Pattern of Anti-hypertensives Usage in Hypertension with or without Comorbidities in a Tertiary Care Hospital

Hypertension is a chronic illness associated with high morbidity & mortality. A large number of antihypertensive drugs alone or in various combinations are available and physicians need to choose the most appropriate drug for a particular patient. The standard treatment guidelines and drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to evaluate the use of antihypertensive in hypertension with or without ischemic heart disease and diabetes mellitus at Department of Cardiology in Mymensingh Medical College Hospital, Mymensingh from July 2015 to October 2015. It was an observational type of descriptive cross sectional study. The study was performed among 400 hypertensive patients in Cardiology department in MMCH who received antihypertensive drug. Out of 400 hypertensive patients 67% were male and 33% were female. Maximum patients (54%) found in 40 - <60 years age group and ≤60 years age group (37.5%). Mean age of the patients was 55.02±12.47 years. Mean systolic BP was 146.74±28.28 and diastolic BP was 90.60±14.27mmHg. In overall prescription combination therapy (63.25%) was prescribed more frequently than mono-therapy (36.75%). In monotherapy ramipril was the most commonly prescribed (27.89%) antihypertensive drug and ARB was the most commonly prescribed group (37.41%). In our study 5 groups of antihypertensive were found (ARB, ACEI, BB, Diuretics, and CCB). In combination therapy 2-drugs combination were found most frequently (37.50%) and ACEI + Diuretics (23.72%) was the most common combination followed by ARB + Diuretics (12.25%), ACEI + BB (11.86%). Average number of antihypertensive drug per prescription was 1.9.

Effectiveness of Topical Corticosteroid, Topical Calcineurin Inhibitors and Combination of Them in the Treatment of Vitiligo

Vitiligo is an acquired pigmentary skin disorder which is disfiguring and difficult to treat. Cure and response rates for vitiligo are significantly lower. This study was conducted to evaluate the effectiveness of topical corticosteroid, topical calcineurin inhibitors (tacrolimus) and combination of them in the treatment of vitilligo in two tertiary care Hospital, in the Department of Dermatology and Venereology OPD (out patient department) in Mymensingh Medical College Hospital and Jahurul Islam Medical College Hospital, Bajitpur, Kishoregonj from January 2015 to December 2015. Newly diagnosed 112 vitiligo patients, aged more than 1 year to 70 years were assigned for therapy and to observe the response. This study indicates that, in case of vitiligo treatment topical tacrolimus was the most effective drug. Topical tacrolimus, topical corticosteroid and combination of them are to be effective in the treatment of vitiligo with reduction in the number of vitiliginous spots by increased repigmentation. But topical tacrolimus was the most effective drug, as it caused highest percentage of repigmentation of vitiliginous spot.

Preoperative Ultrasound Guided Fine Needle Aspiration Cytology of Ovarian Lesions- Is It a Rapid and Effective Diagnostic Modality?

INTRODUCTION

The deep seated ovarian lesions unapproachable by unguided aspiration cytology were easily done under ultrasound guidance. It gave a before hand cytological diagnosis of the lesion to the surgeon determining the modality of treatment for the patient.

AIM

To find the diagnostic accuracy of the method of ultrasound guided cytological assessment of ovarian lesion.

MATERIALS AND METHODS

The study was conducted as a prospective observational study over a period of one year, in hospital setting, where ultrasound guided fine needle aspiration had been used to aspirate ovarian lesions, giving a rapid cytological diagnosis. In 43 sample cases, aspiration of fluid done from ovarian lesions were followed by cyto-centrifugation and staining by May-Grunwald-Giemsa (MGG) and Papanicolaou (Pap) stain providing a cytological opinion regarding benign/malignant nature of the lesion and further categorization. Later the cytological diagnosis was compared with final histopathological diagnosis, taking it as a gold standard.

RESULTS

The overall sensitivity, specificity, and diagnostic accuracy of ultrasound guided aspiration and cytological analysis were high, 96%, 76.92% and 89.47% respectively as calculated by comparing the cytological diagnosis with histological diagnosis, taking it as gold standard.

CONCLUSION

This method has evolved as a highly sensitive, rapid, simple and effective modality for screening and as well as accurate preoperative diagnosis of ovarian lesions.

Giant Cell Tumour of Soft Tissue in Neck: An Uncommon Tumour in an Uncommon Location

Giant cell tumour of soft tissue is an extremely rare tumour. It is thought to be the soft tissue counterpart of giant cell tumours of the bone due to its histological and immunohistochemical resemblances. Almost 80% of these tumours occur in upper and lower extremities; neck is a very rare location. Here we describe a case of primary soft tissue giant cell tumour in right submandibular region. A 35-year-old male patient presented with a swelling in right submandibular area. FNAC suggested a benign soft tissue neoplasm, comprising of spindle cells and multinucleated giant cells. Histopathology of resected specimen showed spindle cell tumour with intricately mixed giant cells, consistent with a primary giant cell tumour of soft tissue. Giant cells were CD 68 positive. Giant cell tumour of soft tissue is benign tumour, though very rarely can show features of malignancy. We present this case for its rarity and morphological overlap with other soft tissue neoplasms containing giant cells.

Retroperitoneal giant ancient schwannoma

Ancient schwannoma is a rare variant of benign peripheral nerve sheath tumor, often morphologically mimicking malignancy. Retroperitoneum is an uncommon location. We describe one case of giant retroperitoneal ancient schwannoma. Literature concerning this variant is also reviewed. A 65 year old male presented with altered bowel habits. Imaging findings revealed a large heterogeneous mass in the retroperitoneum. The patient was treated with complete excision. Grossly, the tumor was predominantly solid with focal cystic degeneration. Histological examination showed an encapsulated spindle cell tumor with nuclear palisading, very focal nuclear atypia and widespread foam cell infiltration - findings consistent with ancient schwannoma. A diagnosis of ancient schwannoma can be considered for a solid-cystic encapsulated mass in the retroperitoneum. Malignant transformation is very rare. Local recurrence is uncommon following complete excision. The authors have nothing to disclose.

Primary renal synovial sarcoma: a rare tumor with an atypical presentation

Primary renal synovial sarcoma (PRSS) is a very rare tumor, first described by Argani, et al. The exact incidence of PRSS is not yet known. Here we present a case of PRSS diagnosed by histopathology, supplemented with immunohistochemistry.

Testicular fibroma of gonadal stromal origin with minor sex cord elements, presenting with hydrocele

Testicular fibroma of gonadal stromal origin is a rare benign tumor of testis which usually presents as a slow growing testicular mass. Only 25 cases of testicular fibroma have been reported in the literature. Presence of minor sex cord elements in this tumor is even rarer. We report a case of testicular fibroma with minor sex cord elements that involved almost the entire testis and tunica vaginalis. The patient presented with hydrocele, a rare presentation for this entity. The rarity of the diagnosis and the clinical presentation prompted this case report.

Clinicohaematological profile of aplastic anaemia in a rural medical college of Northern West Bengal

There is a scarcity of clinical data in the field of aplastic anaemia from rural India. Present study was conducted in North Bengal Medical College to find out the clinicohaematological profile and the possible aetiological factors in patients with aplastic anaemia. The study population (n = 83) included 21 children with male to female ratio 4.93:1. Weakness was present in all cases and pallor was present in 74.70% cases. Fever, bleeding episodes and localised infection were found in 55.42%, 48.19% and 27.71% cases respectively. There was no difference in clinical manifestations between children and adult except occurrence of fever (p = 0.0365). We identified possible aetiological factors in 32.53% cases as relevant drug intake in 10.84%, exposure to chemicals in 13.25% and hepatitis in 8.43% cases. We found low mean haemoglobin (3.81 +/- 1.71 g/dl), leucocyte and platelet (3.05 +/- 1.3 and 37.30 +/- 35 x 10(3)/cmm), neutrophil (30.28 +/- 21.76%) and high lymphocyte (67.27 +/- 22.50%) in peripheral blood. At the time of presentation, aplastic anaemia was moderate in 59.04% cases, severe in 48.19% cases and mild in 4.82% cases. We estimated the prevalence of aplastic anaemia in 4 districts of West Bengal including tea garden areas was 2.98/million populations per year. It was concluded that aplastic anaemia is a major non-malignant haematological disease in this part of India, and an increasing use of chemicals in agricultural and tea garden areas might be the responsible factor. Larger population based study is suggested.

Intranodal palisaded myofibroblastoma

A 35 years old female presented with a left inguinal swelling. Histopathological examination with routine haematoxylin and eosin, Van Gieson's and Congo red stains revealed the swelling to be intranodal palisaded myofibroblastoma. Immunohistochemistry was done and the myofibroblastic nature of the tumour cells was proved. Accurate diagnosis of intranodal palisaded myofibroblastoma is important for therapeutic and prognostic reasons. This case is reported here because of its very rare occurrence and the diagnostic dilemma that it possesses.

Unilateral retinal dysplasia clinically mimicking retinoblastoma

Retinal dysplasia is a rare non-neoplastic congenital disorder characterized by aberrant differentiation of the retina with formation of abnormal tubular and rosette-like structure. Clinically, the lesion presents with leukocoria and mimics a retinoblastoma. One such case is described that occurred unilaterally in a 9-month-old boy.

Clinicohaematological analysis of aplastic anaemia among children of northern districts of West Bengal

Though aplastic anaemia in children is an important haematological disorder, not many studies have been undertaken in India and especially in the northern districts of West Bengal. The present study was carried out at North Bengal Medical College and Hospital to find the occurrence, clinical and hematological profile of children with aplastic anaemia. All the children (less than 15 years) having relevant history and clinical features underwent a complete blood count and bone marrow aspiration study (smear and histological sections) and trephine biopsy. Total number of children diagnosed were 21 (M = 17, F = 4), having an age range of 6-14.5 years (mean 11.36). Relevant aetiological factors were noted in 10 cases (47.61%), including history of exposure to insecticides, fungicides and fertilisers in 5 cases (23.81%). The common symptoms were due to anaemia (weakness, pallor in all cases), leucopoenia [fever in 16 cases (76.19%)] and thrombocytopenia [bleeding in 10 cases (47.61%)]. Severe and moderate aplastic anaemia were noted in 7 (33.33%) and 12 (57.14%) cases respectively. The calculated occurrence of aplastic anaemia is 1.96/million population of children/year in the four northern districts of West Bengal. The bone marrow aspiration was satisfactory in all cases. Histological sections of aspirated marrow particle produced better architectural relationship among different components. Aplastic anaemia is a major hematological problem among the children of northern districts of West Bengal. Simultaneous examination of smear and histological sections of marrow particles is a satisfactory method for detection of aplastic anaemia.

Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features

Leukemias are the commonest childhood malignancy in West Bengal. This study was undertaken on 75 children at NRS Medical College, West Bengal to determine the distribution of signs and symptoms of leukemia and to identify unusual clinical features. After obtaining clinical history, physical examination, hematological and radiological investigations were performed. Acute lymphoblastic leukaemia (ALL, 72%) was the commonest followed by acute myeloid leukaemia (AML, 18.7%). Common symptoms and signs were fever (85.3%), pallor (64%), hepatomegaly (72%), splenomegaly (60%) and lymphadenopathy (50.7%). The uncommon signs and symptoms were abdominal pain (9.3%), joint pain (9.3%), hematemesis and malena (8%), diarrhea (5.3%), proptosis (2 cases), dysphagia, mediastinal mass and parotid swelling (1 case each). Uncommon clinical presentations lead to delay in diagnosis in some cases. Awareness of uncommon signs and symptoms of childhood leukemia together with laboratory tests may help in earlier diagnosis and proper management of the patients.

Primary non-Hodgkin's lymphoma of breast: a case report

Primary breast lymphoma is a relatively uncommon neoplasm, majority being of B-cell origin. Mucosa associated lymphoid tissue (MALT) is one of the common types of breast lymphomas. Though cytologic diagnosis of breast lymphoma is an easy procedure and provides guidance for appropriate pre-operative management, it is often impossible to differentiate a low grade lymphoma from reactive proliferation. A similar difficulty was encountered in the present case, a 42 year old female with a breast lump. Fine needle aspiration cytology revealed a mixed lymphoid cell population. Lymphoepithelial lesions were identified histologically, and the majority of the cell population were confirmed as lymphoma cells of B-cell origin on immunohistochemistry. This case highlights the limitations of cytology and the importance of histological examination supported by immunohistochemistry for making a diagnosis of low grade primary breast lymphoma.

Gastro-intestinal stromal tumour--role of CD117 in diagnosis and management

Gastro-intestinal stromal tumours (GIST) are a biologically distinct heterogenous group of tumours of the gut. They are said to arise from interstitial cells of Cajal in gut wall. The turnour results from mutation of c-kit gene which codes for CD117 containing tyrosine kinase receptor of Cajal cells. Identification of this mutation by immunohistochemistry (IHC) is the key to the diagnosis of these tumours. CD117 negative GISTs develop from gene mutation through alternate pathway (PDGFRA). The accurate diagnosis is important as specific chemotherapeutic agents are now available for their management. We have studied 8 cases of GISTs during last 2 years in our institute. Half of the cases were female, six cases were in the age group between 35 to 50 years, the other two being of 19 and 70 years. On histology, 5 cases were categorized as high grade on the basis of their size and mitotic count. All cases were subjected to IHC. Only 4 cases were CDll7 positive, one case was positive for S100 and one case for SMA. Remaining 2 cases, negative for CD117, S100 and SMA, histologically resembled GISTs. CD117 positive cases are ideal candidates for treatment with molecularly targeted specific chemotherapeutic agents, e.g., imatinib as these tumours are non-responsive to conventional chemotherapy. Histologically diagnosed stromal tumours of the gut should be subjected to immunostain for CD117 so that specific medical management can be provided to prevent recurrence and metastasis as well as pre-operative debulking of the tumour.

Immature mediastinal teratoma--a rare pathology

A 9 year old female presented with 8 months history of right sided chest pain and respiratory distress. Chest X-ray revealed a large anterior mediastinal mass. Histopathology of the mass revealed features of an immature teratoma. The case is being presented because of its rare occurrence in the mediastinum.

Skin cancers in chronic arsenic toxicity--a study of predictive value of some proliferative markers

Prolonged exposure to arsenic contaminated water produces various clinical features, cutaneous features e.g. melanosis, keratosis and cancers being very common. Evaluation of such lesions by proliferative markers can provide useful information in regards to the biological behaviour of the lesions. Thus, cases with high proliferative status can be ominous sign for development of cancers. We studied skin biopsy of 42 cases. These were evaluated with AgNOR score and PCNA stain, in addition to H & E examination. Here, invasive cancer cases had mean AgNOR score of 3.56, those with severe dysplasia had 3.0, moderate and mild dysplasia scored 1.73, benign changes had mean score of 1.35 while normal control cases had 1.08. PCNA index in cancers was above 50, that of severe dysplasia 25-30, mild to moderate dysplasia 1.0-5.0, those with benign changes 0.5 -1.0 and normal control had LI of less than 0.5%. PCNA has the advantage of less chance of observer error over AgNOR stain.

Histopathology of skin lesions in chronic arsenic toxicity--grading of changes and study of proliferative markers

Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with H&E staining for proper assessment of the cases.