Parasite and the Circulating Pool- Characterisation of Leukocyte Number and Morphology in Malaria.

INTRODUCTION: Haematological changes are the most common complications encountered in malaria. There is significant correlation between several of the haematological parameters and the clinical profile, prognosis and mortality in malaria. White cell counts and differentials are among the most basic and primary investigations done in a patient presenting with fever of short duration. AIM: This study analyzes the numerical and morphological changes in White Blood Cells (WBCs) in peripheral blood in patients with acute malaria in endemic region in an effort to get a picture of specific changes that could be identified by basic investigations. MATERIALS AND METHODS: This study was conducted in tertiary care hospital in a region endemic for malaria. EDTA anticoagulated venous blood samples from 600 patients diagnosed with vivax and falciparum malaria was analysed in Coulter counter LH 500 for the white cell count and differentials. Morphological changes were looked for in Leishman stained peripheral blood smear. Comparison with age matched healthy controls was done by ANOVA with Bonferroni test wherever applicable. RESULTS: Patients with malaria showed significant leucopenia, neutrophilia, lymphocytopenia, monocytosis and eosinopenia. Lymphocytopenia was more severe in the falciparum group as compared to the vivax group. A higher White Cell Count (WCC) was seen in patients with higher haemoglobin levels in vivax group. The total leukocyte count showed a negative correlation with neutrophil count in falciparum malaria and a strong positive correlation with neutrophil count in vivax malaria. Band neutrophils were seen in 10% of the patients with falciparum and 1.1% of patients with vivax malaria. Atypical plasmacytoid lymphocytes were the only notable morphological finding. CONCLUSION: Changes in leukocyte number and morphology in the peripheral blood are common. A combination of monocytosis and eosinopenia in a patient presenting with fever should alert the observer to the presence of malaria and should prompt a repeat blood smear examination in case of initial negative results for the parasite.

Human dirofilariasis: an emerging zoonosis in India.

Human dirofilariasis is an uncommon zoonotic infection having a widespread geographical distribution. World over 800 cases of Dirofilaria are on record with highest numbers from Italy, Sri Lanka and republics of the ex-Soviet Union. Dirofilaria repens belongs to the subgenus Nochtiella and is the most common species identified in India. Topographically, the orbital/periorbital regions are the most common regions involved by Dirofilaria. We present a brief review of cases from India including two received in our own institute. This review focuses on the epidemiology of the disease including its geographical distribution and the probable causation of the recent increase in its incidence in Indian subcontinent.

Invasive (solid) Papillary Carcinoma of the Breast: A Report of Two Cases.

Papillary carcinoma is a rare malignant tumour of the breast with an incidence of 1-2% in the general population. The clinical behaviour of solid papillary carcinomas is generally indolent unless it is associated with invasion. Here, we are reporting two cases of solid invasive papillary carcinomas of the breast, who were 2 female patients aged 44 years and 55 years., with breast masses which were diagnosed by FNAC and confirmed by histopathology. The exact incidence and the clinical behaviours of such cases need to be ascertained by further research.

A rare case of primary lymphoma of the caecum presenting as intussusception.

Mucosa associated lymphoid tissue (MALT) lymphomas are rare neoplasms. They are most common in the stomach followed by small intestine and colon. The symptoms are nonspecific and generally do not present with intussusception. Here we report a rare clinical entity in which a 35-year-old female presented to the emergency with severe abdominal pain which was sudden in onset. History revealed that she had been having vague mild abdominal pain for 2 years. Ultrasonography showed ileocolic intussusception with hypoechoic lesion of 54 × 46 mm seen at the lead point. Emergency laparotomy with the right hemi-colectomy was done. The specimen was sent for histopathological examination which revealed a diagnosis of MALT lymphoma. Awareness of the varied clinical presentation helps in formulating the appropriate therapeutic strategy.

Primary umbilical endometriosis - Diagnosis by fine needle aspiration.

Primary (spontaneous) umbilical endometriosis is very rare with an estimated incidence of 0.5-1% of all patients with endometrial ectopia. Endometriosis is a common gynecological condition, the pelvis being the most common site of the disease. Extrapelvic site is less common and even more difficult to diagnose due to the extreme variability in presentation. A 38-year-old woman presented with a blackish nodule over the umbilicus of 3 years duration. Fine needle aspiration cytology of the lesion showed cells in clusters and sheets with background of scant stromal fragment, hemosiderin laden macrophages and RBCs, leading to a suggestion of umbilical endometriosis. Histopathological examination of the excised lesion confirmed the same.