BackgroundIn India, tuberculosis is an endemic disease. Delay in diagnosis results in poor prognosis and fast spread of the disease. The objective of the present study is to look for an effective and acceptable diagnostic test, which may be helpful to initiate early treatment to improve prognosis and reduce spread.MethodsThree hundred and thirty patients with pleural, ascitic, meningeal and synovial effusion were selected and divided depending upon the etiology and the involvement of serosal membranes. Serosal aspirated fluid was subjected to biochemical tests and adenosine deaminase estimation. Cutoff taken is above 40 for pleural, peritoneal or synovial fluid and above 10 for CSF.ResultsIn cases of pulmonary and extra-pulmonary disease, sensitivity was 92.80% and 94.29%; specificity 90.00% and 92.16%; positive predictive value 92.86% and 89.00%; and negative predictive value 90.00% and 95.92% respectively.ConclusionsAdenosine deaminase estimation is not only a fairly sensitive and specific test (more than 90%), helpful in differentiating tubercular from non-tubercular etiology both in pulmonary and extra-pulmonary disease, but is also simple, inexpensive and rapid. For this reason this test may help in early diagnosis, improve the prognosis and reduce spread of disease and sequlae.KeywordsAdenosine deaminase; Serosal effusion; Tubercular; Non-tubercular; Pulmonary; Extra-pulmonary

BackgroundTuberculosis kills five lakh patients every year in India, commonest being pulmonary tuberculosis and is often associated with effusion. Delay in diagnosis and treatment results in poor prognosis. Several studies have suggested the role of adenosine deaminase (ADA) in the diagnosis of tuberculous pleural effusions, but false-positive results from lymphocytic effusions have also been reported. The purpose of this study is to find out the role of ADA levels in differentiation of tuberculous and non-tuberculous exudative pleural effusions of different etiologies.MethodsNinety-six lymphocytic pleural fluid samples were consecutively selected and divided into two groups: tuberculous (n = 56) and non-tuberculous (n = 40), depending upon the etiology [Malignancy (n = 16), Infectious diseases (n = 18), Pulmonary embolism (n = 1), Collagen vascular diseases (n = 3) and Sarcoidosis (n = 2)]. ADA was estimated in pleural fluid in all the cases.ResultsIn all 56 samples, ADA level of tuberculous group was above diagnostic cut-off (40 U/L), while only one sample was above cut-off in non-tuberculous group (2.5%). The negative predictive value of ADA for the diagnosis of non-tuberculous etiology was 97.5% (39 of 40) lymphocytic pleural effusion patients.ConclusionsIn this study, ADA levels in nontuberculous exudative pleural effusions rarely exceeded the cut-off; set for tuberculous disease. The pleural fluid ADA levels were significantly higher in tuberculous exudative pleural effusions when compared with non-tuberculous exudative pleural effusions.KeywordsAdenosine deaminase; Tuberculous effusion; Pleural fluid; Exudative pleural effusions

BackgroundAn increased oxidative level and decreased antioxidant activities in the blood of preeclamptic women have been reported by us and other workers. The present study was aimed to evaluate oxidative stress in infants born to preeclamptic mothers, and to examine whether cord blood with oxygen radical disease had different total enzymatic antioxidant status than those without preeclampsia.MethodsThe present study consisted of 23 normotensive (served as control) and 23 preeclamptic mothers. We compared their oxidative and anti-oxidative system in maternal and cord blood of pair-matched mother and neonate. Their blood malondialdehyde (MDA), antioxidant enzymes were determined and compared to evaluate if pro-oxidative status of preeclampsia differs from the status in cord blood of pair-matched neonate.ResultsThe MDA content in preeclamptic maternal plasma was significantly high (p < 0.001) compared to that of control. Interestingly, its content in preeclamptic cord blood was significantly low (p < 0.001) compared to their pair-matched maternal blood. Superoxide dismutase (SOD) activity was 8.7% higher in cord as compared to pair-matched normotensive maternal blood which was significant (p = 0.01) whereas in preeclamptic cord the level decreased significantly (p = 0.011) in comparison to pair-matched preeclamptic maternal. Glutathione peroxidase (GPx) was 16.4% higher in normotensive cord compared to maternal blood, and 7% low in preeclamptic cord compared to pair-matched maternal blood. The increase was significant (P = 0.011) in normotensive cord whereas in preeclamptic cord the decrease was insignificant (p = 0.06). Contrary to earlier reports on catalase activity, our results showed 20.97% elevation in normotensive and 16.12% increase in the preeclamptic cord blood compared to their pair-matched maternal blood. This change was significant with p = 0.01 and p = 0.017 in control and preeclamptic group respectively.ConclusionsOur results showed the significantly low MDA contents in the pair-matched cord blood and the activities of SOD, GPx and Catalase mentioned above, we conclude that the oxidative stress status is low in the blood of neonates born to preeclamptic mothers. Further studies are needed to explore strategies so that the normal levels of antioxidant vitamins are maintained to combat preeclampsia in women at high risk.KeywordsMaternal; Cord blood; Malondialdehyde; Antioxidant enzymes; Glutathione peroxidase; Glutathione reductase; Superoxide dismutase; Catalase

Introduction: Intraoperative consultation by frozen section technique is an invaluable tool for immediate diagnosis. Its accuracy and limitations vary with different anatomical sites. Various studies comparing diagnostic accuracy are reported, however morphological quality of frozen section and its limitations have not been widely discussed.Aim: Qualitative morphological comparison between frozen section and routine formalin fixed paraffin embedded sections in different tissues, determine the diagnostic accuracy and study limitations of frozen section. Materials and Methods:67 tissue specimens from 52 cases were studied over a period of 2 years. Diagnostic accuracy of frozen section and its morphological quality and reliability in comparison to histopathology was evaluated by 2 pathologists in a blinded fashion for the following parameters: cellular outline, nuclear and cytoplasmic features, staining pattern and overall morphology. The turnaround time and limitations in section preparation and problems encountered were assessed.Results: Diagnostic accuracy of frozen section was 96.2%. Statistical analysis showed that nuclear details, cellular outline and overall morphological quality of frozen section was slightly inferior to that of routine histopathology section, however, staining and cytoplasmic details were comparable. Most common limitation was freezing artifact. The average turnaround time was within 20 minutes in 76.9% cases. Conclusion:Frozen section is a reliable and accurate intra-operative consultation modality, but one needs to be aware of its indications and limitations. Avoiding technical errors in sectioning and staining, combination of knowledge about clinical presentation and experience in interpretation of morphological details can provide rapid diagnosis and subsequent patient management. Intraoperative consultation guides immediate surgical management to establish nature and type of lesion, confirm presence of malignancy, status of surgical margins and ensuring sufficient sampling of lesional tissue. The indications and limitations of frozen section diagnosis vary in different organs. Diagnostic discrepancies between frozen and permanent section are commonly observed in tissue from skin, breast, uterine cervix and thyroid [3][4][5][6]. INTRODUCTIONErrors can be divided into errors of interpretation and errors of sampling. These include the initial selection of tissue by the surgeon, the sampling of the tissue by the pathologist, the technical expertise required to prepare the slides, errors in interpretation and delivery of the result back to the surgeons [5,7]. Diagnosis should be deferred when situation warrants [8]. Many published studies have confirmed the overall diagnostic accuracy of frozen section examination and serves as an integral part of quality assurance [9].Studies comparing the morphological quality of frozen section and formalin fixed paraffin embedded tissue sections have not been widely reported in literature. Also, as frozen section is subject to various pitfalls, ...

Lymphadenopathy is a rare mode of presentation of cysticercus infestation. Hence, in endemic areas, cysticercosis must be included in the differential diagnosis of superficial palpable swellings in the neck region. We report two cases of cervical lymphadenopathy which were clinically suspected to be of tuberculous etiology. However, fine-needle aspiration cytology (FNAC) revealed features of parasitic lymphadenitis consistent with cysticercosis. Our cases highlight the importance of FNAC as an initial and rapid diagnostic modality for detecting parasitic lesions manifesting as lymphadenitis. Diagnosis by the minimally invasive FNA technique prompted an early therapeutic intervention with good response in our patients.