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Background: Neonatal sepsis is one of the leading causes of mortality in developing countries because of its non-specific presentation. Blood culture is the gold standard for diagnosing sepsis, but culture results take 48 – 72 hours. Therefore, there is a need for an indicator that could be used as a simple parameter to indicate the possibility of evolving sepsis to the clinician. The efficacy of mean neutrophil volume as an indicator must be evaluated. Materials and methods: The study aims to evaluate the utility of the mean neutrophil volume in the early diagnosis of neonatal sepsis. Following ethical clearance, the study involved analyzing mean neutrophil volume from peripheral smears of 50 newborns clinically diagnosed with neonatal sepsis. The control group included mean neutrophil volume findings from peripheral smears of normal newborns. Maternal or fetal factors like pregnancy-induced hypertension and birth asphyxia that could cause changes in neutrophils were excluded. The mean neutrophil value was calculated after establishing the mean diameter of 100 neutrophils per case using the National Institutes of Health Image J software. Results: The average mean neutrophil volume was found to be significantly increased in the sepsis group (181x104fl) than in the control group (739x103fl). A statistically significant difference (p= < 0.0001) in the mean neutrophil volume was observed. Conclusions: Mean neutrophil volume is a potential indicator to distinguish neonates with and without sepsis and help clinicians in the early diagnosis and management of sepsis.

Background: Infertility is a public health problem worldwide. One of the important factors involved in infertility is the poor quality of endometrium which leads to death of the ovum before and after implantation. Glycogen is known to be a direct source of nutrients for the early conceptus and its depletion may result in inadequate preparation of endometrium around the time of implantation and leading to infertility. Materials and methods: This is a prospective study conducted at a tertiary care hospital for 2 years. The study included 75 cases of infertility (primary and secondary). Relevant data were collected from all the 75 biopsied infertile cases during the study period. Periodic acid Schiff stain was performed on all cases to detect the amount of glycogen in the endometrium. The findings were compiled, analyzed, and compared with other studies. Results: Primary infertility accounted for 77.3%and Secondary infertility 22.7% of the 75 cases. On histology, anovulatory cycles accounted for 52% of cases. In the remaining cases, 38.7% showed secretory phase, 4%cases each showed luteal phase defect and hyperplasia, and 1.3% tubercular endometritis. Glycogen content of the endometrium was (1+) in 54.6%, (2+) in 9.3%, (3+) in 9.3% and (4+) in 26.8% in the infertility patients.Glycopenia was seen in 12% of the 75 cases studied. Conclusions: Endometrial factors are important causes of infertility and depletion of glycogen, that can be corrected by hormonal therapy to improve the fertility potential needs to be evaluated in all cases of infertility.

Breast carcinoma ranks one among the leading causes of cancer related morbidity and mortality in Indian women closely following carcinoma cervix in order of incidence. Fine needle aspiration cytology has emerged as one of the preliminary investigations besides mammography and clinical examination for the initial assessment of breast masses. Nuclear morphometry can be used as a quantitative adjuvant to FNAC in diagnosing breast lesions, especially the ones in the “gray zone”. Objectives: The aim of this study was to assess the utility of nuclear morphometry as an adjuvant in the cytological diagnosis, categorization of breast lesions and grading of malignant lesions. Materials and Methods: Nuclear parameters were assessed in fine needle aspirates of 49 cases, for which histopathological correlation was available. Morphometric parameters analyzed were nuclear area, nuclear perimeter, minimal nuclear diameter, maximum nuclear diameter, axis ratio, nuclear shape factor and nuclear compactness. Results: Morphometric parameters showed progressive and significant increase in nuclear size parameters from benign to malignant lesions. Nuclear shape parameters also showed a significant increase from grade I to grade III malignant lesions. However these shape factors could not be used to differentiate benign and malignant lesions in our study. Conclusion: Nuclear morphometry is a valuable tool in diagnosis of breast masses. It provides data in a more objective and reproducible form unlike the conventional cytological analysis. Keywords: Breast lesions, FNAC, Nuclear morphometry.

Background: Pap smear examination has been universally used as an effective screening tool for early detection of cervical carcinoma. The aim of this study was to assess the utility of Cervical Acid Phosphatase staining as an adjunct to routine Pap smear testing to improvethe sensitivity and specificity of routine Pap smear examination for cervical cancer detection. Materials and Methods: Cervical smears were taken from patients attending the gynecology department and a few cervical cancer screening programmes. One set of slides were alcohol fixed and stained with rapid pap stain and another set of slides were fixed in a special fixative and stained with Cervical Acid Phosphatase -Pap stain. The nuclear features of these Cervical Acid Phosphatase stained dysplastic cells was studied on Pap stain to diagnose cervical intraepithelial lesion/ malignancy. Results: Out of 489 cases included in the study 6 cases were diagnosed with intraepithelial lesion/ malignancy. On Cervical Acid Phosphatase -Pap stain 2 of the cases diagnosed as inflammatory smears on pap stain showed Cervical Acid Phosphatase positivity and thus were re evaluated. Mild nuclear atypia was observed in the Cervical Acid Phosphatase positive cells and these cases were diagnosed as Low grade squamous intraepithelial lesion and later biopsy proven to be Cervical intraepithelial Neoplasia I. Therefore Cervical Acid Phosphatase -Pap test was 100% sensitive and specific for cervical cancer detection. Conclusions: With 100% sensitivity Cervical Acid Phosphatase -Pap test satisfies the criteria of an efficient screening test.

Hamartoma presenting in the larynx is a rare entity. The common presentation of such a lesion may include stridor, hoarseness of voice, choking sensation, dyspnea and in children, failure to thrive. It is a benign lesion and can be confused with other benign lesions like lipoma, fibroma, chondromas etc. Pathologically it consists of a mesodermal compartment and a granular compartment. Hamartomas mainly occur in pediatric age group. When it occurs in adults, males are more commonly affected than females. With very few cases reported so far, we present a case of laryngeal hamartoma presenting in a lady with progressive hoarseness of voice as a presenting feature.

Background: Thrombocytopenia is one of the most common causes of abnormal bleeding and is defined as platelet counts < 1.5 lakhs/cumm. Three processes can cause thrombocytopenia, namely: Deficient platelet production, accelerated platelet destruction, and abnormal pooling of the platelets within the body. Of these, accelerated platelet destruction is the most common cause for thrombocytopenia and has variety of etiologies. The usefulness of bone marrow analysis in assessing accelerated platelet destruction is still debated. Therefore, a new simple and non-invasive diagnostic approach for thrombocytopenia is needed. Aims and Objectives: The present study was done with an aim to evaluate the use of platelet indices, namely, mean platelet volume (MPV), Platelet Distribution Width (PDW), and Platelet Large Cell Ratio (P-LCR) in differentiating the various causes of hyperdestructive thrombocytopenia. Materials and Methods: This was a prospective study conducted over a period of 2 years and consisted of 206 cases of hyperdestructive thrombocytopenia. After recording relevant clinical details, platelet count along with platelet indices – MPV, PDW, and P-LCR was recorded. Based on the etiopathology identified, cases were categorized into three groups: Group I: Immunologic – cases of Immune thrombocytopenic purpura (ITP), Group II: Non-immune: Cases of sepsis and other non-immune causes of platelet destruction, and Group III: Viral and parasitic infections. Platelet indices were compared between the study groups and the control group which included 100 healthy individuals. Comparison was done among the three study groups as well. Results & Conclusions: Dengue accounted for the highest number of 131 (89.72%) cases in the study. MPV, PDW, and P-LCR were significantly higher (P < 0.0001) when compared to the healthy controls except P-LCR in Group II. A statistically significant increase in MPV was noted among ITP cases when compared to other causes of thrombocytopenia. There was no difference in PDW and P-LCR among the study groups. To conclude, among the three platelet indices, MPV appears to be a good parameter in differentiating immune from other causes of hyperdestructive thrombocytopenia.

Prevalence of pediatric skin disorders vary worldwide. In India, geographic variations in pediatric skin disorders is noted by numerous authors from different parts of the country. Dermatoses in children are much more influenced by socioeconomic status, climatic exposure, dietary habits and external environment as compared to adult skin disorders. Aims and Objectives: The present study was aimed at determining the spectrum of pediatric dermatopathological lesions and correlate the clinical and histopathological diagnosis over a period of 2 years in a tertiary care hospital in a rural setup. Results: Pediatric skin biopsies constituted 12.41% of all the skin biopsies received at our laboratory during the study period. Study consisted of 115 cases ranging from 1 to 18 years of age with a mean age of 12.02 years. A slight female preponderance (53.91%) was noted. The Biopsies received were categorized into various age groups as follows: Infants, n = 2(1.73%); toddler, n= 4(3.47%); preschool, n = 14(12.17%); school, n= 40 (34.78%) and adolescence, n= 55(47.82%). Papulosquamous diseases, n= 36(31.30%) were the most common cause of skin disorders followed by Genodermatosis (12.17%). Overall, Lichen Planus (8 cases; 6.95%) was the most common dermatoses encountered in the study. Fifteen cases (13.04%) were reported as non-specific dermatitis. A positive correlation with the initial clinical diagnosis was obtained in 95 cases (82.61%). Conclusion: A combination of good clinical expertise and histopathological confirmation helps in the proper management of the patients. The importance of histopathology as the gold standard in the diagnosis and management of pediatric skin lesions has been documented by our study. Keywords: Skin biopsy, Pediatric dermatoses, Papulosquamous diseases, Lichen planus, Genodermatoses.

Liesegang rings (LRs) are benign and concentric non-cellular lamellar structures, occasionally found in kidney, synovium, conjunctiva, and eyelid. They are uncommon pathological findings which may cause diagnostic dilemmas for pathologists. We report a rare case of a 40-year-old female patient presenting with the left-sided lumbar pain, burning micturition, and hematuria for 1 week. With the radiological impression of a renal tumor, she underwent left radical nephrectomy. A diagnosis of clear cell renal cell carcinoma, the WHO/ISUP Grade II, and a stage of pT2aNxMx was made. An additional feature noted was the presence of LRs at the periphery of the tumor. It is important to recognize these rings to avoid mistaking them with parasites and dystrophic calcification. Hence, awareness among pathologists about these lesions would help in the proper management of the patients.

Dyschromatosis Universalis Heriditaria (DUH) is an autosomal dominant disorder that usually presents in infancy or early childhood in Asian families and is characterized by pinpoint to pea-sized hypo- and hyper- pigmented macules, distributed in a reticulated pattern over the trunk, abdomen, and limbs, usually sparing the face and palmoplantar surfaces. It was reported initially and mainly in Japan. However, subsequent cases have been reported from other countries. This report describes DUH in four members of the same family. Skin biopsies of representative lesions from all the affected family members were taken and processed for histopathological examination. The tissue sections were stained with hematoxylin and eosin, and also a special stain for melanocytes was performed to arrive at a diagnosis.

Leiomyomas are the most common benign uterine tumours. They are usually asymptomatic but may cause menometrorrhagia, abdominal pain and infertility. They may be single or multiple and may have variable size. When fibroids increase in size, their vascular supply becomes insufficient causing hyaline, myxoid, cystic and haemorrhagic degeneration. Differential diagnoses include adenomyosis, solid adnexal masses, and focal contraction of myometrium and leiomyosarcomas of the uterus. Our purpose was to describe USG, MR imaging findings, histological features and clinical aspects of uterine fibroids. MATERIALS AND METHODS This prospective study was conducted in the Department of Radiodiagnosis and Department of Pathology, MVJ Medical College and Research Hospital from January 2014 to December 2015. Our MR protocol includes sagittal, coronal, axial T2-weighted fast spin-echo, T1-weighted axial spin echo and axial short tau inversion recovery sequence. Optional sequences include sagittal and coronal short tau inversion recovery, axial diffusion weighted sequence, axial GRE sequence and sagittal T2 weighted 3D space sequence. RESULTS Uterine leiomyomas typically appear as well-defined, homogeneously hypointense masses on T2-weighted images and with intermediate signal intensity on T1-weighted images. Hypercellular leiomyomas show higher signal intensity than that of nondegenerated leiomyomas on T2 weighted images. Degenerated leiomyomas show signal intensity on T2-weighted images and on T1-weighted images obtained before and after contrast administration. 75 cases of leiomyomas were detected. In our study, majority of the cases belonged to the 41-50 years age group. Intramural fibroids were seen in 45 cases, subserosal fibroids were seen in 23 and submucosal fibroids in 15 cases. Both intramural and subserosal fibroids were seen in 7 cases. Broad ligament fibroids were seen in two cases. Pathological features of hyaline degeneration were noted in 5 cases, cystic degeneration in 7 cases, and red degeneration in one case. CONCLUSIONS MRI is the most specific imaging modality in detection and localisation of uterine leiomyomas. Leiomyomas characterisation, often possible with MR imaging, requires knowledge of pathological features and imaging findings associated with the different kinds of degeneration. MRI is useful in planning the correct therapeutic strategy and in followup after therapy.

Background: Prostate-specific antigen (PSA) is a widely used biochemical marker for the early detection and monitoring of patients with prostatic cancer. PSA level show ever may vary with patient age, race and may be elevated in conditions such as benign prostatic hyperplasia (BPH) and prostatitis. Any diagnostic or surgical maneuver that alters the normal prostate architecture can lead to diffusion of PSA into the stroma and thus into the vasculature. Objectives: The present study was done to study the efficacy of PSA to categorize men with prostate pathology into benign, premalignant, and malignant lesions. Materials and Methods: Two years prospective study from September 2012 to August 2014 in the Department of Pathology, MVJ Medical College and Research Hospital, rural Bengaluru on 62 cases of prostate biopsies in men with prostatism. Clinical digital rectal examination (DRE) findings and PSA levels of each patient were noted from the case records. The levels of PSA in the various pathological lesions encountered were analyzed. Results: 62 prostate biopsies were received over a 2-year period, 41 cases satisfied the inclusion criteria were analyzed. DRE findings showed majority of the benign lesions (82.7%) to be firm. PSA levels below 4 ng/mL efficiently could segregate the benign lesions but with values beyond 4 ng/mL the picture becomes murkier with contributions from inflammation and BPH raising PSA to levels where malignancy would be suspected. Conclusion: In our study, PSA levels appear to be elevated in both benign and malignant lesions, therefore, the usefulness of PSA alone as an early detector of prostatic cancer by itself is questionable. In elderly patients with PSA levels above 4 ng/mL and with abnormal DRE, a prostatic biopsy is advisable to rule out cancer.

Leprosy is the oldest disease known to mankind and has piqued humans since Before Christian Era (BCE) [1]. The causative agent, Mycobacterium leprae, was thefirst bacterium to be identified as causing disease in humans. Effective treatment, viz, Promin, was introduced only in the 1940s. Multi-drug therapy came into vogue in the 1970s [2,3] and was popularised by the World Health Organisation (WHO) in the 1980s. This resulted in a rapid decline in the new case detection rates [4]. Global efforts to eliminate leprosy have met with only partial success and the disease continues to prevail in certain endemic pockets in the developing countries [5–8]. In India the prevalence of leprosy reduced from 58 per 10,000 population in 1980 to 0.69 per 10,000 in 2010 [9]. Thus, leprosy has been ‘eliminated’ as a public health problem.However, this has not ensured complete interruption of disease transmission and new cases continue to occur, sometimes after several years because of the long incubation period. This underscores the need for active and continued efforts to identify new cases [9]. The primary targets of M. leprae are the skin and peripheral nerves [6]. The diagnosis of leprosy rests on the demonstration of one or more of the three cardinal signs namely anaesthetic/hypoesthetic skin patches, thickened peripheral nerves with impaired sensation in the areas innervated by the affected nerves and acid-fast bacilli in skin smear [4,10]. Characteristically, the superficial and cooler regions of the body are affected [11,12]. The commonly affected nerves in leprosy include ulnar, radial, median, lateral popliteal, tibial, facial and trigeminal [13]. Leprous neuropathy can occur in the absence of skin lesions [14]. Even in the presence of skin lesions, a mismatch in the severity of disease in the nerves vis-a-vis skin occurs. Thus the disease may be paucibacillary in the skin, but multibacillary in the nerves [15,16]. Untreated or delayed treatment of peripheral neuropathy is the major cause of disability, deformity, morbidity and social isolation in patients with leprosy [11]. Thus it is imperative to recognise and establish an early diagnosis and institute timely therapy. Meanwhile, each one of the cardinal signs is considered to be highly sensitive and specific for leprosy [4,10]. A considerable skill and experience is required for detecting their presence failing which the diagnosis is delayed or missed [17].

Background: Pregnancy induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity. A variety of hematological abnormalities may occur in women with PIH of which thrombocytopenia is the most common. Objectives: This study was done to estimate the incidence of thrombocytopenia in pregnant women diagnosed with PIH and to correlate the severity of PIH with the degree of thrombocytopenia. Materials and Methods: 2 years retrospective study on 100 pregnant women admitted in MVJMC and RH with a diagnosis of PIH from January 2012 to January 2014. Data from case files were collected, compiled, and analyzed. PIH cases were classified into: (1) Gestational hypertension (HTN), (2) mild preeclampsia, (3) severe preeclampsia, (4) eclampsia, (5) hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. The incidence and severity of thrombocytopenia along with maternal and fetal complications encountered in the five groups were analyzed. Results: Preeclampsia - mild (56%) and severe (36%), accounted for most of the cases followed by eclampsia (6%) and gestational HTN (2%). In the 100 cases, mild thrombocytopenia (41%), moderate thrombocytopenia (29%), severe thrombocytopenia (6%), and normal platelet counts (24%) were encountered. Varying platelet levels were seen in the five groups with 23.4% of severe eclampsia and 50% of eclampsia cases having normal platelet counts and 7.1% of mild preeclampsia cases showing severe thrombocytopenia. Poor maternal outcome was seen 11% cases due to HELLP syndrome, postpartum hemorrhage, and maternal death. Poor fetal outcome was seen in 18% cases due to intrauterine growth restriction and perinatal mortality. Conclusion: Platelet count alone cannot be relied upon to assess the severity of PIH. The search for a simple cost effective test for prompt management and prevention of maternal and neonatal morbidity performable in a rural hospital set up still continues.

Haemophilia is the most common inherited coagulation disorders, with X linked recessive inheritance, affecting the males w hile females are the carriers of the disease. Haemophilia A and Haemophilia B are the commonest form of Haemophilia encountered and they result from defect in Factor VIII and Factor IX gene respectively. A clinico hematological study with suspected coagula tion disorder was conducted over a period of two years, from June 2008 to July 2010. Of the 76 patients visited OPD, based on clinical presentation and family history, 50 cases were categorized as Hemophilia A or B after laboratory investigations. Majorit y (41) of the cases were categorized as Hemophilia A & only 7 cases were Hemophilia B. The mean age group of the patients was 2.87 years with an age of onset ranged between 3

All the techniques employed for the study of histology bring an insight into the details inside the cell with the use of microscope .The simplest and most common method in the study of histology is prepa ration of sections. Tissues are exposed to the series of reagents that fix ,dehydrate, clear, infiltrate with final embedding in a medium which provides support for the tissue. The quality of structural preservation is determined by the choice of reagents and exposure times to the reagents during processing. Each step in the tissue processing is important from the procurement of the specimen, selection of sample, determining the appropriate protocols and reagents to be used. This paper compares certain methods of tissue processing and the results obtained through them.

Introduction: the diagnosis of papillary-cystic variant of acinic-cell carcinoma (Acc-PcV) is easy on histology. However, the diagnosis on cytology usually poses a problem because of the cytoarchitecture which is different from classic type. case report: A 39-year-old male presented with left parotid swelling for last four months. Fine needle aspiration cytological smears revealed papillary fragments and tumor cells with varied morphological features. cell block prepared from the fluid aspirates confirmed the diagnosis of papillary-cystic variant of aciniccell carcinoma. Histological study of the excised specimen confirmed the diagnosis of acinic cell carcinoma, papillary cystic variant. conclusion: this case describes papillary-cystic variant of acinic-cell carcinoma and discusses the myriad of cytological features exhibited by it.