Tuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a major cause of death worldwide. Tuberculosis continues to be a huge peril disease against the human population and according to WHO, tuberculosis is a major killer of the human population after HIV/AIDS. Tuberculosis is highly prevalent among the low socioeconomic section of the population and marginalized sections of the community. In India, National strategic plan (2017-2025) has a national goal of elimination of tuberculosis by 2025. It requires increased awareness and understanding of Tuberculosis. In this review article history, taxonomy, epidemiology, histology, immunology, pathogenesis and clinical features of both pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) has been discussed. A great length of detailed information regarding diagnostic modalities has been explained along with diagnostic algorithm for PTB and EPTB. Treatment regimen for sensitive, drug resistant and extensive drug resistant tuberculosis has been summarized along with newer drugs recommended for multi drug resistant tuberculosis. This review article has been written after extensive literature study in view of better understanding and to increase awareness regarding tuberculosis, as a sincere effort that will help eliminate tuberculosis off the face of the earth in near future.

A systemic review on tuberculosis.

Childhood cancer: a handbook from St Jude Children's Research Hospital. Edited by G Steen and J Mirro. (Pp 606; hardback; £21.99). USA: Perseus Publishing, 2000. ISBN 0738202770.

This book is somewhat depressing from the point of view of a UK paediatric oncologist. Coming from such an outstanding hospital it is, as one would expect, an excellent text for all those who care for children with cancer whether they be family or professionals attempting to explain the complex, clearly and succinctly. However, it highlights the great divide between the …

https://adc.bmj.com/content/archdischild/72/2/192.2.full.pdf

The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence

Oral iron supplementation in iron-deficient women: How much and how often?

This is the protocol for a review and there is no abstract. The objectives are as follows:


To determine the diagnostic accuracy of ferritin concentrations (serum or plasma) for detecting iron deficiency


To determine the diagnostic accuracy of ferritin concentrations (serum or plasma) for detecting iron overload in primary and secondary iron loading syndromes




To determine the diagnostic accuracy of ferritin to determine iron deficiency at current WHO cut-off values (WHO 2011b): <12 ng/mL <15 ng/mL and <30 ng/mL; as well as other commonly utilised cut-offs


To assess the diagnostic accuracy of ferritin to determine iron overload at putative cut-off values such as 150ng/mL in females and 200 ng/mL in males (Bacon 2011; WHO 2001); 200 ng/mL and 300 ng/mL in males and females (Brissot 2009), and 500 ng/mL in mild iron overload (Brissot 2009)

Serum or plasma ferritin concentration as an index of iron deficiency and overload

Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%.

/pdf/diagnosis-of-abdominal-tuberculosis-lessons-learned-over-30-1tjnrasvfw.pdf

Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay

AIM To evaluate reticulocyte hemoglobin (RET-He) vis-a-vis serum ferritin as a marker of bone marrow iron store in iron deficiency anemia (IDA). MATERIAL AND METHODS A hospital based analytic study was conducted among patients (age group 15-65 years) with newly diagnosed and untreated IDA admitted in medicine ward and not suffering from any inflammatory disorders (excluded by C-reactive protein). Patient having other forms of anemia/ hemoglobinopathies/ malignancy, MCV > 80 fL and pregnant female were excluded. All patients were subjected to automated CBC, RET-He, iron studies and iron staining of bone marrow aspirates. RESULTS Total 142 patients were included. Of these, 42 patients were excluded due to aparticulate bone marrow aspirate. Remaining 102 patients were classified in to Group A (grade 0 and 1-depleted iron stores) and Group B (grade 2 and 3 - functional iron deficiency). There were significant difference in means of RET-He (Group A 17.84 ± 2.39 vs. Group B 25.08 ± 4.42; P< 0.0001) and serum ferritin (Group A 8.68 ± 2.80 vs. Group B 15.61 ± 4.68; P < 0.0001). We observed significant positive correlation of ferritin with RET-He in total patients (r = 0.7860, p 0.0000), Group A (r = 0.7089, p 0.00) and Group B (r = 0.4675, p < 0.05) patients. RET-He was the only significant predictor of bone marrow iron stores (at P < 0.05). On ROC curve analysis, the AUC for RET-He was found to be 0.894 (P value < 0.01) and best cut off value for predicting IDA was 22.4 pg (sensitivity 98.88%, specificity 84.21%). The AUC for serum ferritin was 0.891 (P value < 0.01) and best cut off value for predicting IDA was 11.6 ng/ml (sensitivity 86.75%, specificity 89.47 %). CONCLUSIONS RET-He correlated significantly with serum ferritin and is also a better predictor of bone marrow iron stores than the latter.

Reticulocyte Hemoglobin vis-a-vis Serum Ferritin as a Marker of Bone Marrow Iron Store in Iron Deficiency Anemia.

Background: Platelets and their activity have a crucial role in acute coronary events. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets.

Objectives: The aim of this study is to investigate whether there is an association between mean platelet volume (MPV) measurement and cardiac Troponin I( cTn I ) in patients admitted with a suspected diagnosis of ACS and to assess the potential diagnostic efficiency of MPV in the diagnostic workup for ACS.

Materials and Methods: After thorough evaluation of 215 eligible patients, 3 ml. Venous blood collected using Becton, Dickinson and company vacutainer and MPV measured within 1-2 hr of sample collection. Sample for cTn I collected at 6 hr and at 12 hrs, if required and level measured using Biosite analyzer.

Results: Mean platelet volume (MPV) was found to be higher among ACS patients as compared to non ACS, 11.44±1.23 vs 9.91±1.27 fl (p-value<0.001). The NPV of MPV in the diagnostic workup of chest pain suggestive of ACS within 6 hours of presentation were found to be 82.53% .

Conclusion: In this study the MPV is significantly higher in patients with ACS than in those with chest pain of non-cardiac origin and its negative predictive value of 82.53%, it might be useful as an assisting rule-out test in conjunction with other markers in the early prediction of the risk of ACS.

pdf/mean-platelet-volume-in-patients-with-acute-coronary-2ay4lc42pt.pdf

Mean platelet volume in patients with acute coronary syndromes: a supportive diagnostic predictor.

:Iron deficiency anemia (IDA) is one of the most common nutritional anemia worldwide. Anemia imposes a significant hypoxic environment in different organs and tissues including the testes. This study evaluated the effect of treatment of IDA on the pituitary gonadal axis (Serum FSH, LH, Testosterone) and sperm parameters in adult eugonadal males. Methodology A hospital based interventional, analytic study was conducted at a tertiary care center among 25 eugonadal males (fully sexually developed, fertile) with newly diagnosed and untreated IDA, admitted in medicine wards and not suffering from any inflammatory disorders (excluded by C-reactive protein) after exclusion of patients having other forms of anemia/ hemoglobinopathies/ any malignancy/having MCV >80 fL, aplastic anemia and primary hypogonadism. Sexual maturation was assessed according to maturity stages 5. Investigations were performed before and 6 weeks after treatment of IDA with intravenous iron sucrose included CBC, peripheral blood smear, serum ferritin, serum iron, TIBC, serum FSH, serum LH, serum Testosterone and semen analysis (Semen volume, Sperm count, Sperm motility and Sperm morphology). Results The change in mean Hb level before (5.66 ± 1.97gm/dl) and after treatment (11.96 ± 0.87 gm/dl) was statistically significant. (P<0.001) Patients who had subnormal and normal serum level of FSH, LH, Testosterone and sperm parameters before treatment were divided into group A and group B respectively. Serum levels of FSH, LH and testosterone along with sperm parameters significantly improved after correction of anemia (p<0.01). The mean change in these parameters was significantly higher in patients having subnormal value of these parameters before treatment (Group A) than in patients having normal pre-treatment level (Group B) (p<0.01). The level of anemia (hemoglobin) had significant positive correlation with serum FSH, serum LH, serum testosterone levels and sperm parameters (semen volume, sperm count, sperm morphology, RPM and sperm motility) (p<0.001). Conclusion IDA had significant negative association with the pituitary gonadal axis (Serum FSH, LH, Testosterone) and sperm parameters in adult eugonadal males. The serum levels of FSH, LH and testosterone along with sperm parameters significantly improved after correction of anemia, especially in patients having subnormal value of these parameters.

Assessment of Pituitary Gonadal Axis and Sperm Parameters in Anemic Eugonadal Males Before and After Correction of Iron Deficiency Anemia.

Aim: Bone marrow evaluationis an integral part of staging workup in patients with Non-Hodgkin’s lymphoma (NHL). Aim of this study is to analyze incidence and histological pattern of bone marrow involvement in diagnosed cases of NHL. Methodology: This is a retrospective study on 85 patients diagnosed with NHL. Bone marrow biopsy was performed under local anesthesia as a part of staging workup in cases of NHL. Complete blood counts (CBC) were also noted in each case. Results: In this study, NHL cases comprised of low grade NHL 68.2%, intermediate grade 28.2% and high grade 3.5%. The age ranged from 10 to 75 years and M: F ratio was 1.07:1. 38.8% (33/85) cases showed bone marrow involvement. Majority of bone marrow involvement was seen in indolent lymphomas (87.8%). Most common pattern of involvement was mixed (12/33) followed by diffuse (9/33), interstitial (8/33) and nodular (4/33). 87.9% cases showed increase in reticulin which included reticulin grade 1(9/33), grade 2(14/33) and grade 3(6/33). Only 48.5% cases of bone marrow involved cases had CBC abnormalities while 51.5% were completely normal. CBC abnormalities included anemia (5/16), leucopenia (3/16), leukocytosis (8/16) and thrombocytopenia (9/16). Discussion: In the present study, bone marrow involvement by non-Hodgkin lymphoma was seen in 38.8% cases. Other studies also described the incidence of bone marrow involvement from 27.6% to 53%. Predominant involvement was observed in indolent cases which were similarly noted in other studies. Conclusion: Bone marrow biopsy is an essential part of staging work up of NHL affecting the prognosis and treatment.

Hematological and Bone Marrow Biopsy Evaluation in Non Hodgkin Lymphoma

Hemophagocytic lymphohistiocytosis (HLH) is a rare but aggressive and potentially fatal condition characterized by excessive immune activation. It can occur as primary/ familial and secondary/sporadic/ acquired form. Infections can play a role as triggers in the secondary form of HLH. A case of Hemophagocytic lymphohistiocytosis (HLH) in a patient of Scrub typhus is being reported here. Such association of scrub typhus and HLH is rare.

Hemophagocytic Lymphohistiocytosis in a Patient of Scrub Typhus.

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