should be encouraged in our country, because of its relative ease of reproducibility. Although there was a great deal of agreement in implementing TBSTRC in the present study; disagreements were seen in the categories of AUS/FLUS and FN/SFN in the study which was conducted at our centre. This corroborated with the findings of the studies which were done elsewhere.
ABSTRACT
BACKGROUND: Thrombocytopenia (platelet counts less than 150,000/µl) is commonly encountered in various hematological disorders including myelodysplastic syndromes as well as various non-myelodysplastic hematological conditions. AIM: The present study was undertaken to calculate the prevalence of various conditions associated with thrombocytopenia and to record the megakaryocytic alterations in various cases of thrombocytopenia. Apart from this by means of statistical analysis it was tried to analyze whether a significant difference existed in megakaryocytic alteration noted in myelodysplastic versus non- myelodysplastic conditions. MATERIALS AND METHODS: A prospective series of 60 bone marrow aspirations along with concomitant bone marrow biopsies was conducted in a tertiary care centre catering to both urban as well as rural population in north India. STATISTICAL ANALYSIS: The distribution of morphological changes in cases of non myelodysplastic conditions and myelodysplastic were compared using Chi-Square test. A p-value less than 0.05 was considered significant. RESULTS: The commonest cause of thrombocytopenia for which bone marrow examination was sought was dimorphic anaemia (18 cases, 30%), followed by myelodysplastic syndrome (06 cases, 10%) which was followed equally by acute lymphocytic leukemia and blast crisis of chronic myeloid leukemia (CML). Of all the non-MDS conditions apart from dimorphic anaemia, idiopathic thrombocytopenic purpura and chronic myeloid leukemia (blast crisis); megakaryocytic dysplastic forms were not noted in any other condition. In cases of myelodysplasia; dysplastic forms, bare megakaryocytic nuclei, hypogranular forms and micromegakaryocytes were seen. Comparison between frequencies of normal, high and low number of nuclear lobes among MDS (n=9) and non MDS (n=68) conditions were found to be statistically significant. CONCLUSION: Further studies on the evaluation of megakaryocytic alteration and their contribution to thrombocytopenia can provide growing knowledge to the pathogenesis of numerous hematopoietic disorders that may identify broader clinical applications of the newer strategies to regulate platelet count and functioning.
ABSTRACT
Bone Marrow Necrosis (BMN) is regarded as a rare entity in the aspirates and the trephine biopsies which are obtained from living patients and it is a rare antemortem diagnosis. Usually, BMN is associated with a poor prognosis and it has a 90% association with malignancies (mainly haematological). Its other causes include infections, drugs and other non malignant haematological causes. BMN which occurs due to unknown causes (idiopathic), is very rare. The present case report describes a case of BMN in a 14 year old male child from rural background, who came to the medicine outpatient department of a tertiary care centre in north India, with the complaints of generalized weakness, severe bone pains, especially in the ribcage area and fatigue. His peripheral blood film revealed pancytopaenia. His bone marrow aspiration yielded a watery, sero-sanguinous fluid from 2 different sites. Microscopy revealed "ghost like" haematopoietic cells lying in eosinophilic, proteinaceous material. Bone marrow biopsies from both the sites revealed extensive foci of gelatinous transformation and necrosis. A diagnosis of BMN was rendered. No underlying neoplastic / non neoplastic cause was identified, even after a thorough systematic investigation (haematological/biochemical/ radiological and immunological). Thus, a final diagnosis of BMN due to an idiopathic cause, was finally given. The patient was given supportive treatment, after which he was referred to a higher centre. BMN which arises idiopathically is usually very rare and often precedes the aetiological diagnosis and obscures the diagnosis. Traditionally, the prognoses of the patients with BMN were considered as poor, but with better treatment aids (chemotherapy and supportive treatment), the prognoses of these patients have been found to improve. Vigorous supportive care, along with a disease specific treatment, is the key to its management. This case was worth reporting, as no cause of BMN was elicited in it and we have summarized the signs and symptoms, the associations, haematological and other lab investigations and the role of radiology, which helped in its diagnosis.
ABSTRACT
OBJECTIVE: To compare the efficacy and safety of azithromycin with ofloxacin in patients with uncomplicated typhoid fever. MATERIAL AND METHODS: Forty adult patients with bacteriologically or serologically diagnosed, uncomplicated typhoid fever were included from Medicine out-patient department at Government medical college, Amritsar, India. They were randomized into 2 groups of 20 patients each. Group I: patients received ofloxacin 200mg orally twice daily for 7 days. Group II: Patients received Azithromycin orally 1 gm on day 1 and then 500 mg daily from day 2 to day 6. The following parameters were noted a) fever clearance time b) cure rate c) adverse drug reaction d) recurrence of symptoms, if any, during 4 weeks follow up. RESULTS: Nineteen out of 20 patients from group I were cured with mean fever clearance time of 3.68 days while all 20 patients from group II were cured with mean fever clearance time of 3.65 days. No significant side effects were noted in any of the patients. No relapse was recorded in the present study in a follow up period of 4 weeks in both study groups. CONCLUSION: Both ofloxacin and Azithromycin are almost equally efficacious and safe in treatment of typhoid fever with no major adverse effect. Azithromycin is an effective alternative in conditions where ofloxacin is contraindicated i.e., children, pregnant women and quinolone resistant cases of typhoid fever.
