Cells that provide immune defenses are organized into  Encapsulated lymphoid organs o Lymph nodes o Thymus o Spleen  Non-encapsulated aggregates of cells o Diffuse non-encapsulated aggregates or nodules of cells = harbored in many areas underlying mucosal epithelia where bacterial infections tend to occur (i.e. GI tract)  Individual free cells distributed in the blood, lymph fluid, or in intercellular spaces throughout the body Lymphoid organs  Primary = Bone marrow (B-cells) and Thymus (T-cells) o Where stem cells are involved in lymphopoiesis (differentiation of lymph cells from pluripotent progenitor cells)  Secondary = areas where aggregates of lymphocytes are found in close proximity to APC and can also furnish an adaptive immune response (seeded with cells from primary tissues, lymphoid cells proliferate and differentiated in response to environmental conditions)

On the lymph nodes

Background: Hypertension is a major global concern and public health problem affecting more than one billion individuals worldwide. It is risk factor for cardiovascular diseases (CVDs). The main objective of this study was to determine the prescription pattern of antihypertensive medications among patients on follow-up at cardiac clinic of Zewditu Memorial Hospital.Method: A cross-sectional retrospective study design was used to collect the data from the patient chart by reviewing the hypertension patient’s medical record.Result: Out of the 356 patient cards reviewed, 204 (57.3%) were for females and with the mean age of 56.2 ± 12.4 years. Among total study participants, 124 (34.8%) had co-morbid conditions. Majority of the patients were on combination therapy 252 (70.8%). Angiotensin converting enzyme inhibitor (ACEI), 215 (60.4%) was the most prescribed drug. Blood pressure was controlled in 107 (30.1%) of patients. About 140 (39.3%) and 134 (37.6%) hypertensive patients were appropriately prescribed according to national guideline 2014 and Joint National Committee (JNC 8) guideline, respectively. The result of the multivariate analysis showed that there was a positive statistically significant association between inappropriate prescription pattern of antihypertensive medications with age ≥ 60 years (P=0.01) and uncontrolled blood pressure (BP) (P=0.001).Conclusion: In conclusion, the general use of antihypertensive medications seemed not to be in accordance with the Ethiopia national guideline.

Assessment of Blood Pressure Control among Hypertensive Patients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background: Cervical lymphadenopathy can be a confounding problem in surgical practice. The analysis of cervical lymphadenopathy is never straightforward and the difficulty is compounded by the differential diagnoses that include several diseases that resemble each other. Clinical evaluation, aspiration cytology, and open biopsy are some of the methods available for this purpose. Aim: To study the prevalence of the cervical lymphadenopathy in respect to age, sex, to study about the various clinical presentation of cervical lymphadenopathy, to correlate the pathological findings with the clinical diagnosis and to study the role of FNAC by correlating with confirmed biopsy report. Materials and methods: 75 patients with cervical lymphadenopathy were selected from the General Surgery OPD of Tirunelveli medical college. They were subjected to FNAC and excision biopsy of the nodes after a thorough history and clinical examination. The results were tabulated and analyzed. Results: The most common diagnosis was Tuberculous lymphadenitis (67%) followed by reactive (9%) and non-specific lymphadenitis (9%) with malignant secondaries (11%) and lymphomas (4%). There was a slight male preponderance (57.3%) The most common presenting age groups were between 31 to 40 years followed by 21 to 30 years. The most common presenting symptom was neck swelling (88%) followed by fever (37.3%) and Loss of weight (18.7%). Conclusion: Tuberculous lymphadenopathy continues to be the major reason for cervical lymphadenopathy with malignancy as an important differential diagnosis. FNAC is a versatile diagnostic tool and one of the least invasive tests in the workup of cervical lymphadenopathy. It is very accurate in diagnosing malignancy and lymphomas and reasonably so in diagnosing tuberculosis.

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Clinicopathological study of cervical lymphadenopathy

BACKGROUND. The primary diagnosis of non-Hodgkin's lymphoma/leukemia (NHL) by fine-needle aspiration (FNA) is controversial. The authors reviewed their experience with FNA and flow cytometry (FC) to determine the usefulness and limitations of these techniques in the diagnosis of NHL. METHODS. Slides and reports from all lymph node and extranodal FNAs performed during the period July 1993 to January 1997 with a diagnosis of lymphoma or benign lymphoid process were reviewed. Clinical and biopsy follow-up data were recorded. Results were tabulated and the usefulness of cytology was analyzed. RESULTS. There were 100 adequate aspirates from 87 patients. These included 72 cases of NHL, 58 (80%) of which were diagnosed by FNA and FC without the need for histologic sampling (69% of the primary lymphomas and 88% of the recurrent lymphomas). There were 22 aspirates suspicious for lymphoma, 12 equivocal results, and 7 benign diagnoses. Eighty-six percent of malignant FNAs (50 of 58) had flow cytometry (FC) as compared with only 15% (5 of 34) of the suspicious or equivocal FNAs. CONCLUSIONS. FNA is a valuable method for diagnosing and subclassifying NHL, although immunophenotyping by FC is often an essential ancillary test. In our experience, correlating the FNA results with the FC results can eliminate the need for a more invasive surgical biopsy in many cases.

Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma

BACKGROUND: Diabetes mellitus is a group of heterogeneous disorders of multiple etiologies characterized by chronic hyperglycemia resulting from defects in insulin secretion and/or insulin action. Diabetes mellitus has been reported to disturb normal hemostasis by various mechanisms. However, data on hemostasis of diabetic patients in the study area are lacking. This study was aimed at determining hemostatic profile and associated factors of hemostatic abnormality in diabetic patients.METHODS: A comparative cross-sectional study was conducted involving a total of 238 (119 diabetic and 119 apparently healthy) individuals who came to the chronic care clinic, Jimma University Specialized Hospital. Socio-demographic and clinical data were collected through a structured questionnaire. A blood sample of 10ml was collected in EDTA (4ml), citrate (3ml) and chemistry (3ml) tubes to do platelet count, coagulation tests, and glucose and lipid profile analysis, respectively. Descriptive statistics as well as the median (25 th , 75 th ) percentile and Mann Whitney U test were used during data analysis.RESULTS: The overall hemostatic abnormality in diabetes individuals was 58.8%. The median (25th, 75th percentile) prothrombin time for diabetic and non-diabetic subjects was (12.8, 15.6) vs. (12.8, 14.2), respectively, and the difference was not statistically significant (p>0.05). The median (25 th , 75th percentile) activated partial thromboplastin time was significantly different between the two groups (p<0.0001); (24, 36.8) vs. (36, 39.6). The median (25 th , 75th percentile) fibrinogen level was significantly different between the two groups (p<0.0001); (277, 462) vs. (243, 328). The median (25 th , 75th percentile) platelet count was also significantly different between the two groups (p<0.0001); (146,248) vs. (190,319). All variables were not significantly associated with hemostatic abnormality in multivariate regression analysis.CONCLUSION: An overall hemostatic abnormality in diabetic patients was found to be high. The APTT and platelet count were lower in diabetic patients whilst the fibrinogen level was higher. Routine coagulation tests should be part of tests among diabetic patients. Advanced coagulation tests should also be considered to identify specific markers so as to pinpoint the particular problem.

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Hemostatic Abnormality and Associated Factors in Diabetic Patients at Jimma University Specialized Hospital, Jimma, Southwest Ethiopia: A Comparative Cross-sectional Study.

Background: The new guidelines issued by the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-8) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Patient non-adherence is a serious obstacle to the effective treatment of many acute and chronic disorders. Successful treatment and outcome of a chronic disease such as hypertension depend on many factors, including resources (e.g., funds, space, and people), avoidance of serious adverse events, patient adherence with treatment plans, and the availability of effective therapies. The aim of this study is to assess the antihypertensive drug prescription patterns and adherence to joint national committee (JNC-8) hypertension (HT) treatment recommendations among hypertensive patients attending a tertiary care teaching hospital. Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year in ambulatory patients attending medicine OPD. A total of 500 prescriptions prescribed to diagnose HT were analyzed. Drug prescription patterns, and their adherence to JNC-8 report was assessed. Results: Out of 500 patients, 299 (59.8%) were male and 201 (40.2%) were female. Mean age of male and female patients were found to be 57.68±15.32 and 61.29±12.65 years respectively. As per present study, most of the physicians prescribed single drug (monotherapy, 34.6%) to control BP followed by two-drug combination (18.4%), three-drug combination (11.8%) and four-drug combination (3%). Two drugs regimen was prescribed in 18.4% of the hypertensive patients. Angiotensin receptor blocker + diuretic combination (4.4%) was mostly used in two drug combination therapy followed by Angiotensin receptor blockers + Diuretics (3.6%) and Calcium channel blocker + ACEIs combination (2.6%). No combination of ACEIs + ARBs was prescribed in any prescription. The overall rate of adherence was 16.5 % (Pre-hypertension); 87.90% (Stage 1 hypertension); and 68.20% (Stage 2 hypertension). Conclusions: In conclusion, present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with comorbid conditions.

An assessment of antihypertensive drug prescription patterns and adherence to joint national committee-8 hypertension treatment guidelines among hypertensive patients attending a tertiary care teaching hospital -

Introduction: The lymphadenopathy consist wide range of etiology from inflammatory process to a malignant condition and it is most common clinical presentation in outpatient department Fine needle aspiration cytology is a simple, safe, reliable, rapid and inexpensive method of diagnosis in lymph nodes Aims and objectives: To find out diagnostic accuracy of FNAC in lymphadenopathy and common pattern of lymphadenopathy in our institute Methods: This prospective study was carried out in the department of Pathology of Index Medical College Hospital and research Centre, Indore, India from June 2011 to May 2013 The patients with palpable lymph nodes were included in this study The slides were stained with Papanicolaou and May Grunewald Geimsa stainSpecial stain like Ziel Neelson, Alcian blue was done whenever is required A detailed analytic study was performed for correlation of Cyto-histopathological diagnosis Results: The result shows male to female ratio of 10:08 The age of the patients ranges from 2 to 79 year with mean age of 32 years The study shows reactive hyperplasia 149 (3338%), tubercular lymphadenitis 177 (3977%), granulomatous lymphadenitis 32(71%), lymphoma 25 (55%), metastatic carcinoma 40 (89%) and others 22 (49%) We found cyto-histpathological concordant in 161 (958%) cases and discordant in 7 (42%) cases Conclusion: The sensitivity of FNAC in lymphoma and metastatic tumors is 8148% and 975% with test accuracy of 965% and 994% respectively Hence FNAC should be used as preliminary screening investigation in all forms of lymphadenopathy and interpretation should be done in conjunction with clinical picture of the patients

Diagnostic accuracy of FNAC in diagnosis for causes of lymphadenopathy: a hospital based analysis -

Background: Diabetes mellitus comprises a group of common metabolic disorders where increased fibrinogen levels can act as a thrombogenic factor. Diabetic patients have higher cardiovascular morbidity than non-diabetic subjects. Several studies have shown that haemostatic factor especially hyperfibrinogenemia is implicated as a source of atherosclerosis and its complications. Methods: A comparative observational study was conducted to compare fibrinogen levels between type 2 diabetes patients and healthy controls. Their fibrinogen levels were compared and co-related with glycemic status and other risk factors and parameters like glycosylated haemoglobin, age, sex, smoking, body mass index (kg/m 2 ), hypertension and ischemic heart disease. Results: It was seen that in the diabetic subset, the plasma fibrinogen levels are significantly higher than the non-diabetic subset (386.04±132.87 vs. 314.38±97.42; p<0.001). Our study re-established correlation between HbA1c and fibrinogen levels of the diabetic patient is positive i.e., poorer the glycemic status, higher the fibrinogen levels (r=0.24). Conclusions: It can be concluded from the study that fibrinogen levels are in­creased in type 2 diabetic subjects with and without CHD. Plasma fibrinogen levels usually increased in type 2 diabetes, thus suggesting that hyperfibrinogenemia could contribute to the excess cardiovascular morbidity and mortality in this disease.

Study of plasma fibrinogen level and its relation to glycemic control in type-2 diabetes mellitus patients attending diabetes clinic at a tertiary care teaching hospital in Madhya Pradesh, India

Background: Regional anesthesia increasingly used for gynecological surgeries, has advantage of decreased stress response to surgery, decreased cardiorespiratory depression, with improved postoperative analgesia. Methods: This randomized, prospective, double blind study was conducted at Amaltas Institute of Medical Sciences, Banger Dewas in Department of Anesthesia between June 2016-December 2016. Sixty patients who were posted for gynecological surgeries were enrolled and randomly divided into two groups: Group R received 3.5 ml (17.5 mg) 0.5% ropivacaine plain and Group L received 3.5 ml (17.5 mg) 0.5% levobupivacaine plain. The onset and duration of sensory and motor block and any undesirable side effects were noted. Results: Demographic parameters were comparable between the two groups (P >0.05). Onset of sensory and motor block was significantly faster in Group L, duration of motor and sensory block was significantly less in Group R. Patients in group R were hemodynamically stable (P = 0.032) compared to group L. Conclusions: Both ropivacaine and levobupivacaine have the desirable blocking property and can be used in gynecological surgeries. Ropivacaine showed shorter duration of sensory and motor block allowed early mobilization and early recovery of patients.

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Comparative study of ropivacaine (0.5%) plain versus levobupivacaine (0.5%) plain in gynecological surgeries

Rhabdomyosarcomas (RMS) are aggressive malignant neoplasm of mesenchymal origin, related to skeletal muscle lineage. These are the most common soft tissue tumors in children. The diagnosis is made by microscopic analysis and ancillary techniques like immunohistochemistry, electron microscopy, cytogenetics and molecular biology. We encountered a case of a 03 years old child who presented with a tender, reddish, soft swelling over cheek for three weeks. The FNAC was reported as a small round cell tumor, Probably Primitive Neuroectodermal Tumor (PNET). The biopsy of tumor revealed a small round cell tumor with an alveolar pattern. Tumor giant cells were absent and mitotic figures were infrequent. Hence, differentials of alveolar rhabdomyosarcoma and PNET were rendered. Immunohistochemistry (IHC) demonstrated desmin positivity. Thus, a final diagnosis of alveolar rhabdomyosarcoma was offered.

Pawan Bhambani

Papers

An assessment of antihypertensive drug prescription patterns and adherence to joint national committee-8 hypertension treatment guidelines among hypertensive patients attending a tertiary care teaching hospital -

Diagnostic accuracy of FNAC in diagnosis for causes of lymphadenopathy: a hospital based analysis -

Study of plasma fibrinogen level and its relation to glycemic control in type-2 diabetes mellitus patients attending diabetes clinic at a tertiary care teaching hospital in Madhya Pradesh, India

Comparative study of ropivacaine (0.5%) plain versus levobupivacaine (0.5%) plain in gynecological surgeries

Case Report Alveolar rhabdomyosarcoma in children with histomorphological review