Prevalence and clinical significance of IgA anti-tissue transglutaminase antibodies in patients with chronic liver disease.

BACKGROUND AND AIM: Celiac disease is a multi-systemic disease, which can affect any organ system including liver. However, the prevalence of celiac disease and the sensitivity and specificity of anti-tissue transglutaminase (anti-tTG) in diagnosing celiac disease in patients with cirrhosis of liver is not well established. METHODS: We screened a cohort of patients with chronic liver disease for an associated diagnosis of celiac disease. Anti-tTG was carried out in all patients, and those with a high value were subjected to duodenal biopsy for histological confirmation. In patients where biopsy was contraindicated or refused, anti-endomysial antibody (anti-EMA) was tested. RESULTS: Of a total of 595 patients with chronic liver disease, high levels of anti-tTG were noted in 150 (25.2%) patients, and celiac disease was diagnosed in 14 patients (2.4%). Celiac autoimmunity (high levels of both anti-tTG and anti-EMA) was noted in seven patients (1.2%). CONCLUSIONS: Although a large number of cirrhotic patients have high levels of anti-tTG, duodenal histology and/or anti-EMA is normal in majority of these patients. This suggests high false positivity of anti-tTG in patients with cirrhosis and highlights the need of duodenal biopsy for histological confirmation of the diagnosis of celiac disease.

Flow Cytometric DNA Ploidy Analysis in Haemato-Lymphoid Neoplasms: An Analysis of 132 Cases.

Background: FxCycleTM Violet (FCV) based flow cytometric (FCM) DNA ploidy analysis is a rapid and simple tool that can substantiate in characterizing the biological behaviour across the spectrum of haematological malignancies and correlates with cytogenetic studies. Materials and Methods: In this prospective study, we performed simultaneous immunophenotyping with FCV based on ploidy analysis in n=132 consecutive new samples, comprising n=110 samples of haemato-lymphoid neoplasms, including acute leukemias (n=67, 60.9%), CML with myeloid blast crisis (n=1, 0.9%), MDS with excess blasts (n=2, 1.8%), mature B cell/ T cell neoplasms (n=37, 33.7%), multiple myeloma (n=3, 2.7%) along with n=22 normal samples. The FCM DNA data was compared with corresponding conventional karyotyping results, wherever available. Results: In FCM ploidy analysis (n=110), the overall DNA index (DI) ranged from 0.81 to 2.17 and S-Phase fraction (SPF) from 0.1-31.6%. Diploidy was seen in n = 90 (81.8%), low-hyperdiploidy in n = 10 (9.1%), high-hyperdiploidy in n = 7 (6.4%) with one case each (0.9% each) having near-tetraploidy, high-hypodiploidy and low-hypodiploidy. The DI of all viable cell populations in normal samples ranged from 0.96-1.05. Conventional karyotyping was performed in n=76/110 cases (70%) with n= 11/76 (15%) culture failures. The modal chromosome number ranged from 45 to 63. A concordance of 95.4% (n=62/65) was noted with corresponding FCM DI. Conclusion: FCV-based ploidy is a sensitive technique that provides complementary information and ascertains a strong correlation with conventional cytogenetics across all haemato-lymphoid neoplasms. It can detect aneuploidy in all B-ALL and myeloma cases, even in hemodiluted samples with cytogenetic culture failure; supplement the diagnoses of erythroleukemia, and provide a useful screen for a higher grade lymph node disease in lymphoma cases with SPF > 3%.

Hodgkin Variant of Richter's Transformation in Chronic Lymphocytic Leukemia (CLL): An Illustrative Case Report and Literature Review.

Hodgkin lymphoma variant of Richter's transformation (HL-RT) is a rare event, occurring in < 1% chronic lymphocytic leukemia (CLL) cases, of which, in < 10% cases, HL is the first finding leading to a diagnosis of CLL that co-exists simultaneously. Here we report a 60 years old male patient who presented with an outside diagnosis of lymphocyte-rich classical HL. On evaluation, he had only B-symptoms in the form of low-grade fever and weight loss. Peripheral smear revealed mild leukocytosis with an absolute lymphocytosis and a few smudge cells. Bone marrow (BM) aspirate and biopsy exhibited diffuse infiltration by a small cell, low grade, Non-Hodgkin's lymphoma with no immunohistochemical evidence of HL. Flow cytometry performed on BM was consistent with classical immunoprofile of CLL. Meanwhile the lymph node received for review revealed diffuse effacement of nodal architecture by small mature lymphocytes with immunoprofile of CLL expressing CD20, CD5, and CD23. Interspersed between these cells, were a few eosinophils along with classical Reed Sternberg cells, expressing CD30, MUM-1, CD15, and dim PAX-5, with a surrounding rosette of T-Cells highlighted by CD3 and PD-1 and negative for CD45, CD20, and EBV immunohistochemistry. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed hepatosplenomegaly with multiple supra/infra diaphragmatic lymph nodes. So, a final diagnosis of HL-RT in CLL was considered. The patient is currently doing well after the first cycle of ABVD chemotherapy. HL-RT occurring in CLL is a rare event with heterogeneous clinical presentation, morphology, clonal origin, disease course, prognostic features, and survival.

Spectrum and Immunophenotypic Profile of Acute Leukemia: A Tertiary Center Flow Cytometry Experience.

BACKGROUND: For diagnosis, sub-categorization and follow up of Acute Leukemia (AL), phenotypic analysis using flow cytometry is mandatory. MATERIAL AND METHODS: We retrospectively analyzed immunophenotypic data along with cytogenetics/molecular genetics data (wherever available) from 631 consecutive cases of AL diagnosed at our flow cytometry laboratory from January 2014 to August 2017. RESULTS: Of the total 631 cases, 52.9% (n=334) were acute lymphoblastic leukemia (ALL), 43.9% (n=277) acute myeloid leukemia (AML), 2.2% (n=14) mixed phenotypic acute leukemia (MPAL), 0.5% (n=3) acute undifferentiated leukemia (AUL) and 0.5% (n=3) chronic myeloid leukemia in blast crisis (CML-BC). ALL cases comprised of 81.7% (n=273/334) B-cell ALLs (95.2%, n=260/273 common B-ALLs and 4.8%, n=13/273 Pro B-ALLs). CD13 was the commonest cross lineage antigen, expressed in B-ALL (25.6%, n=70/273), followed by CD33 (17.9%, n=49) and combined CD13/CD33 (11.3%, n=31/273) expression. T-ALLs constituted 18.3% (n=61/334) of total ALLs and included 27.9% (n=17/61) cortical T- ALLs. CD13 was commonest (32.7%, n=20/61) aberrantly expressed antigen in T-ALLs, followed by CD117 (19.1%, n=9/47). AML cases included 32.1% (n=89/277) AML with recurrent genetic abnormalities, 9.0% (n=25/277) with FLT3/NPM1c mutation and 58.9% (n=163/277) AML NOS including 14.7% (n=24/163) AML M4/M5, 1.8% (n=3/163) AML M6 and 3.7% (n=6/163) AML M7. In AMLs, CD19 aberrancy was the most common (20.2%, n=56/277) followed by CD56 (15.8%, n=42/265). CONCLUSIONS: In this study, we document the spectrum, correlate the immunophenotype with genetic data of all leukemias, especially concerning T-ALL where the data from India is scarce.

FxCycle™ Based Ploidy Correlates with Cytogenetic Ploidy in B-Cell Acute Lymphoblastic Leukemia and Is Able to Detect the Aneuploid Minimal Residual Disease Clone.

BACKGROUND: Flow cytometry (FCM) is a simple, sensitive, and specific technique that can potentially determine DNA ploidy in B-cell precursor ALL (BCP-ALL) and is complementary to cytogenetics. METHODS: A prospective FCM DNA ploidy analysis using FxCycle™ Violet (assay sensitivity 0.01%) was done in 125 consecutive new cases of BCP-ALL (90 cases <15 years of age) and compared with corresponding cytogenetic ploidy (karyotyping and/or FISH) data wherever available. This assay was also subsequently evaluated for detection of residual aneuploid clone in few BCP-ALL cases. RESULTS: Of the total 125 BCP-ALL cases evaluated, flow ploidy analysis revealed diploidy (DI 0.96-1.05) in 44.8% (n = 56), low-hyperdiploidy (DI 1.06 to 1.15) in 13.6% (n = 17), high-hyperdiploidy (DI 1.16-1.39) in 32.8% (n = 41) and near-tetraploidy (DI ≥ 1.80) in 2.4% (n = 3) cases. The high risk sub-group of low-hypodiploidy (DI 0.70 to 0.88)/near-triploidy (DI 1.40 to 1.79) constituted 5.6% (n = 7) cases while there was only one case with haploidy (DI 0.58). Overall, high concordance of 90.4% (n = 113) was noted between the combined cytogenetics ploidy and FCM ploidy. Of the total discordant cases (n = 12), the maximum discordance was seen in the low-hyperdiploid DI subgroup (n = 10), which included seven cases with low DNA index high hyperdiploidy (LDI-HHD). FCM DNA ploidy assay was able to detect the residual clone in all six MRD positive aneuploid cases evaluated. CONCLUSIONS: FxCycle™ based DNA ploidy ascertains strong correlation with cytogenetic profiles and yields complementary information that can be used by the cytogenetics laboratories or otherwise. © 2019 International Clinical Cytometry Society.

Evaluation of Various Laryngeal Pathologies: Videolaryngoscopy Versus Videolaryngostroboscopy.

Voice disorders are common in various laryngeal pathologies. The aim of this study is to evaluate the diagnostic value of videolaryngostroboscopy (VLSS) over videolaryngoscopy (VLS) in laryngeal pathologies. This was a prospective observational study. Detailed examination was carried out for 80 cases which presented with different laryngeal pathologies. Cases were evaluated on the basis of VLS and VLSS in the same sitting and diagnosed separately. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to find out the relationship between diagnoses made by VLS and VLSS. The diagnostic value of VLSS is significant; it has 98.15% Sensitivity and 50% specificity over VLS in finding true vocal cord abnormalities. Around one third of the cases, i.e. 26 cases (32.50%) were misdiagnosed on VLS. Also, VLSS gave additional diagnosis in 6 cases (7.50%) which were missed on VLS. However, the diagnoses revealed by VLS and VLSS were same in 48 cases (60%). The diagnostic value of VLSS correlated with the type of laryngeal pathology. Through the present study, it has been deduced that VLSS is the superior modality for diagnosing laryngeal pathologies. It offers better visualisation of the finer aspects of the vocal cords. It has various advantages over VLS in terms of sensitivity and specificity.

Efficacy of 1% clotrimazole drops vs. 1% clotrimazole cream vs 10% povidone-iodine in the treatment of otomycosis - A randomized controlled study

Introduction: Otomycosis is a term used to describe the epithelial infection caused by yeast and filamentous fungi, in the External Auditory Canal (EAC). It is one of the common infections seen in ENT OPD because of its prevalence in hot and humid climate. Due its high recurrence rate and different treatment modalities, it’s important to come out with ideal treatment modality. Aim: To compare efficacy of 1% clotrimazole drops vs. 1% clotrimazole cream vs 10% povidone- iodine in the treatment of otomycosis. Materials and methods: Randomized control study was performed for 2 months on clinically diagnosed otomycosis patients. Total 60 patients were included in the study, which were randomly divided in 3 groups and treated by 1% clotrimazole drops, 1% clotrimazole cream and 10% povidone- iodine respectively. Patients were reviewed after 7 days on the basis of clinical response and symptoms of pain, ear blockage, pruritus and burning sensation. Results: After 7 days of treatment groups treated with 1 % clotimazole drops and cream had good response of 90% and 95% as compared to 10% povidone-iodine group which was 70%. Clotrimazole cream group had more ear blockage complain which was 75% and clotrimazole drops group had more burning sensation complain which was 55%.Conclusion: 1% clotrimazole drops and cream are equally effective in management of otomycosis but 10% povidone-iodine can be considered if patient has complain of ear blockage and burning sensation.

Steroid Cell Tumour of Ovary - A Rare Case Report.

Steroid cell tumours of the ovary are uncommon sex- hormone secreting tumours characterized by a steroid cell proliferation. The incidence of steroid cell tumour of the ovary is only 0.1% of all ovarian tumours. As far as steroid cell tumours, not otherwise specified (NOS) is concerned; it constitutes about 56% of all steroid cell tumours. Here we present a case of 55-year-old, postmenopausal patient who presented with complaints of bleeding per vaginum and abdominal pain for last 3-4 months, with history of excessive hair growth since 3-4 years. Ultrasonography revealed a solid right ovarian mass with a possibility of ovarian sex cord tumour. Histopathology confirmed the diagnosis of steroid cell tumour NOS type with no cytological atypia.

Effect of glare on night time driving in alcoholic versus non-alcoholic professional drivers.

CONTEXT: The use of alcohol during nighttime driving may affect recovery from glare leading to increased traffic accidents. OBJECTIVE: To compare the glare recovery time in alcoholic versus non-alcoholic drivers. MATERIALS AND METHODS: Alcoholic (n = 25) and non-alcoholic drivers (n = 25) were subjected to glare recovery test and they also filled a questionnaire about the nighttime driving. RESULTS: The glare recovery time got prolonged in alcoholic drivers and they also complained of more problems during nighttime driving as compared to non-alcoholic drivers. CONCLUSIONS: The use of alcohol delays recovery from glare during nighttime driving. This can have considerable implications for developing countries in improving regulations for driving licensing.