Diagnostic Evaluation of Doshaja Kasa w.s.r to Hematological Investigations

Kasa is one of the commonest complaints in day to day life and clinical manifestation affecting Pranavaha Srotas. Among the five major types of Kasa mentioned by Acharyas, Vata, Pitta & Kaphaja Kasa have distinct and significant clinical features and Samprapti. Early intervention is necessary in case of Kasa as it is a potential Nidanarthakara Vyadhi (disease having tendency to produce secondary diseases) to produce Kshaya. This observational study involving 150 subjects of age group 16 to 60 was carried out to assess the utility of hematological investigations (T.C, D.C, AEC, and ESR) to diagnose Vata, Pitta and Kaphaja Kasa respectively. Assessment of type of Kasa was done by scoring system of classical symptoms and changes in laboratory parameters were noted for each. Results are drawn based on Statistical evaluation of each type of Kasa with respect to each of the hematological investigation involved in the study. Investigations like neutrophil count, absolute eosinophil count and lymphocyte count have shown significant association with respect to Vataja, Pittaja and Kaphaja Kasa.

Monoclonal and polyclonal immunoglobulin G deposits on tubular basement membranes of native and pretransplant kidneys: A retrospective study

BackgroundMonoclonal tubular basement membrane immune deposits (TBMID) are identified by renal biopsy and are associated with progression of interstitial injury in renal allograft. However, the significance of TBMID in the native kidney remains unclear.MethodWe retrospectively analyzed 3,126 native kidney biopsies and 1,724 zero-hour biopsies performed between 2008 and 2018 in our institution.ResultsThe rate of immunoglobulin G (IgG) TBMID was found to be 5.2 % among native kidney biopsies and 0.4 % among zero-hour biopsies. The rate of IgG TBMID was relatively common in the case of diabetic nephropathy (31.3%) and lupus nephritis (25.5%), but rare in IgA nephropathy (IgAN) (1.1%). Monoclonal IgG TBMID was identified in seven cases, including three zero-hour biopsies. The pathological diagnosis from native kidney biopsy was IgAN in two cases, antineutrophil cytoplasmic antibody-related vasculitis in one, and Focal segmental glomerulosclerosis in one. Zero-hour biopsy revealed IgAN in one case and mild atherosclerosis in two. The combination of IgG1κ was observed in two cases, IgG1λ in three, and IgG2κ in two. Interstitial injury is not severe in all cases. Electron microscopy revealed powdery electron-dense deposits. Monoclonal gammopathy of undetermined significance was diagnosed in one case with IgA nephropathy. Although One patient developed renal failure, all others exhibited stable renal function.ConclusionMonoclonal IgG TBMID in the native kidney is not associated with renal prognosis or interstitial injury. However, this could be a useful immunopathological parameter for early identification of cases requiring hematological investigation and microscopic evaluation.

Clinical profile of malaria and HIV co-infection

Background: Malaria and human immunodeficiency virus (HIV) are two common disease in India. Therefore we undertaken this study and compare the incidence clinical feature and outcome of concurrent infection of malaria and HIV infection.Methods: All the patients of fever within 7days duration were investigated for malaria, HIV and other cause of fever. Patients of concurrent HIV and malaria (Group A) were compare with HIV mono-infection (Group-B) and malaria mono-infection (Group C). Biochemical and hematological investigation were done and compared.Results: During the study period 340 patients of malaria were admitted concurrent infection HIV and malaria was found in 52 (15.29%). There were 52 (15.29), 120 (21.7%) and 340 (72.5%) in Group A, B and C respectively. The clinical feature of concurrent infection were more like HIV than malaria. Unlike malaria the outcome of concurrent infection are not good.Conclusions: The study suggested that Malaria and HIV co-infection are uncommon disease. For the diagnosis investigations for both the infections should be carried out routinely.

Splenomegaly in children

Background: Splenomegaly occurs when the size of the spleen is increased by cells or tissue components or by vascular engorgement. In childhood, it is generally first suspected upon physical examination. The aim of the present study was to find out the prevalence and possible cause of splenomegaly in children admitted in pediatric ward and NICU at tertiary care center.Methods: In this study, total 124 children of age between 0-12 years with clinically palpable splenomegaly, admitted to the wards were studied during the period of 18 months. A detailed history, thorough clinical and all relevant investigation was done. The enlargement of the spleen was graded as per Hacketts and conventional classification. The prevalence, cause of splenomegaly and outcome of the study was noted.Results: The prevalence of splenomegaly was 1.46%. Most common grade of splenomegaly was grade III (33%) of Hackett’s classification. The most common presenting symptom was fever (75%) and sign was pallor (97%). Most common cause of splenomegaly was hemolytic anemia (80.64%) among which thalasemia was 50% followed by sickle cell anemia 30.64%. Out of 124 patients, 123 (99.1%) received medical treatment while only one patient (0.9%) underwent surgical treatment. Among medically treated patients 18 (14.5%) were recovered completely while 100 (80.6%) improved and 4 (3.2%) stable and two patients were (1.6%) died.Conclusions: In patient with grade III, IV, and V of splenomegaly is more likely to have hemolytic anemia as common etiology and hematological investigation should be given more emphasis in a case of splenomegaly.

Report of Beta Thalassemia in Newar Ethinicity

Beta thalassemia trait is a heterogeneous autosomal recessive form of beta thalassemia. Individual with beta thalassemia are clinically asymptomatic. Here we have described a case that has been incidentally diagnosed as beta thalassemia trait. A 31 year old male form Newar Community came to hospital for routine health checkup was send for hematological investigation. On examination, his red cell morphology was found to be microcytic hypochromic and his hemoglobin concentration was mildly decrease. His other parameters was evaluated and requested for analysis of iron profile and hemoglobin electrophoresis. Iron profile test was normal. Hemoglobin electrophoresis showed prominent band in HbA2 region. Presence of HbA2 band was confirmed by hemoglobin variant HPLC analysis. A diagnosis of heterozygous beta thalassemia trait was made. Prevalence of beta thalassemia gene in Tharu population was reported but its presence in other communities is still unknown so it is recommended to study the prevalence of beta thalassemia gene in Newar community as well.