Manjula Jain

Retroperitoneal ganglioneuroma: Report of a case diagnosed by fine‐needle aspiration cytology, with review of the literature

A case of ganglioneuroma presenting as a retroperitoneal mass in a 5‐yr‐old girl was diagnosed by preoperative fine‐needle aspiration cytology. The cytologic smears predominantly showed clusters of Schwann cells, with scattered mature ganglion cells. The cytologic diagnosis of ganglioneuroma was subsequently confirmed on histopathologic examination. To date, very few reports on the cytologic features of this tumor exist. The importance of con‐sidering a confident diagnosis by cytology, and of the uncommon age group that may be affected, is stressed. Diagn. Cytopathol. 1999;21:194–196.

Prevalence, risk factors and virological profile of chronic hepatitis B virus infection in pregnant women in India.

A large program was conducted by the Government of India to study the prevalence and profile of chronic hepatitis B virus (HBV) infection and its risk factors in pregnant women attending a tertiary care hospital in India. From September 2004 to December 2008 consecutive pregnant women attending the antenatal clinic were screened and those found positive for HBsAg were enrolled. Healthy non‐pregnant women of child‐bearing age, who presented for blood donation during the same period, served as controls. Women with symptoms of liver disease or those aware of their HBsAg status were excluded. Of the 20,104 pregnant women screened, 224 (1.1%) and of the 658 controls, 8 (1.2%) were HBsAg positive (P = ns). Previous blood transfusions and surgery were significant risk factors for infection with HBV. Of the women who were HBsAg positive, the ALT levels were normal in 54% of the women and HBV DNA levels were above 2,000 IU/ml in 71% of women. The median HBV DNA levels were higher in women who were HBeAg positive compared to the HBeAg negative group. The most common HBV genotype was D (84%) followed by A + D and A (8% each). In conclusion, the prevalence of HBsAg positivity among asymptomatic pregnant women in North India is 1.1% with 71% having high HBV DNA levels. These women may have a high risk of transmitting infection to their newborns. J. Med. Virol. 83:962–967, 2011.

The prevalence of irregular erythrocyte antibodies among antenatal women in Delhi

BACKGROUND Universal screening of all antenatal women, including D antigen-positive pregnant ones, is mandatory in most developed countries. However, no guidelines on this issue are available for developing countries such as India. Furthermore, there is limited information on immunisation rates in pregnant women (D antigen-positive and D antigen-negative) from India. We, therefore, studied the prevalence of alloantibodies among multigravida women in India. MATERIALS AND METHODS In this prospective study, carried out to detect the prevalence of alloantibodies among multigravida women in India, 3,577 multigravida women attending antenatal clinics were typed for ABO and D antigens and screened for alloantibodies by column agglutination technology. The medical history and detailed obstetric history of these women were reviewed and information recorded on any prior haemolytic disease of the foetus and newborn among siblings and/or blood transfusions. RESULTS The overall prevalence of alloantibodies in this study was 1.25%. There was a statistically significant difference between alloimmunisation rates in the D antigen-negative and D antigen-positive groups (10.7% versus 0.12%, respectively). Anti-D antibody contributed to 78.4% of total alloimmunisations in our study. DISCUSSION Anti-D was the most common culprit responsible for alloimmunisation. Other alloantibodies found included anti-C, anti-M, anti-S and anti-c. Large-scale population-based studies are required to assess the real magnitude of alloimmunisation in pregnant women in India.

Estimation of hemoglobin in blood donors: A comparative study using hemocue and cell counter

Hemoglobin estimation is an integral part of donor screening in blood banks. Various methods are available for hemoglobin estimation and each one of them has its advantages and limitations. Hemocue as a hemoglobinometer is gaining widespread popularity not only for donor screening but also as a bedside hemoglobinometer. We conducted a study involving 535 donors with an aim to assess the accuracy of hemocue readings and compared it with cell counter values. We also compared the hemocue readings using capillary blood with the venous blood.

Adverse reactions in whole blood donors: an Indian scenario

BACKGROUND Whole blood donation is generally considered to be a safe procedure, but occasionally adverse reactions of varying severity may occur during or at the end of the collection. The aim of the study was to estimate the frequency and type of adverse events occurring during blood donation and to assess the practices which would help to minimise them. MATERIALS AND METHODS This retrospective single-centre study was conducted from June 2007 to November 2009 at a regional blood transfusion centre. All whole blood donations made at the centre were analysed. All adverse events occurring during or at the end of donation were noted using a standardised format. RESULTS Overall 113 adverse events were reported in relation to 19,045 donations, resulting in an overall adverse event rate of 0.6%, that is, an incidence of 1 in every 166 donations. Presyncopal symptoms, in other words vasovagal reactions of mild intensity, were the most commonly observed adverse reactions and accounted for approximately 70% of all adverse reactions noted. CONCLUSIONS Only 0.6% of blood donations were complicated by adverse events and most of these events were presyncopal symptoms. Our study reinforces the fact that blood donation is a very safe procedure which could be made even more event-free by following certain friendly, reassuring and tactful practices.

M/M/R Machine Interference Model with Balking, Reneging, Spares and Two Modes of Failure

This paper is concerned with M/M/R machine interference model consisting of M operating and S spare units. The units are assumed to fail in two modes. The life times and repair times of units are assumed to follow a negative exponential distribution. The both failure modes have equal probability of repairing. The both types of failed units are served by a pool of R repairmen according to FIFO discipline. We obtain queue size distribution at equilibrium in explicit form. The expressions for various performance measures such as the average number of failed units, the average number of idle repairmen etc. have been obtained. The expected total cost per unit time has also been derived. Numerical results are given for various performance measures to validate the analytical results. Optimal allocation of repairmen and spares based on heuristic approach is done in order to minimize the expected total cost under the constraint of availability.

Cytological features of chondroblastoma: A case report with review of the literature

Chondroblastoma is an uncommon benign tumor of bone with a characteristic epiphyseal location. This report documents the cytological features on fine‐needle aspiration biopsy (FNAB) of a chondroblastoma which appeared as a lytic lesion, predominantly in the metaphysis of the medial condyle of right femur in a 20‐year‐old male. Smears characteristically revealed hyper‐ to hypocellular lobules comprising small round to polyhedral cells (chondroblasts) embedded in an abundant myxoid stroma. The cytological diagnosis of chondroblastoma was confirmed on histopathology. The radiological appearance and differential diagnosis in this case is discussed. Diagn. Cytopathol. 23:348–350, 2000.

Amyloidosis cutis dyschromica: a rare pigmentary disorder

Amyloidosis cutis dyschromica represents a rare type of primary cutaneous amyloidosis with few reported cases worldwide. It is characterized by asymptomatic, generalized hyperpigmentation with intermingled hypopigmented macules without atrophy or telangiectasia. We report herein a 19‐year‐old female who developed this pigmentary abnormality at 4 years of age. Her aunt and great grandfather also had similar skin pigmentation. An unusual finding in our patient was the presence of papules in addition to characteristic macules. Amyloid deposits were shown histopathologically in both dyschromic macules and papules.

Use of rapid detection tests to prevent transfusion-transmitted malaria in India.

Sir, As we all are aware, transfusion-transmitted malaria is emerging as a major problem especially in developing countries, which fall in the zone of endemicity. Transmission of malaria by blood transfusion was one of the fi rst recorded incidents of transfusion-transmitted infection.[1] The frequency of transfusion-transmitted malaria varies from 0.2 cases per million in nonendemic countries to 50 or more cases per million in endemic areas.[2] Although it was in 1971 that screening of donated blood for viral infections was begun, but there are no defi nite guidelines to the choice of the test. Testing of blood for malarial parasite is mandatory as per the drugs and cosmetic act part X11 B of Schedule F, but there are no clear guidelines to date. Microscopic detection of blood though considered the gold standard for malaria diagnosis for decades is quite labor-intensive and requires adequate technical skill and manpower. This has spurred the development of several nonmicroscopic malaria rapid detection tests (RDT) based on the detection of malaria parasite antigen in whole blood. We at our blood bank, Regional Blood Transfusion Centre, have been routinely screening all donated units of blood for malaria using RDT, based on immunochromatographic methods detecting antigens, histidine-rich protein 2 (HRP2-P. falciparum), and p-lactate dehydrogenase (pLDH-P. vivax) (Paraview, First Sign; Diagnova Pvt. Ltd. New Delhi, India Ltd.) since March 2008. Thick and thin smears were made of all positive cases to corroborate the results of RDT. Total of 11,736 units of donated blood were screened between March 2008 and September, 2009. Three (0.03%) units were found to be positive, 2 for P. vivax, and 1 for P. falciparum. All the three cases were found positive microscopically. None of the donor had given a history of fever/malaria during predonation screening [Table 1]. Table 1 Comparison of rapid detection tests and peripheral smear screening of positive cases The RDT works through lateral flow/immuno chromatographic strip method and signifi es the presence of antigens by a color change on the absorbing nitrocellulose strip. Three main types of antigens are being detected by the commercially available RDTs. Falade et al. in 2009 conducted a study on 391 consecutive potential blood donors in malaria endemic area of South-West Nigeria using 3 methods’ microscopy, OptiMAL RDT (pLDH), and Clinotech Malaria cassette (detects surface protein of merozoites and sporozoites). Microscopy revealed parasitemia in 79 (20.0%) of potential donors, mean level of parasitemia being 445/μl. The corresponding prevalence of malarial parasitemia detected using RDT were 3.8% for OptiMAL and 57.8% for Clinotech, with the results for microscopy being the gold standard.[3] Bharti et al. in 2008 evaluated the usefulness of a new RDT, pLDH/HRP2 malaria card test (First Response Combo Malaria Antigen Test, New Delhi, India) for malaria diagnosis in the forested belt of central India. Analysis revealed that RDT was 93% sensitive, 85% specifi c with a positive predictive value of 79%, and a negative predictive value of 95% (microscopy being used as the gold standard).[4] Kyabayize et al. studied the operational accuracy and persistent antigenicity of HRP2 RDTs for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Using a cross-sectional study design, a total of 357 febrile patients of all ages were tested using RDT out of which 40% (139) had positive blood smears for P. falciparum. RDT had overall sensitivity of 98%, specifi city of 72%, positive predictive value of 69%, and a negative predictive value of 98%. In the children followed-up after successful antimalarial treatment, the mean duration of persistent antigenicity was 32 days, this duration varied signifi cantly depending on pre-treatment parasitemia.[5] Therefore, a donor who is deferred for 12 weeks following completion of treatment will not give a false positive test for malaria by RDT. Importance of recognizing transfusion-transmitted malaria lies in the fact that it can lead to febrile transfusion reaction which can falsely simulate a hemolytic transfusion reaction. It can lead to the widespread dissemination and spread of drug-resistant malarial parasite. The utmost importance is derived from the presumption that the screened blood units are transfused to patients ranging from newborns (requiring exchange transfusions) to the geriatric group. These along with the immune-suppressed (cancer and leukemia therapy) patients are at a higher risk of falling prey to units not effectively screened for malarial parasite. Thus clinicians will waste valuable time manage on lines of hemolytic transfusion reaction. Nonetheless, no matter what strategy is adopted, it is likely that cases of transfusion-transmitted malaria may still occur, so malaria must always be considered in any patient with a febrile illness post-transfusion. Thus we would like to recommend that use of rapid detection devices with peripheral smear screening of positive cases is reasonably reliable method to prevent transfusion-transmitted malaria in India.

Critical appraisal of cytological nuclear grading in carcinoma of the breast and its correlation with ER/PR expression

Background: Cytological nuclear grading is one of the several key prognostic factors that should be addressed in cytological analysis of breast carcinomas. Aims: To evaluate different cytological nuclear grading methods on fine needle aspirates of breast carcinomas and its correlation with histopathological nuclear grading as well as with the immunocytochemical expression of estrogen receptor (ER) and progesterone receptor (PR). Materials and Methods: The smears from 30 cytologically proven cases of breast carcinoma were graded by - Nottinghams modification of Scarff Bloom Richardson, Fishers modification of Blacks nuclear grading and Robinsons cytological grading methods. 18 cases were available for correlation with histology grading. Results: Robbinsons cytological grading system was found to have the best correlation with histopathology grades (P Conclusions: The Richardsons cytology grading method is recommended for cytological nuclear grading along with ER / PR expression, without which the cytological diagnosis of breast carcinoma is incomplete.