IntroductionTuberculosis is a global health problem that mostly affects people in developing countries. Tuberculosis can occur in various organ systems and may present with diverse manifestations in the same system. Primary muscular tuberculosis is a very rare condition in both adults and children, and tuberculosis of various muscle groups presenting as intramuscular nodules is an even more uncommon presentation.Case presentationA 9-year-old Asian girl presented with multiple painless, gradually progressive swellings over different parts of her body for 3 months with no history of contact with tuberculosis. A physical examination was normal except for multiple swellings in her right forearm, a single swelling in her interscapular region and multiple swellings in her right calf. Ultrasonography of swellings revealed multiple nodules in the intramuscular layer. Excisional biopsies performed from two different sites revealed swellings in muscular layers and histopathology showed granulomatous inflammation with caseous necrosis consistent with tuberculosis. The child was started on antitubercular therapy after which the swellings resolved; she was kept on regular follow up.ConclusionsIntramuscular nodules in multiple muscular sites may be the presenting symptoms of tuberculosis of the muscles. Tuberculosis of skeletal muscles should be considered in a differential diagnosis when presented with single or multiple masses even when a chest X-ray is normal and there is no evidence of tubercular foci elsewhere in the body.
Background: Ovarian cancer accounts for 3% of all cancers in females. About 80% of these are benign, and they occur mostly in young women between 20 and 45 years. Borderline tumors occur at slightly older ages while incidence of malignant tumors increases with age, occurring predominantly in perimenopausal and postmenopausal women. About 190,000 new cases and 114,000 deaths from ovarian cancer are estimated to occur annually worldwide. The aim of the study was to fi nd the incidence of surface ovarian tumor in a tertiary referral centre. Materials and methods: This was a retrospective study carried out in the department of pathology, Manipal Teaching Hospital from January 2001 to December 2012. Specimens were received from the same and other hospitals. Records were retrieved from the departmental data bank and were analyzed. Results: : A total of 310 cases of ovarian tumors have been reported in the same period. Among them, 180 cases were of surface epithelial origin and out of which 24 cases had bilateral tumors. Benign tumors comprised of 148 cases, 6 were borderline and 44 were malignant. Among these, the commonest was serous cystadenoma (98 cases) and the least common was malignant Brenner (2 cases). Combined or mixed tumor was seen in 9 cases. Conclusion: : In our study surface epithelial tumors comprised 58% of all ovarian tumors. In both benign and malignant cases, serous tumor was the commonest followed by mucinous tumors. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 397-402 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7868
Background: The outcome of Chronic Obstructive Pulmonary Disease depends upon the partial pressure of oxygen and carbon dioxide This study was aimed to find the role of arterial blood gas parameters during the length of hospital stay among patients admitted for Chronic Obstructive Pulmonary Diseasewith acute exacerbation. Materials and Methods: This was an observational study conducted in KIST Medical College Teaching Hospital from February 2017 to August 2019. Patients admitted with the chronic obstructive pulmonary disease were evaluated. Demographic data as well as oxygen saturation (SPO2), pulmonary function test, and arterial blood gas analysis were recorded and analyzed. Results: Among 112 patients, the female to male ratio was 1.38: 1 with 84.8% over 60 years of age. One-third of patients (n=38) had exposure to both tobacco smoking and biomass and of them, 86.8% were females. Mean SpO2 was 75.9% and mean FEV1 was 0.92 L (SD=0.295) and significant association was found (p<0.001) between them. Furthermore, 70 (62.5%) patients had type I respiratory failure and 42 patients (37.5%) had type II respiratory failure. Patients with type II respiratory failure and hypercapnic patients had prolonged hospital stay with significant p-value (p<0.001). Similarly, significance was observed in the p-value for acidic blood pH, which was <0.05. Conclusions: Increased length of hospital stay is seen in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease with type II respiratory failure. Hence, aggressive early management to correct hypercapnia may lead to decreased hospital stay along with a better outcome. Thus hypercapnia should be considered as one of the important criteria to flag the patient and manage accordingly.
Background: Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.Materials and Methods: This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.Conclusion: Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.
Osteoarthritis, rheumatoid arthritis, and gout are frequently encountered diseases in the orthopedic clinic. CRP is done to evaluate and monitor these disease processes. This study aimed to evaluate total leukocyte count with differential count, neutrophil/lymphocyte ratio, platelet, platelet/lymphocyte ratio, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit in patients with arthritis. This was a cross-sectional study conducted at KIST Medical College, Teaching Hospital from 15 Ashad 2075 to 14 Ashad 2076. The patient’s demographic data and laboratory findings: total leukocyte count, differential count, hemoglobin, platelet count, plateletcrit, mean platelet volume, platelet distribution width, and plateletcrit. CRP, ESR, RA factor/anti-CCP, and Uric acid tests were also performed. Among 67 patients, osteoarthritis was seen in 53 (79.1%), rheumatoid arthritis among 11(16.4%), and Gout among 3(4.5%). The ROC area under the curve was within acceptable limits for the neutrophil count, neutrophil/lymphocyte ratio, mean platelet volume, platelet distribution width. The sensitivity and specificity of the neutrophil count were 75% and 62% respectively (cut-off: 64.5%). Neutrophil/Lymphocyte ratio was increased and correlated with CRP (p-value: <0.001). PDW had a sensitivity of 90% and specificity of 83.0% (cut-off: 16.8 CV). For MPV, the sensitivity was 80% and specificity was 81% (cut-off: 9.1 fL). At 1.92 cut-off value, the sensitivity and specificity of neutrophil/lymphocyte ratio were 80.0% and 62.0% respectively. CBC parameters can provide an important clue to the treating physician, which helps to manage a patient with arthritis effectively. Neutrophil count, Neutrophil/Lymphocyte ratio, MPV, and PDW correlated with other inflammatory biomarkers and can be used to assess the patient with arthritis.
Introduction: Gastric carcinoma is leading cause of death world wide including Nepal. The 5 years survival rate of gastric carcinoma (25%) has drastically decreased compared to early gastric cancers (90-90%) hence implying the need for early detection. Atrophic gastritis and intestinal metaplasia are considered as major high-risk factors and is a precancerous lesion along with Helicobacter pylori. This study tries to look at the distribution of atrophy and intestinal metaplasia across age and gender and their occurrence in Helicobacter pylori positive cases.Materials and methods: It is Cross-sectional study of a retrospectively collected data at KIST medical college and GRP poly clinic private limited from April 2008 till March 2018. Total of 10,683 cases were included. The slides were stained with Hematoxilin and Eosin stain and Giemsa stain and evaluated by two pathologists. Statistical analysis was done using SPSS vs 21.Results: Total numbers of cases studied were 10,683 with male to female ratio of 1.04:1. The most common age group of the study was 18-40 years (n=6206; 58.8%). Atrophy was seen in 81 (0.8 %) cases, Intestinal metaplasia in 298 (2.8 %) cases and Helicobacter Pylori was positive in 4459 (42.2%) cases. The incidence of atrophic gastritis was more in H. pylori positive group 54 (0.5%) group where as intestinal metaplasia was more in H. pylori negative 190(1.8%) group.Conclusion: Atrophic gastritis and intestinal metaplasia, high-risk factors for gastric carcinoma, were not the common findings. Atrophic gastritis was seen in 0.8% and intestinal metaplasia was seen in 2.8% of the total study population.
Giant solitary trichoepithelioma (GST) is a rare adnexal skin tumor with hair structure differentiation. It varies from trichoepithelioma in size (>2cm) and location (common in thigh and perianal region). So far only 18 cases of GST have been reported worldwide. This is a case of GST in the thigh of a 42 year old man. This form of trichoepithelioma can be a cellular tumor which needs to be differentiated from trichoblastoma, keratotic basal cell carcinoma, nevoid basal cell carcinoma and microcystic adnexal carcinoma.
Introduction: Any adverse effect on health resulting from repeated exposure to a substance against which the individual has been sensitized against is allergy. Food allergens are one of the many common causes of allergies. The aim of this study is to find out the common food allergens and also specify the type of food suspicious for allergy among the patients with allergic reactions. A total of 178 patients with allergic reactions were included. The test was carried out using kit with an enzyme-labelled antihuman IgE catalysing a colour reaction. The kit contains test stripes coated with 21 different common antigens. Concentration of antibody specific to certain allergen is calculated and graded into different classes. Among the patients sensitized to allergic food, mean age was 34.36 years with female to male ratio of 2.9:1. Ninty two patients (51.7%) patients were sensitized to 1 to 3 allergens, whereas, 3.9% w ere sensitized to more than 10 food allergens. Thirty three (27.9%) patients had definite antibody detection, 11(9.3%) patients had strong antibody titre and 4 (3.3%) patients had very high antibody titre. Most common food allergen was crab (20.1%) followed by potato (25.8%). Cross reactivity was seen in various food allergens. Cereals and rice showed significant reactivity (P <0.001). Other food like soybean with mustard, peanut with coconut and apple with grape also showed significant correlation (P<0.001). The most common food allergens were crab, potato, spinach, peanut, coconut, soybean, mustard, wheat, rice, shrimp/prawn, cucumber and onion. While determining the specific allergen, we should be aware of potential cross-reactivity against one or more food allergens.
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