Clinical profile and response to first-line ARV in HIV patients from Eastern UP and Bihar: a retrospective study.

BACKGROUND AND OBJECTIVES: Spectrum of infections in Human Immunodeficiency Virus (HIV) infected patient from Eastern UP and Bihar has not been systemically evaluated. This study was conducted with the following objectives; a) explore the spectrum of clinical conditions associated with HIV disease, b)the difference between clinical and investigatory parameters in those patients who presented with infection from those who present without infection and c) to evaluate the effect of anti-retroviral (ARV) therapy. METHODS: 1248 subjects who fulfilled the inclusion criteria were enrolled for the study from May 2007 to November 2008. Patients were evaluated for their baseline characteristics along with CD4 count and followed up for at least for 6 months after initiation of ARV (6-24 months). RESULT AND INTERPRETATION: In this retrospective study, tuberculosis (58.96%) was the commonest infection followed by chronic diarrhoea (26.56%) and various skin infections. Males had significantly higher incidence (p value < .001) of infection as compared to females. There was a significant difference between the patients who presented with infection from those who presented without infection for their baseline weight (42.3 vs 45.42), haemoglobin (9.06 vs 9.91), mean CD4 count at baseline (107.38 vs 128.38/microL) and CD4 count after 6 month of therapy (298.09 vs 322.98/microL). Mortality was also significantly high (p value < 0.05) in those who presented with infection (19.95% vs 15.1%), although there was no difference between these two groups on their improvement in CD4 count from baseline after 6 months of therapy. CONCLUSION: Among the spectrum of infection in HIV patient from North East part of India, tuberculosis was commonest, followed by skin infections and chronic diarrhoea. Patients who presented with infection at the time of initial presentation had a low haemoglobin, body weight and CD4 count and had high initial mortality but if they survived they show similar response to ARV therapy as patients who presented without infection.

Can dual staining with p16 and Ki67 be biomarkers of epithelial dysplasia in oral lesions?

Background: Oral carcinogenesis is a multistage process with epithelial dysplasia as a premalignant condition. There is a significant inter-observer variation in diagnosing and grading the oral epithelial dysplasia. As human papillomavirus (HPV) is believed to have à strong relationship with oral carcinogenesis, using P16 as a biomarker may help in identifying the cells which may be undergoing the malignant transformation. However, due to the low specificity of P16, dual staining test P16INK4/Ki67 might be a better promising marker for identifying the transformed cells. This study was designed to evaluate the dual expression of P16 and Ki67 as a promising biomarker for dysplasia and their correlation with clinicopathological factors. Materials and Methods: Immunohistochemical analysis for p16 and ki67 was performed on 30 premalignant oral lesions and 36 oral squamous cell carcinoma (OSCC) by dual staining using the CINtec PLUS kit. Results: CINtec positivity was observed only in leukoplakia with dysplasia (46.7%) and squamous cell carcinoma (25%). None of the cases of leukoplakia without dysplasia or oral submucosal fibrosis stained positive for CINtec plus staining. In leukoplakia with dysplasia, there was no significant association with any of the clinicopathological parameters studied. In OSCC cases, alcohol intake showed statistically significant association with CINtec positivity. Conclusion: P16INK4/Ki67 assessment by dual staining is a promising biomarker for identifying dysplasia in cases with diagnostic dilemmas.

Clinical spectrum and treatment response in patient of chronic myeloid leukemia in correlation with ABO blood group.

Background: Several studies have been conducted to evaluate and investigate the molecular mechanisms underlying alterations in ABO blood group antigens in oncogenesis. We observed that no study has been reported yet that correlate cytological, molecular and haematological responses of Imatinib therapy in chronic myeloid leukemia (CML) patients with different types of blood groups. Objective: To determine the distribution of CML in the ABO blood group, clinical spectrum of CML in different blood groups, and treatment response of CML patients in correlation with ABO and Rh blood groups. Material and Methods: All the patients included in the study were diagnosed on the basis of clinical features, peripheral smears and bone marrow aspiration findings. Real-time reverse transcriptase polymerase chain reaction (PCR) and cytogenetic analysis were done in all patients at the time of initiation of therapy. Blood grouping and Rh typing of each patient were done at the initiation of therapy. Results: Out of 100 included patients, 58 were male and 42 were female patients. It was observed that 45 (45%) patients were having a B+ blood group; 33% patients were having O+ blood group, followed by A+ (10%), AB+ (8%), A- (2%), B- (1%) and AB- (1%). Around 43.64% study subjects with O + blood groups showed complete cytogenetic response, followed by B+ (41.82%), A+ (10.91), A- (1.82) and AB+ (1.82). An equal number of patients (40% each) with O+ and B+ blood groups, followed by A+ (20%) showed undetectable Abelson-breakpoint cluster region (BCR-ABL)/ratio (%). About 75% of patients showed complete haematological response (CHR) and 25% showed PHR. Patients with B+ and O+ blood groups (41.33%) showed a CHR. It was observed that a maximum number of patients were suffering from symptoms of an abdominal mass (37%), 43.24% of patients with B+ blood group showed an abdominal mass, followed by O+ (35.13%), A+ and AB+ (8.11% each), B - and AB- (2.70% each). Conclusion: This study revealed that study subjects with B+ and O+ blood groups showed better cytogenetic, molecular and haematological responses as compared with patients with other blood groups at 6 and 12 months of treatment with Imatinib.

Hematological malignancies in relation with ABO blood group at a teaching hospital, Varanasi, India.

BACKGROUND: There has been enormous progress in the diagnosis and treatment modalities of leukemia, but its pattern and prevalence vary throughout India. This inter-regional variation may be due to geographic, cultural or racial variation or maybe due deficiency in case of notification, especially in rural areas. OBJECTIVE: The aim of our study is to determine the prevalence of different types of hematological malignancies with the ABO blood group at a teaching hospital in Varanasi, India. This cross-sectional study of 77 cases was conducted during 2016-2017 at a tertiary care center. We analyzed the age, sex, subtype of leukemia, blood group, clinical features, and laboratory parameters of patients. Age ranged between 1 year and 81 years with a male to female ratio of 1.9:1. A total of 66.3% of patients were suffering from acute leukemia and 33.7% from chronic leukemia. The most common blood group was B positive (44.8%) but no significant association was found (P = 0.822). Fever (76.6%) and generalized weakness/easy fatigability (46.75%) were common complaints, whereas pallor (68.8%) and splenomegaly (51.9%) were common signs. Cases were from 23 districts of eastern Uttar Pradesh and western Bihar. The majority of the cases (70.12%) were from 8 districts (Jaunpur, Varanasi, Azamgarh, Ballia, Bhadhoi, Gazipur, Kaimur, Rohtas) of Uttar Pradesh, India and Aurangabad district of Bihar. Acute leukemia is more prevalent than chronic leukemia with more male preponderance. Acute lymphoblastic leukemia (ALL) were commonly found in children, acute myeloid leukemia (AML) was found in both children and adults. Chronic Myeloid Leukemia (CML) and chronic lymphocytic leukemia (CLL) mainly noted in adults. Unclassified acute leukemia was seen mainly in children and young adults. Anemia was more severe in acute conditions and thrombocytopenia was also more in acute leukemia. The most common blood group was B positive.

Study to evaluate the etiology of iron deficiency anemia at a teaching hospital in northeastern part of India.

INTRODUCTION: The causes of iron deficiency may be either due to excessive loss or, less frequently, decrease absorption. Data related to etiology are not available from this part of the country. OBJECTIVE: A study to evaluate the etiology of iron-deficiency anemia at a teaching hospital in the northeastern part of India. MATERIALS AND METHODS: In this cross-sectional study, cases of iron-deficiency anemia were selected from the OPD and indoor, after taking proper written consent. Iron-deficiency anemia was diagnosed by sending the complete hematological investigations. Other specific investigations including imaging were done in selected patients as per indications. RESULTS: A total of 102 patients of iron-deficiency anemia were included in the study. The age of the selected population was between 18 and 80 years. 37.3% were male and 62.7% were female patients. Upper gastrointestinal endoscopy was done in 56, out of these, 9.7% had antral gastritis and 2.9% had a duodenal ulcer. Lower gastrointestinal endoscopy was done in 30 patients and out of these seven patients had hemorrhoids, one patient had multiple ulcers in the colon, one had ulcers in the sigmoid colon, and one had ulceroproliferative mass in the transverse colon. Biopsy through the upper gastrointestinal endoscopy showed chronic duodenitis in three patients (2.9%), carcinoma stomach in one (0.98%), and periampullary carcinoma in one (0.98%). Biopsy after lower gastrointestinal endoscopy showed one case each of carcinoma colon, ulcerative colitis, nonspecific colitis, and nonspecific enteritis. CONCLUSION: Diagnosis of iron-deficiency anemia is not sufficient without the diagnosis of underlying etiology. Special concern will be taken to gastrointestinal malignancies like colorectal cancers in which iron-deficiency anemia may be the only manifestation and diagnosis that can be missed if we do not investigate properly.

A study to determine the clinical, hematological, cytogenetic, and molecular profile in CML patient in and around Eastern UP, India.

INTRODUCTION: Myeloproliferative disorders are characterized by proliferation of one or more myeloid lineages cells. In order to assess the burden of these illness for public health planning, it is important to know their frequency. OBJECTIVES: A study to determine the clinical, hematological, cytogenetic, and molecular profile in chronic myeloid leukemia (CML) patient in and around Eastern UP, India. MATERIALS AND METHODS: Newly diagnosed and follow-up adult and pediatric cases of myeloproliferative disorder were taken into study. Detailed history, physical, and systemic examination was done with informed consent. Investigations like complete blood count including hemoglobin level, platelet count, total and differential leucocyte count, general blood picture, and bone marrow aspiration/biopsy were done. Molecular and cytogenetic studies were also done whenever required. RESULTS: In total, 90 patients were enrolled in the study. The median age of presentation of CML was 37 years and the mean age was 38.6 years. M: F ratio of 1.4:1.75 patients (83%) were in CML-chronic phase (CP), 11 patients (12%) in CML-accelerated phase (AP) phase, and 4 patients (5%) were found in CML-blast crisis (BC) phase. The common symptoms of the patients were fullness of the abdomen (66.6%). Among these 69 cases, Philadelphia chromosome was present in 65 (94.2%) cases. Revers transcriptase polymerase chain reaction (RT-PCR) was done in 40 out of 90 cases, breakpoint cluster region (BCR)-Abelson oncogene (ABL) gene came out to be positive in all the 40 cases. CONCLUSION: Most CML patients in eastern UP (India) are relatively young (31-40 years). In addition, males were more commonly affected.

A study to determine the prevalence, clinical profile and incidence of formation of inhibitors in patients of hemophilia in North Eastern part of India.

INTRODUCTION: Deficiency of factor VIII (Hemophilia A), factor IX (Hemophilia B) and Von Willebrand's factor are the most frequent coagulation defects. The incidence of inhibitors in patients of factor VIII deficiency is varies in different regions of India. AIM: To determine the prevalence, clinical profile and incidence of formation of inhibitors in patients of Hemophilia in north eastern part of India. METHODS: Selected patients were under went for complete Blood Count (CBC), General Blood Picture (GBP), Prothrombin time (PT), Activated partial thromboplastin time (APTT), Thrombin time, Correction experiment to know the specific factor deficiency or inhibitors present by Normal Plasma, Normal aged serum, Al(OH)3 adsorbed plasma. RESULTS: 92 patients diagnosed as suffering with Hemophilia A or B were included in study. The age of patients ranged from 2.5 month to 53 years. Out of 92, seventy nine (85.87%) were Haemophilia A and thirteen were (14.13%) Hemophilia B patients. 3.50% (2/55) cases of treated Hemophilia A patient develop inhibitor. CONCLUSION: The prevalence of hemophilia and incidence of inhibitors in these patients is varies in different regions of India. This variation may be due to the type of product used as treatment, intensity of treatment or the genetic characteristics of the patients.

Systemic lupus erythematosus with hepatosplenic granuloma: a rare case.

Background. Systemic lupus erythematosus (SLE) is an autoimmune disease which is known to present with a wide variety of clinical manifestations. Case Report. A 15-year-old male presented with complaints of moderate grade fever and generalized body swelling. There was no history of cough, weight loss, joint pain, oral ulcerations, skin rash, photosensitivity, loss of hair, pain abdomen, jaundice, or any significant illness in the past. Contrast enhanced computerized tomography of the abdomen revealed hypodense lesions in both liver and spleen (without contrast enhancement), suggestive of granulomas along with few retroperitoneal and mesenteric lymph nodes. On the basis of immunological tests and renal biopsy report, SLE with hepatosplenic granulomatosis diagnosis was made. He was given pulse methylprednisolone 500 mg, for 3 days and he showed dramatic improvement clinically. Conclusion. Hepatic and splenic granulomas are not common in SLE, but this should be kept in differential diagnosis.

Study the drug adherence and possible factor influencing drug adherence in HIV/AIDS patients in north eastern part of India.

BACKGROUND: Majority of HIV/AIDS patients who are on Highly Active Anti Retroviral Therapy (HAART), are not aware about drug adherence and its importance which is the most important factor for drug adherence. OBJECTIVES: To study the level of drug adherence in patients accessing antiretroviral therapy (ART) through the National program and factor influencing drug adherence. MATERIALS AND METHODS: In present study, we enrolled 102 newly diagnosed patients, among them in 79 patients, ART was started. To study the drug adherence a pretested, semistructured questionnaire was formed and patients were followed up for 6 months of the study. Pretest and posttest counseling was done to all such patients. RESULTS: A total of 28 patients missed the dose in 1(st) follow-up, nine patients missed in 2(nd) follow-up, eight patients missed in 3(rd) follow-up. Three patients lost follow-up in 2(nd) follow-up, three patients further lost follow-up in 3(rd) follow-up. Running out of pills (40.0%), side effect (15.5%), and family problem (13.3%), poor transport facility for taking drug (8.9%) and forgetfulness (11.1%) are five major causes related to miss dose. In females patients, drug adherence (69%) was initially less than male patients (76%) but latter on female patients (96.3%) had better adherence than males (95.2%). CONCLUSION: This study suggest that drug adherence can be increased by proper counseling and close monitoring of the patients which may have a great role in preventing the drug resistance and ART response.

Study of Mutations in ß-Thalassemia Trait among Blood Donors in Eastern Uttar Pradesh.

BACKGROUND: Knowledge on distribution of different mutations of thalassaemia, which are prevalent in a particular area, is a prerequisite for prenatal diagnosis. OBJECTIVES: Studying mutations in ß - thalassaemia trait among blood donors in eastern Uttar Pradesh, India. MATERIAL AND METHODS: One thousand non - remunerated voluntary blood donors who were between 18 - 40 years of age, were included in the study. Both replacement and voluntary healthy blood donors were included. 4ml of venous blood was collected and it was stored at 4°C. Complete Blood Count (CBC), Haemoglobinopathy Screening and Molecular Analysis by ARMS - PCR (Amplification Refractory Mutation System - PCR) were done. Screening for ß thalassaemia was done in a blood bank by using D - 10, Bio Rad, which was based on High Performance Liquid Chromatography (HPLC). RESULTS: Twenty Eight subjects with ß- thalassaemia trait were found among 1000 voluntary blood donors. IVS 1-5 (G-C) mutation was most common type (50%), followed by FS 8/9 (+G) 25% which was the second most common type. In our study, a rare mutation of CD 16 (-C) was also found. Out of 14 subjects who had IVS 1-5 (G-C) mutation (most common), six were from Varanasi (6/261) and five of them were Sindhis. It was seen that FS 41/42 (TCTT) mutation was distributed among all groups of populations which had higher prevalences of ß-thalassaemia trait. CONCLUSION: A comprehensive knowledge on beta thalassaemia mutations is necessary for determining a prenatal diagnosis. The occurrence of mutations may vary according to geographic region. Therefore, this study dealt with current problem of unknown mutations, in order to avoid complications.

Assessment of left ventricular diastolic dysfunction in sub-clinical hypothyroidism.

BACKGROUND: Adverse cardiovascular effect of hypothyroidism has been identified in many studies. Early identification of patients with sub-clinical hypothyroidism may lead to early treatment and thereby favourable effect on cardiovascular morbidity and mortality. OBJECTIVES: To find out the association of sub clinical hypothyroidism and left ventricular dysfunction and also to find out relationship between systolic and diastolic dysfunction in these patients. MATERIAL AND METHODS: A total 30 cases of sub clinical hypothyroidism along with 15 age sex matched healthy control subjects were included in study. Serum TSH, T4, T3 hormone level was measured and those who were found to have sub-clinical hypothyroidism underwent for 2DEcho. RESULTS: Significant reduction in peak early filling velocity (PE) (p<0.001) and early filling time velocity integral (Ei) (p<0.001). Ratio of early and late peak velocities (PE/PA) (p<0.001), ratio of time velocity integral of early and atrial filling (Ei/Ai) (p<0.001) and ratio of the early peak to average velocity (PE/M) (p<0.001) were also reduced. Mean EF was 54.9± 5.55 as compared to 55.7 ± 3.46 of control subjects with a T.value of 0.48 ,however there was significant diastolic dysfunction in case of hypothyroid patients (mean Ei/Ai = 1.35 ± 0.53) as compared to control group subjects (mean Ei/AI = 2.11 ± 0.26) with a T value of 5.22. CONCLUSION: Sub-clinical hypothyroidism showed significant diastolic dysfunction in the absence of significant impairment of systolic function.