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2009| January-June | Volume 1 | Issue 1
July 30, 2009
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IgA plasma cell leukemia
Tejinder Singh, CS Premalata, KV Sajeevan, Ankit Jain, Ullas Batra, KS Saini, CT Satheesh, K Govind Babu, D Lokanatha
January-June 2009, 1(1):19-21
Plasma cell leukemia (PCL) is a rare entity. There are two presentations of PCL, primary or secondary. The primary or
form of PCL presents with an acute and rapidly progressive leukemic phase. This form occurs when the patient has no pre-existing multiple myeloma (MM). The secondary form is the most advanced form of MM. The PCL is a rare disorder representing 1-2% of the diagnosed cases of MM. Median age at presentation is usually above 50 years. The monoclonal protein in patients with PCL may be IgG (50%), IgA (15%), or in rare cases IgD or IgE (6%). We report a case of IgA primary PCL that is very rare. Patient was started on combination therapy with vincristine, adriamycin, and dexamethasone. There was poor response and patient died three months after diagnosis.
Apoptotic count as a guide for histological grading of carcinoma esophagus: A light microscopic study
Ankit Seth, Asha Agarwal
January-June 2009, 1(1):11-14
Many studies have been done in the past on the correlation between apoptotic count and histological grading of different tumors.
The study aims to find out if a correlation between apoptotic count and histological grading exists in squamous cell carcinoma of the esophagus, and also to review the literature on such a relationship in the context of some other tumors.
Settings and Design:
Cases of squamous cell carcinoma of the esophagus who presented at a tertiary care center over a period of one year were reviewed.
Materials and Methods:
The endoscopic biopsy specimens of 56 patients of squamous cell carcinoma of esophagus were fixed in 10% buffered formalin, processed for routine paraffin sections, sections taken, stained by hematoxylin and eosin and examined under light microscope, using 40x objective and 10x eyepiece. Apoptotic bodies were counted in each high-power field (HPF). Statistical Analysis Used:
Standard error of difference in apoptotic count in different tumor groups found and
value calculated, using Student's t test.
An inverse correlation of the apoptotic count per HPF with the histological grade of the tumor was found.
Grading of squamous cell carcinoma of esophagus, solely on the basis of apoptotic count can be used in the first place or to corroborate conventional histological grading done on the basis of morphology.
Detection of extended spectrum β-lactamase production among uropathogens
Ritu Aggarwal, Uma Chaudhary, Rama Sikka
January-June 2009, 1(1):7-10
Detection of extended spectrum β -lactamase (ESBL) production among uropathogens is an important marker of endemicity.
Intervention of this endemic transmission is important for the control of initial outbreak of ESBL producing organisms in a hospital or specialized unit of hospital.
Materials and Methods:
During the study period of one and a half months, 1,551 urine samples were processed for significant bacteriuria. Two hundred gram negative bacterial isolates were tested for ESBL production. Antimicrobial sensitivity pattern was ascertained for ESBL producing isolates.
ESBL production was seen in 36% of isolates. All the isolates were multidrug resistant with uniform sensitivity to imipenem.
This study reveals the significant prevalence of ESBL producing organisms in this north Indian tertiary care hospital. Constant revision of antibiotic policies with infection control interventions is suggested.
Immune hemolytic anemia: A report of two cases
Paramjit Kaur, Sabita Basu, Ravneet Kaur, Gagandeep Kaur
January-June 2009, 1(1):22-24
The transfusion-medicine specialists and physicians are often in a difficult situation when the patient has severe worsening anemia and all the blood is mismatched. This situation can arise in patients with red cell autoantibodies or alloantibodies due to previous transfusions. We report two cases of immune hemolysis - one due to warm auto antibodies and the second due to alloimmunization from multiple transfusions.
An interesting case of lung mass
Venkata Satya Suresh Attili, C Obula Reddy
January-June 2009, 1(1):25-26
A 46-year-male smoker presented with cough and fever to a chest physician, who on the basis of chest X-ray started him on antitubercular treatment. However, further evaluation suggested that the patient was suffering from a rare disease, i.e. Anaplastic large cell lymphoma of lung. Although lung involvement in cases of lymphoma is observed in as high as 40% of cases, in autopsy series, the exact clinical incidence is not known. One of the largest lymphoma groups reported it to be around 25%. However, primary pulmonary lymphomas have been extremely rare (0.4%), and whenever present they are of (Mucosa Associate Lymphoid tissue) MALT type, with occasional diffuse large cell lymphomas. The anaplastic variant is extremely uncommon. Usually the treatment results are satisfactory with more than 80% of the cases surviving even after 3 years. Here we report the case of anaplastic primary nonHodgkin's lymphoma of lung and review the literature.
Recognizing the laboratory physicians
January-June 2009, 1(1):1-1
HOW DO I DO IT?
Laboratory approach to the management of clinical emergencies: A diagnostic series
January-June 2009, 1(1):27-30
This article emphasizes on the laboratory investigations that may play a significant role in the prompt management of the patient. Hence, other conditions where laboratory investigations will not play a major role are not included in this article. An attempt has been made to highlight certain issues wherein we can prevent inadvertent ordering of tests to minimize the burden on the overworked emergency laboratory, without compromising patient care. The conditions that will be dealt here include: acute chest pain, acute abdominal pain, road traffic injuries, acute respiratory distress, high grade fever, vomiting, loss of consciousness, poisoning and laboratory accidents, and lastly occupational exposure to potential biological hazards.
Hunt for the hidden trait
Vanamala Alwar, Reeti Kavdia, Nandini Singh, Karuna Rameshkumar
January-June 2009, 1(1):15-18
To assess the efficacy of a peripheral smear examination as a screening tool for β-thalassemia trait.
Materials and Methods:
17 623 Leishman-stained peripheral smears were evaluated during the period from July 2006 to September 2007. The following parameters were studied: hemoglobin, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and red cell distribution width. All the cases that showed microcytosis, hypochromia, erythrocytosis and absence of anisopoikilocytosis were suspected of having the thalassemia trait (TT), and all these cases were further evaluated with Alkaline Hemoglobin Electrophoresis for confirmation.
Of the 17 623 smears examined, 60 cases were considered suspicious of having TT. Alkaline hemoglobin electrophoresis carried out on all these cases revealed an elevated HbA
(Mean = 7.5%). Five cases evaluated were found to have other hemoglobinopathies (1 Sickle cell trait, 3 Hb-E, 1 thalassemia intermedia).
Careful screening of peripheral smear is an invaluable screening tool for thalassemia trait (PPV - 95%). There must be awareness among the peripheral centers about the importance of peripheral smear screening and the affected persons should be counseled.
Progress of science from microscopy to microarrays (Part 1): Diagnosis of parasitic diseases
Ayan Dey, Sarman Singh
January-June 2009, 1(1):2-6
Even though description of the magnifying glass goes back to 1021 by an Arabic physicist in his book, Antony van Leeuwenhoek was the first man to improve the then simple microscope for viewing biological specimens in 1674. This suggests that every discovery has scope for improvement, be it physics or be it biology. In the field of biology, scientists have long studied gene expression as a hallmark of gene activities reflecting the current cell conditions and response to host immune defense systems. These studies have been cumbersome, technically demanding and time-consuming. Application of microarrays has revolutionized this field and help understand the simultaneous expression of thousands of genes in a single sample put onto a single solid support. It is also now possible to compare gene expression in two different cell types, different stages of life cycle or two tissue samples, such as in healthy and diseased ones. Thus microarrays are beginning to dominate other conventional and molecular diagnostic technologies. The microarrays consist of solid supports onto which the nucleic acid sequences from thousands of different genes are immobilized, or attached at fixed locations. These solid supports themselves are usually glass slides, silicon chips or nylon membranes. The nucleic acids are spotted or synthesized directly onto the support. Application of microarrays is new for parasites. Most of these applications are done for monitoring parasite gene expression, to predict the functions of uncharacterized genes, probe the physiologic adaptations made under various environmental conditions, identify virulence-associated genes and test the effects of drug targets. The best examples are vector-borne parasites, such as Plasmodium, Trypanosoma and Leishmania, in which genes expressed, during mammalian and insect host stages, have been elucidated. Microarrays have also been successfully applied to understand the factors responsible to induce transformation from tachyzoite-to-bradyzoite and vice versa in
. Thus microarrays provide a novel tool for diagnosis, prognosis and clinical management of infectious disease.
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