Background Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.
Background: Gall bladder diseases can be an incidental finding and when symptomatic, present with signs and symptom of cholecystitis and cholelithiasis. On histopathological examination however wide range of pathological changes are encountered including carcinoma. Several studies have been carried out to establish relationship of helicobacter infection with gallbladder diseases. This study tries to look at the frequency of risk factors, spectrum of histological changes and the relationship between different types of gallbladder diseases and helicobacter infection. Materials and Methods:Total of 500 gallbladder specimen received over the period of 24 months was included in the study. Bile culture and histopathological examination cholecystectomy were performed with routine hematoxylin and eosin stain and Giemsa stain. Result:Out of the 500 cases. Helicobacter was seen in 166(33%) of cases. Carcinoma was seen in 7 (1%) cases. Helcobacter infection was seen positive in 5/7 (71%) malignant cases which showed a statistically significant p value of 0.03. Conclusion:Cholecystitis is the most common gallbladder disease. All gallbladder carcinomas were incidental finding and were of lower grade and stage. Helicobacter infection was prevalent in variety of gallbladder pathology and had significant association with gallbladder carcinoma. However, definite relation between the helicobacter infection and gallbladder diseases cannot be concluded.
Non Alcoholic Fatty Liver Disease is the deposition of fat in liver in absence of excessive of alcohol consumption. Non Alcoholic Fatty Liver Disease ranges from simple steatosis to Nonalcoholic steatohepatitis and cirrhosis. Most cases (90%) of Non Alcoholic Fatty Liver Disease have simple steatosis with benign prognosis. Ten to thirty percent of Non -Alcoholic Fatty Liver Disease progresses to NASH and 25-40% of Nonalcoholic steatohepatitis undergoes progressive liver fibrosis.Ultimately 20-30% of Nonalcoholic steatohepatitis will go into cirrhosis during their lifetime. Nonalcoholic steatohepatitis cirrhosis has higher chances of (2.6% per year) going into hepatocellular carcinoma. There are several risk factors noted for Non Alcoholic Fatty Liver Disease. Some of which includes increasing age, metabolic syndrome, dietary factors etc. Investigations regarding liver function test can be divided into invasive and noninvasive types. Under invasive procedures comes liver biopsy and non-invasive includes radiological tests and various biochemical tests. This article tries to analyze different scoring systems and their significance in diagnosing steatohepatitis and fibrosis.
Background: Gastritis is commonly reported using several parameters such as infiltration by neutrophils, lymphocytes, intestinal metaplasia, atrophy and Helicobacter pylori. In recent years, mast cells are also suggested in several studies to play central role in development of gastritis. This study tires to look at the relation between the mast cell count and infiltration by neutrophils and Helicobacter pylori. Materials and methods:This is a retrospective study which includes endoscopic gastric biopsies received at the histopathology department of GRP polyclinic that have been diagnosed as chronic gastritis. Clinical information regarding associated gastrointestinal symptoms and conditions were obtained from the medical database. Patients taking antibiotics, proton-pump inhibitors, H2-antagonists, nonsteroidal anti-inflammatory drugs or corticosteroids were excluded from the study. Also excluded are patients with dysplasia or carcinoma. Sections were then stained by H&E and Giemsa for the evaluation of H pylori infection and inflammation. These sections were examined by two pathologists. Mast cells were counted in 1000 epithelial cells in 40x.Three different counts were performed by each pathologists and an average score was taken for every case.Result: A total of 534 cases were included in the study. Mast cells were detected in all the cases. However, mast cells were seen mostly in mild grade 60%. Ninty-eight percent of our cases showed H.pylori positivity and 72% of cases had active gastritis. A positive correlation was found between mast cells density and infiltration by neutrophils as well as Helicobacter pylori infection with significant P value of 0.0001 in each. Conclusion:Mast cells are seen in a significant number of biopsies with gastritis showing positive correlation with neutrophilic infiltration and Helicobacter pylori infection.
Background: Neonatal sepsis is one of the common causes of neonatal mortality. Blood culture is the gold standard procedure to confirm sepsis. However, the rapid rate of disease progression makes its timely diagnosis and prompt management very crucial before the availability of culture. The study aimed to determine the significance of complete blood count parameters including platelet indices in diagnosing neonatal sepsis. Materials and Methods: This study included 129 suspected cases of neonatal sepsis admitted to KIST Medical College Teaching Hospital from 15th April 2018 to 14th April 2019. Complete blood count, platelet indices, micro erythrocyte sedimentation rate, C-reactive protein, and blood culture were performed and analyzed. Results: Of 129 suspected neonatal sepsis, abnormal leukocyte count was encountered in 31 (24.0%) patients. Culture-proven sepsis was seen in 25 (19.1%) patients. The sensitivity and specificity of Neonatal Sepsis Screening Criteria were 10.0% and 80.0% respectively. Among platelet-derived indices, PDW (full form) had a sensitivity of 80% and specificity of 56% with a cut of 17.02 CV. MPV (full form), with a cut-off value of 9.78 fL had a sensitivity of 88 % with a specificity of 59%. Both MPV and PDW had low positive predictive values (33.3%) but a high negative predictive value (95.2%). Conclusions: Along with total leukocyte count, platelet indices have shown their significance in determining neonatal sepsis with significant negative predictive value. The addition of MPV and PDW to the Neonatal Sepsis Screening Criteria might help the treating physician to rule in or rule out neonatal sepsis and manage it accordingly.
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