Paratubal Atypical Proliferative Serous Tumour in a Young Adolescent Female - A Diagnostic Dilemma

Introdcution: Paratubal atypical proliferative serous tumoursare rare usually arising from the mesothelium or from theremnants of mesonephric and paramesonephric ducts. Wepresent a rare case of paratubal borderline serous tumour in ayoung adolescent female presenting clinically as an omentalcyst.Case Report: A 14-year old unmarried female presentedwith abdominal pain in right iliac fossa. MRI revealed awell demarcated space occupying lesion in the pelvis almostin midline measuring 12x11x8cm. Lesion was abutting anddisplacing overlying bowel loops with likely adhesionssuggestive of complex omental cyst. The patient underwentcystectomy. The final histopathologic report confirmed thecyst as Paratubal atypical proliferative serous tumour.Conclusion: We experience a rare case of atypical proliferativeserous tumour of paratubal origin. The patient was youngestthan any of the other cases reported in the literature. Fertilitysparing surgery should be considered as a standard treatmentof borderline paratubal tumour, if patient desires futurefertility.

Osseous Metaplasia in Leiomyoma: Case Report with Literature Review

Introduction: Leiomyoma is being one of the commonesttumors of the female genital tract during the reproductiveyears. It is a benign neoplasm of smooth muscle.Case report: We present one such case in a 60 year oldpostmenopausal female patient presented with uterovaginalprolapse.Conclusion: The leiomyoma demonstrate a wide spectrum ofhistological variation, but osseous metaplasia is a rare clinicalentity

Comparative Study of Bacteriological Profile of Cellulitis in Diabetic versus Non-Diabetic Patient

Introduction: Comparative study of bacteriological profile of cellulitis - in diabetic versus non diabetic patient.Materials and Methods: During a period of June 2018–May 2019 in Sanjay Gandhi Memorial Hospital surgical wards,approximately 100 cases including both diabetic and non-diabetic getting admitted through surgery out patient department,casualty, or transferred from other departments diagnosed as cellulitis based on clinical suspicion. Samples were collectedfrom the deeper portion of the ulcers, among these samples, one swab was used for Gram staining and the other was usedfor culture. A direct Gram stained smear of the specimen was examined. The organisms were identified on the basis of theirGram staining properties, their biochemical reactions, and the culture identified.Results: According to pus culture sensitivity is was found that among Gram-negative isolates, Pseudomonas aeruginosa(25.19% in D and 28.06 in ND) is most common in both diabetic and non-diabetic followed by Escherichia coli (16.12% in Dand 17.39% in ND) and Klebsiella pneumoniae (12.9% in D and 8.6% in ND). Among Gram-positive isolates, Staphylococcusaureus is most commonly isolated followed by Enterococcus in diabetics, as in non-diabetics, S. aureus (32. 25% in D and30.43% in ND) is most commonly isolated followed by Enterococcus (9.6% in D and 4.3% in ND) and methicillin-sensitive S.aureus (1.6% in D and 2.17% in ND) (D – diabetics and ND – non-diabetics).Conclusion: Microbiological evaluation of the ulcers revealed that the prevalence of Gram-negative organisms 47 (57.75%)was found to be more than Gram-positive organisms 14 (17.5%), Candida albicans 3 (3.75%), and polymicrobial species17 (21.25%). Among Gram-negative isolates, P. aeruginosa is most common in both diabetic and non-diabetic followed by E.coli and K. pneumoniae. Among Gram-positive isolates, S. aureus is most commonly isolated followed by Enterococcus indiabetics, as in non-diabetics, S. aureus is most commonly isolated followed by Enterococcus and methicillin-sensitive S. aureus.

Prevalance of Rh Antigen Subgroups Among Blood Donors in a Tertiary Care Hospital in Rural Harayana

Rh system in today’s world is probably the most complex red cell antigen system in humans. The presence ofD antigen confers Rh positivity and vice versa. Two allelic antigen pairs, E/e and C/c are also found on the Rhprotein. The D antigen is the most immunogenic red cell antigen after A and B. As there is paucity of datadistribution of Rh antigen subgroup from the Indian literature, the study was conducted to know the prevalenceof Rh antigen subgroups in this part of the region and to determine the phenotype and most common genotypeof Rh antigen among the blood donors. The observational 1 year prospective study was conducted on blooddonors attending the blood bank in the Department of Pathology, MMIMSR, MMDU, Mullana.The studycomprised of blood donors of various age groups which included 90%(450) males and 10%(50) females. Anoverall Rh D positivity was seen in 88.4% of blood donors while 11.6% lacked the D antigen. The mostcommon Rh phenotype was ccDEE 26.6%. In conclusion, sensitization to clinically important blood groupantigens can be prevented through complete blood typing. All patients should be genotyped before the firstblood transfusion

Comparison of Automated Analyzer Generated Red Blood Cell Parameters and Histogram with Peripheral Smear in the Diagnosis of Anaemia

Introduction: Red blood cell (RBC) indices and histogramobtained from automated analyzer give an idea aboutmorphological changes in anaemia. Along with the peripheralsmear, they can be used to interpret the cause of anaemia.The aim of the present study was to correlate typing ofanaemia based on RBC indices and histograms obtained fromautomated analyzer with peripheral smear examination and togive a better approach in the diagnosis of anaemia and analysetheir limitations.Material and methods: Blood samples collected from1575 anaemic patients, over a period of one year, in theHematology laboratory, were typed for anaemia, first byparameters obtained by haematology analyzer (RBC indiceswith red cell distribution width) and then by peripheral bloodsmear findings. The correlation between the diagnosis madeby peripheral smear versus RBC indices and histogram wereanalysed to find out the significance of the mean difference invarious parameters.Results: Microcytic hypochromic anaemia (50.86%) wasthe most common followed by normocytic normochromic(25.14%), macrocytic (2.29%), dimorphic (15.43%) andhaemolytic anaemia (6.29%) as diagnosed on peripheralsmear examination. Analysis by RBC indices showed 59.43%,32%, 3.43%, 2.86% and 2.29% of microcytic hypochromic,normocytic normochromic, macrocytic, dimorphic andhaemolytic anaemia respectively. Out of 801 (50.86%) casesof microcytic hypochromic anaemia on smear, 513(32.5%)revealed left shift while 288 (18.3%) showed broad-basedcurve on the histogram. In normocytic normochromic anaemia,anormal bell-shaped curve was seen in 378 cases (25%)while 18 cases (1.1%) showed the broad curve. Histogramsin macrocytic anaemia show a right shift in 27 cases (1.7%)while 9 cases (0.6%) showed left shift. In dimorphic anaemia,the histogram was bimodal only in 2.9% of cases whereas amajority (11.4%) showed broad-base histogram.Conclusion: Histogram and RBC indices give valuableinformation, but peripheral smear examination remains theimportant diagnostic tool in haematological disorders.

Clinicopathological Correlation Of Gastric Endoscopic Biopsies In A Tertiary Care Hospital In Rural Area In Haryana

The study included gastric endoscopic biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 130 gastric biopsies were included in the study. The most common presentingcomplaint was pain abdomen. The neoplastic lesions commonly presented as carcinoma whereas thenon-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplastic lesions werefound to be common out of which gastritis was the most common lesion. Associated conditions werefound to be H. Pylori and intestinal metaplasia with gastritis. Majority of the lesions were nonneoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. The neoplasticlesions comprised of adenocarcinoma & signet ring cell carcinoma. 4 cases of signet ring cell carcinomawere noted. Percentage of concordance between endoscopic & histologic diagnoses was calculatedwherein cases of gastritis, ulcer, polyps & carcinoma showed 100%, 96.3%, 71.4% & 100%concordance respectively.The conclusion of the study was that histological examination in adjunct with endoscopy should beconsidered as much more valuable diagnostic tool rather than endoscopy alone.

Clinicopathological Correlation of Endoscopic Duodenal Biopsies in a Tertiary Care Hospital in Haryana

The study included endoscopic duodenal biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 44 biopsies were included in the study. The most common presenting complaintwas pain abdomen followed by diarrhea. The neoplastic lesions commonly presented as carcinomawhereas the non-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplasticlesions were found to be common with villous atrophy predominating the list. Majority of the lesionswere non-neoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. Theneoplastic lesions comprised of adenocarcinoma. A single case of ampullary carcinoma was alsonoted. Percentage of concordance between endoscopic & histologic diagnoses was calculated whereinduodenitis, scalloping, polypoidal & carcinomatous lesions showed 100%, 60.7%, 0% & 100%concordance between the two diagnostic modalities respectively. The conclusion of the study wasthat endoscopic examination alone might miss out in diagnosing majority of the lesions. So, histologicalexamination in adjunct with endoscopy should be considered as much more valuable diagnostic toolrather than endoscopy alone.

Correlation of Cervical Pap Smear with Histopathological Diagnosis in Cervical Lesions: A 2 Years Retrospective Study

Introduction: Cervical cancer is one of the most commonforms of cancer worldwide. In developing countries, cancerof uterine cervix is ranked second with a relative frequency of15% of all cancers in women. Screening women with regularPap smears allows diagnosis of treatable pre-invasive lesions.The objective of the study was to correlate the Pap smeardiagnosis with histopathology and to know the accuracy ofPap smears, so as to assess the efficacy of Pap smears indiagnosing cervical lesions.Material and methods: This two year retrospective study wasdone in the department of Pathology in a tertiary care centre,which includes 250 Pap smears for which histopathologicaldiagnosis was also done. Detailed clinical history of patientswas taken from requisition forms received in cytologydepartment along with Pap smears. The cervical biopsies orhysterectomies received from the same patients were alsostudied and then correlated with the diagnosis of Pap smears.Results: Out of 250 Pap smears, maximum patients (32%)belonged to the age group of 41-50 years and were multipara.Maximum cases were reported as NILM (59%),followedby ASCUS (16%), LSIL (15%), HSIL (7%), squamous cellcarcinoma (1.6%) and 0.8% cases of adenocarcinoma werediagnosed. On histopathology, 41.2% cases were diagnosedas chronic cervicitis, 27.2% cases as chronic cervicitis withsquamous metaplasia, CIN I (22.4%),CIN II (4.0%),CIN III(2.8%), squamous cell carcinoma (1.6%) and (0.8)% casesof adenocarcinoma. Overall sensitivity, specificity, positivepredictive value, negative predictive value and diagnosticaccuracy was 75.24%, 97.98%, 96.20%, 85.38% and 88.8%.Conclusion: As per our study, maximum number of casesdiagnosed on Pap smears correlated on histopathology,thereby concluding that Pap smears have an important role indiagnosis of cervical lesions.

Evaluation and correlation of stress scores with blood pressure, endogenous cortisol levels, and homocysteine levels in patients with central serous chorioretinopathy and comparison with age‑matched controls.

Context: Stress had been associated with the development of central serous chorioretinopathy (CSC). The study was designed to evaluate the effect of stress on other risk factors of CSC such as serum cortisol levels, serum homocysteine levels, and blood pressure (BP) in CSC patients. Aims: To compare stress scores, serum cortisol and serum homocysteine levels, and BP of CSC patients with that of control population and to correlate stress scores of CSC patients with BP, serum cortisol levels, and serum homocysteine levels. Materials and Methods: Stress scores, serum morning and evening cortisol levels, serum homocysteine levels, systolic and diastolic BP of 54 CSC patients were measured and compared with that of 54 age‑ and sex‑related controls using Student’s t‑test. Stress scores of CSC patients were correlated with systolic and diastolic BP, serum morning and evening cortisol levels and serum homocysteine levels and Pearson correlation coefficient (r) were calculated. Results: Stress scores, serum homocysteine levels, serum morning and evening cortisol levels, and systolic and diastolic BP were all elevated in CSC patients as compared with age‑ and sex‑related controls (P < 0.05). Stress scores of CSC patients were found to correlate strongly with serum homocysteine levels, serum morning and evening cortisol levels, and systolic and diastolic BP, with r values 0.82, 0.8, 0.8, 0.8, and 0.81, respectively (P < 0.0001). Conclusions: Stress scores were elevated in CSC patients and were strongly correlated with serum homocysteine and cortisol levels and BP.

Effect of Aerobic Exercise on Auditory and Visual Reaction Times: A Prospective Study.

Physical exercise provides multiple benefits to an individual. However, the beneficial effect of exercise on psychomotor performance remains controversial. The present study was undertaken to determine the effect of aerobic exercise on auditory reaction time (ART) and visual reaction time (VRT). Fifty subjects were enrolled consisting of healthy subjects who were not exercising (n=25; group I) and subjects doing regular aerobic exercisers (n=25; group II). ART and VRT were recorded using digital display response time apparatus equipped with three lights (red, green and yellow) and three auditory stimuli (low, medium and high pitched sounds). The mean VRT of group II subjects (318.24±6.709) was significantly lower than that of group I (505.73±16.961) (P<0.001). The mean ART of group II subjects (313.33±8.160) was significantly lower than that of group I (573.09±17.950) (P<0.001). Auditory and visual reaction times are better in aerobic exercisers as compared to non-exercisers irrespective of age and gender.

Tuberculous lesions at autopsy.

Tuberculosis (TB) today remains one of the world's most lethal infectious diseases. Despite the availability of effective treatment for most cases, tuberculosis is still a cause of death in our environment. Some cases of active tuberculosis are not identified until after the patient had died and an autopsy has been performed. This study was done to determine the prevalence of tuberculosis in autopsy cases. We analysed all the autopsy cases sent for histopathology over a period of one month. 8.7% cases of active tuberculosis were found in autopsy specimens, of which 60% were males. Tuberculosis was suspected in only 40% of patients before death. Tuberculosis is not an uncommon finding at autopsy for most of autopsy surgeons, but as the cause of death it is not so common. The presence of unspecific symptomatology, insufficient cost-effectiveness of the diagnostic tests and precocious death, are identified as the most frequent causes of undiagnosed tuberculosis. Awareness of tuberculosis and its high prevalence in India is essential for minimising missed diagnoses. Absence of suspicion and delayed diagnosis mean increased risk in health care and at autopsy.

Coronary atherosclerosis and myocardial infarction an autopsy study.

The incidence of coronary heart disease has markedly increased in India over the past few years. Ischemic heart disease, the largest cause of morbidity and mortality in the developed and developing countries today is overwhelmingly contributed by atherosclerosis. The study highlights the impact of atherosclerotic lesions in the population of Haryana. We studied atherosclerotic lesions in coronaries in cases subjected to autopsy, to grade and to evaluate the atheromatous plaques; and to assess the cases of myocardial infarction amongst them. The study comprises dissected specimens of heart in 115 cases subjected to autopsy. The vessels were examined for the presence of atherosclerotic lesions which were graded according to American Heart Association and examined for evidence of myocardial infarction. The study comprises the cases in age group of 15 to 85 years. 46.4% showed significant atheroma. Commonest type of atherosclerosis seen was grade-3. Triple vessel involvement was seen in 44.4% cases. Left Anterior Descending was most commonly involved artery. Myocardial infarction was the cause of death in in 3 cases (3%) while 23 showed changes of chronic ischemic heart disease. The data obtained may form a baseline for the forthcoming studies.

A review of medicolegal consequences of gossypiboma.

Foreign bodies forgotten in the abdomen include towels, artery forceps, pieces of broken instruments or irrigation sets and rubber tubes. The most common surgically retained foreign body is the laparotomy sponge. Such materials (textilomas or gossypibomas) cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico legal implications. The diagnosis of gossypiboma and the second surgical operation needed for removal of medical problem can lead to start of legal problem between the patient and the surgeon at fault. The medico legal consequences of gossypiboma are significant. Patients may be inadvertently informed that masses might be malignant and may undergo unnecessarily invasive investigations, procedures or operations. Gossypiboma may lead to disappointing and undesired consequences for a surgeon; moreover, it is one of the significant medico-legal problems needs to be solved by specialists of forensic medicine.