Changes in Different Cytokines (IL-2, TNF-α, and IFN-γ) Profile in Acquired Aplastic Anemia Patients: A Study From Eastern India.

Although aplastic anemia has been extensively investigated, little is known about their circulating cytokine pattern. The present study was done to evaluate the severity of the disease with the 3 major anti-hematopoietic cytokines interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ). This study is ethically cleared. A total of 102 bone marrow plasma and peripheral blood plasma paired samples were collected from the confirmed acquired aplastic anemia (AAA) patients and 10 control cases after taking written consent and analyzed by the quantitative enzyme-linked immunosorbent assay. The Mann-Whitney U test was used for statistical analysis. Considerably increased levels of IL-2, TNF-α, and IFN-γ were found in the peripheral blood plasma and bone marrow plasma of AAA patients as compared with controls, that is, 45.76±20.61 versus 1.99±1.25, P<0.00001; 26.51±15.62 versus 11.7±3.67, P=0.00188; 17.04±11.64 versus 5.27±1.92, P=0.00034 and 70.54± 37.57 versus 3.12±1.82, P<0.00001; 251.82±243.80 versus 15.66±6.35, P<0.00001; 39.35±22.58 versus 11.12±2.41, P=0.00012, respectively. The IL-2, TNF-α, and IFN-γ levels were observed to be extraordinarily elevated in AAA, but were very low in the control cases. The results confirm that IL-2, TNF-α, and IFN-γ may have an imperative association with the disaster in the bone marrow compartment of AAA patients. The levels and ranges of the observed cytokines can also be predicted by the severity basis of this study.

Cytogenetic study is not essential in patients with aplastic anemia.

Depending on contemporary treatment approach of aggressive immunosuppression, Aplastic Anemia (AA) is caused by immunological destruction of otherwise normal hematopoietic stem cells. The aim was to summarize the cytogenetic abnormalities in AA patients and the frequency of Fanconi Anemia (FA) in morphologically normal AA patients in eastern India. Ethical clearances were obtained from both institutions involved in this study. Out of 72800 patients attending the outpatient department, 520 pancytopenia patients were screened for AA after Bone marrow (BM) aspiration and biopsy. Samples were collected from 117 cases in 3 phases. 51 peripheral venous blood (PVB) samples in the first phase, 19 BM & PVB paired samples in the second phase and 47 BM samples in third phase were collected followed by leukocyte and/or BM stem cell culture. Next GTG banding and karyotyping were performed. PVB was collected from 63 (< 50 years) AA patients and stress cytogenetics was done to diagnose FA. In the first phase of the study, out of 51 PVB samples, 1 (1.96%) showed a unique chromosomal abnormality, i.e. 45,XY,rob(14:21)(p10:q10)[20]. In the second phase of study, among 19 BM & PVB paired samples, 1 (5.26%) showed abnormal karyotype i.e. 45,X,-Y[3]/46,XY[47]. In the third phase of the study, 47 BM samples showed normal karyotype. Only 6 (9.52%) cases were found positive for stress cytogenetics. A negligible percentage showing cytogenetic abnormality in such a considerable number of AA cases indicates that routine cytogenetic analysis of AA patient is not essential. A significant percentage was positive for stress cytogenetics; suggestive for FA, even the patients were morphologically normal.

Eccrine angiomatous hamartoma: late onset facial presentation.

Eccrine angiomatous hamartoma (EAH) is a very rare benign neoplastic condition characterized by hamartomatous proliferation of eccrine glands and accompanying blood vessels and lymphatics. These lesions are more often present at birth or appear during early infancy and childhood and present as solitary nodule or plaque with occasional pain and sweating. They are generally present on the extremities, mostly the palms and soles. We report here a case of EAH in a 20-year-old female who presented with a solitary angiomatous plaque close to the lower eyelid of the right eye with occasional pain and sweating for its rarity.

Analysis of FNAC of cervical lymph nodes: experience over a three-year period.

This study was taken up with the aim to investigate the pattern of cervical lymphadenopathy among patients presenting to IPGME&R, Kolkata, a tertiary care institution in Eastern India to evaluate the diagnostic efficacy of FNAC, and to dissect the diagnostic pitfalls. A total of 509 patients were subjected FNAC of cervical lymph nodes over a three-year period (August 2006-July, 2009). Since in 34 patients, as either the aspirate was inadequate or the opinion equivocal, the remaining 475 cases were analysed. Overall tuberculous lymphadenitis was the most common finding (222/475; 46.7%), while reactive hyperplasia was the commonest presentation (45%) in patients less than 20 years of age. Malignant pathology accounted for 13.7% (65/475) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (44/65; 67.7%). Histopathology reports were available for comparison in 220 cases. Twelve cases of tuberculosis were missed in FNAC and were reported as either reactive hyperplasia (n = 9) or acute non-specific lymphadenitis (n = 3). Among the 3 cases of metastatic squamous cell carcinoma that were missed in FNAC, one was reported as tuberculous lymphadenitis (due to granuloma formation) and the other 2 as reactive hyperplasia due to sampling error. FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

Eccrine angiomatous naevus revisited.

Hamartomatous, circumscribed swellings of the extremities make an interesting study. Presentations are manifold and the naevi are not always present from birth. Excessive growth of hairs leads to remarkable appearance of such swellings. A young woman presented to the dermatology department, complaining of tenderness over 4(th) finger of her left hand. The defect was present for the last couple of years and was typified by visible hyperhidrosis on gentle tapping. Counseling of the affected lady made her agree for a skin biopsy. The histopathology revealed it to be of the nature of eccrine angiomatous hamartoma. Blood vessels were scarce. Eccrine ducts were plentiful without other associated anomalies. The deformity was removed by simple excision with good result.

Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period.

AIMS: This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls. MATERIALS AND METHODS: A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases. RESULTS: Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases. CONCLUSION: FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

A locally developed snakebite management protocol significantly reduces overall anti snake venom utilization in West Bengal, India.

OBJECTIVE: The purpose of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom (ASV) used in treating snakebites in a developing country and its effect on mortality. In addition, basic epidemiology data were collected and analyzed. METHODS: Experts in Indian snakebites developed a protocol specifically designed for snakebite treatment in India. A training program was implemented in Midnapore Medical College in West Bengal, India, under the direction of the Health Minister to train care providers in the new protocol. After training, data were collected for 839 snakebite victims over a 12-month period and included epidemiological data, ASV volumes administered, and mortality. The results were collated and compared with results calculated from 780 snakebite victims treated during the 12-month period before implementation of the protocol. Treatment prior to protocol implementation was based on knowledge gained by the care providers from western and forensic medicine textbooks. RESULTS: Protocol-guided treatment resulted in a 66% decline in the amount of ASV administered to victims. Fewer victims received ASV based on rational guidelines for assessing envenomation, dosage and repeat dosage, and clear endpoints to ASV therapy. In addition, there was a trend towards reduced mortality and an absolute reduction of 24%. CONCLUSION: Use of the protocol reduced ASV utilization and the number of deaths. Locally developed protocols should be encouraged by such organizations as the World Health Organization and national and state governments and should be established with significant input from local experts.

A clinicopathological study of malignant melanoma with special reference to atypical presentation.

Malignant melanoma is a tumor of melanocytic origin. Lymphatic and hematogenous metastases are common in this condition. Retrospective analysis was performed in 16 consecutive cases diagnosed histopathologically as malignant melanoma at the pathology department of a medial college in eastern India. 75% of the patients were male; majority of them was in their sixth decade. All (100%) the lesions were pigmented. The primary site was known in all cases, except two (12.5%). Out of the 14 cases with known primary site 11 (78.57%) were cutaneous melanomas, including one arising in labia minora, two (14.29%) were ocular and one (7.14%) was vaginal in origin. Among cutaneous melanomas, superficial spreading type was the commonest variety and mixed population of epithelioid and spindle cell was the commonest histopathological pattern. The commonest grade of invasion was grade III (Clark's). The clinical presentation of the case of vaginal melanoma and the two cases of secondary melanomas, including the one with obscure primary tumor, were bewildering and hence are discussed separately.