Search

Abstract Background Tissue eosinophilia is a diagnostically challenging entity. An accurate diagnosis can benefit the patient with appropriate treatment. Histopathology is the gold standard. Manual counting results in errors and is time consuming. Artificial intelligence (AI) acts like a human brain in terms of memory and reproducibility. Methods The aim of this study was to determine the eosinophil count in gastrointestinal biopsies using AI and compare it with the manual method. A total of 400 digital images of hematoxylin and eosin‐stained slides of gastrointestinal biopsies were included in the study. Annotations were performed on images containing eosinophils. The neural network prepared using the Python language was a modified U‐Net architecture containing five down blocks and five up blocks. The results obtained using the AI model were compared with manual counts. Pearson's correlation coefficient and Cohen's kappa coefficient of agreement were used for statistical analysis. Results Pearson's correlation coefficient demonstrated a strong positive correlation between AI and manual eosinophil (0.8), which suggests a very strong correlation. The Cohen's kappa coefficient of agreement was 0.85, which corresponds to excellent agreement. Conclusions The manual eosinophil count and AI predictions demonstrated a very strong positive correlation. It is necessary to count eosinophils using an AI model because it saves time, and eliminates interobserver variability and human error.

Background. The first line anti-tubercular (anti-TB) treatment normally involves isoniazid, rifampicin, pyrazinamide, and ethambutol. Clearance of these drugs depends on the activity of several enzymes such as N-acetyl transferase 2, cytochrome P450 oxidase and glutathione S-transferase (GST). Some of these enzymes are highly polymorphic leading to significant inter-individual variation in their activity thereby increasing the risk of drug induced hepatotoxicity (DIH).Aim. To investigate the possible association of anti-TB DIH with genetic polymorphism of GST genes in Western Indian population.Material and methods. A prospective case-control study was undertaken on patients who received anti-TB treatment. Cases (n = 50) were distinguished from controls (n = 246) based on occurrence of DIH during anti-tubercular treatment. A multiplex polymerase chain reaction was employed to identify homozygous null mutation at GSTM1 and GSTT1 loci.Results. Homozygous null mutation in GSTM1 gene alone or in both GSTM1 and T1 genes was found to be significantly associated with anti-TB DIH at p < 0.02 and p < 0.007, respectively, in our study population.Conclusions. This is the first study to report GSTM1 null and combined GSTM1 and T1 null genotypes to be risk factors of anti-TB DIH in Western Indian population. Screening of patients for these genotypes prior to anti-TB regimen would provide better control of hepatotoxicity.

Background: Chronic liver disease is characterized by inflammation and fibrosis. As a consequence angiogenesis leading to new vasculature may have prognostic value in disease progression. Interfering with angiogenesis may be a potential target to avoid progression of liver disease. Hence we planned to evaluate the CD34 and vascular endothelial growth factor (VEGF), the markers for angiogenesis in chronic liver disease.Method: Liver biopsies from 79 patients of chronic liver disease and 21 cases of HCC (M: F = 4:1, age range 22 to 80) were stained for routine HE, CD 34 and VEGF immunostaining (Dako Corp & Santa Cruz respectively). Etiologies of chronic liver disease were alcoholic liver disease, HBV, HCV infection, NAFLD, autoimmune liver disease, and cryptogenic liver disease. Thirty biopsies from normal liver obtained at autopsy were taken as controls. Expressions of CD 34 and VEGF were compared with the stage of fibrosis. Results: Out of 79 patients, angiogenesis was seen in 45.5% cases of chronic liver disease. None of the case with normal liver histology was CD 34 or VEGF positive. No significant correlation of angiogenesis was found between any etiologies of chronic liver disease. CD 34 was positive in 18/21 (85.7%) cases of hepatocellular carcinoma. CD 34 and VEGF positivity was 20.9% and 46.5% in stage 1 and 2 fibrosis while it was 75% and 80% in stage 3 and 4 fibrosis respectively. VEGF appeared more common as compared to CD 34 in early fibrosis. Conclusion: Angiogenesis was present in 45.5% cases of chronic liver disease. It was proportional to the increase in stage of fibrosis. Expression of VEGF was commonly found in early stages of fibrosis. Hence, therapeutic strategies of inhibiting VEGF expression may be of importance in preventing the progression of chronic liver disease in its early stage.

Introduction: Liver abnormalities are common in HIV positive patients. They are usually part of generalized process and rarely produce significant liver failure. Aim: To evaluate histological spectrum of liver disease in HIV positive patients and to ascertain if any pathologic features are widespread among HIV infection. Material & methods: Autopsy data from year 1991 to 2003 consisting of 60 HIV positive patients were evaluated. Demographic profile, clinical and laboratory data were obtained from hospital records. Macroscopic findings of all organs at autopsy were noted. Histological features of liver were studied in detail using routine H & E., Ziehl-Neelson stain for acid fast bacilli and other special stains such as PAS and GMS for fungal infection were done whenever indicated. Results: Patients were in age group 19 to 55 years with mean age of 32.1 year; male to female ratio was 4:1. Evidence of tuberculosis either pulmonary or extrapulmonary was found in 35 (58.3%) cases. On histological examination of liver, tubercular granulomas were seen in 19 (31.6%) cases of disseminated tuberculosis. Granulomas were typical caseating epitheloid cell type in 14 (73.6%) and in 5 cases granulomas were not typical. Acid fast bacilli were demonstrated in 4 (6.6%) cases, all of which showed presence of granulomas. Other histological findings were sinusoidal and centrivenular congestion in 14 (23.3%), extensive fatty change 6 (10%), portal inflammation resembling chronic hepatitis 5 (8.3%), focal necrosis 2 (3.3%), Kupffer cell hyperplasia 1 (1.6%) and metastasis from known case of adenocarcinoma of pancreas 1 (1.6%). Associated hepatitis C and B infections were seen in 4 (6.6%) and 1 (1.6%) respectively. Opportunistic infection was seen in only 1 (1.6%) case with disseminated cryptococcosis involving liver. In remaining 6 (10%) liver histology was normal. Considering cause of death, 58.3% patients died due to disseminated tuberculosis. Patients with associated hepatitis B & C infection died due to liver cirrhosis and the remaining died of miscellaneous conditions, which were not related to HIV infection. Conclusion: Histopathological findings of the liver in HIV positive patients were mainly non specific. Tuberculosis was the commonest infection noted. There was no significant mortality observed specifically related to liver involvement in these patients.

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.

Introduction: Incidence of gastric carcinoma and gastric polyps is on rise all over the world. Chronic atrophic gastritis to intestinal metaplasia progressing to adenocarcinoma has been documented pathway for gastric carcinogenesis. Another pathway for gastric carcinoma is adenoma carcinoma sequence similar to colon cancer. Aim: To study prevalence, endoscopic, and histomorphological features of gastric polyps. Methods and Material: This was retrospective analysis of gastric polyps from 2012 to 2019 in consecutive 10,800 upper gastrointestinal endoscopies. Demographic, endoscopic, and histopathological data were obtained from hospital records. All gastric polyps were classified as per standard histologic criteria. Additional histological features noted were presence of dysplasia, focus of adenoma, or malignancy. Results: The prevalence of gastric polyps was 434 (4%) of 10,800 upper gastrointestinal endoscopies. Majority of polyps were found in the last 4 years (277: 63.8%). Mean age was 55.4 years with male to female ratio 1:1.2. Most of the polyps (94.9%) were less than 1 cm, located in gastric antrum. Multiple polyps were seen in 20.9% cases. On histopathology, fundic gland polyps were most common (147: 33.8%), followed by hyperplastic (128: 29.4%) polyps. Adenomatous polyps were nine (2%); of these, two cases of hyperplastic polyps and one each of fundic gland polyp and benign epithelial polyp showed adenomatous foci. Conclusion: Fundic gland polyps were the most common polyps. With rising incidence of gastric carcinoma, identification of gastric polyps on endoscopy with biopsy can prevent progression to carcinogenesis.