Annals of Pathology and Laboratory Medicine 2019-11-19T13:38:06+00:00 Dr. Prashant Goyal Open Journal Systems <p><strong>Annals of Pathology and Laboratory Medicine (APALM)</strong> is an international, Double-blind peer-reviewed, indexed, open access, online and print journal&nbsp;for pathologists, microbiologist, biochemist and clinical laboratory scientists, and is published by <strong><a href="" target="_blank" rel="noopener"><strong>Pacific group of e-Journals</strong>' (<strong>PaGe</strong>)</a>, </strong>an&nbsp;<em>ISO 9001:2008</em> Certified&nbsp;academic publishing house.</p> <p>Set up in 2014, APALM is a specialized journal, which publishes original, peer-reviewed articles&nbsp;in the field of Pathology and Laboratory Medicine which, <em>inter alia</em>, includes Histopathology, Cytopathology, Hematology, Clinical Pathology, Forensic Pathology, Blood Banking, Clinical Bio-Chemistry, Medical Microbiology (Bacteriology, Virology, Mycology, Parasitology), etc.</p> <p><strong>DOI: 10.21276/APALM (<a title="Verify APALM DOI " href="" target="_blank" rel="noopener"></a>)<br></strong></p> <p>Index Copernicus (IC) Value (ICV 2016): 74.20</p> Prognostic Significance of Ki-67 and p53 Immunoexpression in Breast Carcinoma Patients with Positive Axillary Lymph Nodes 2019-10-25T11:57:03+00:00 Lalit Sharma Kafil Akhtar Syed Shamshad Ahmad Atia Zakaur Rab <p><strong>Introduction:</strong> Breast carcinoma is a heterogenous disorder in which the treatment modality should be based on a risk assessment approach and only patients with higher relative risk of recurrence and distant metastasis should be the appropriate candidates for adjuvant therapy. This is where role of prognostic variables like Ki-67 and p53 immunoexpression as biomarkers of proliferative activity of tumor cells becomes important.</p> <p><strong>Aims and Objectives</strong>: The aim of this study was to evaluate the significance of Ki-67 and p53 immunoexpression as prognostic biomarkers in breast carcinoma patients with positive axillary lymph nodes.</p> <p><strong>Material and Methods:</strong> A total of 182 breast cancer patients were included in the study, assessed for various clinicopathological characteristics and after receiving the mastectomy/lobectomy specimen, tissue sections about 1cm thick were taken from representative areas, processed in an automated tissue processor (Histokinette) and simultaneously stained for routine hematoxylin and eosin stain along with Ki-67 and p53 immunostains and patients followed up.</p> <p><strong>Results:</strong> High Ki-67 and p53 immunoexpression was significantly associated with larger tumor size, higher tumor grade, axillary lymph node metastasis, higher disease stage at presentation, lymphovascular invasion, early recurrence, shortened disease free survival and worse overall survival.</p> <p><strong>Conclusions:</strong> Ki-67 and p53 immunoexpression can be used as a surrogate biomarker along with other clinicopathological characteristics in resource constrained facilities for better prediction of prognosis of breast cancer patients with positive axillary lymph nodes.</p> 2019-10-25T11:57:03+00:00 ##submission.copyrightStatement## Tumor Desmoplastic Stroma - Its Utility as A Prognostic Marker for Breast Carcinoma 2019-10-25T12:05:55+00:00 Vaddatti Tejeswini B Chaitra P Premalatha I V Renuka R Vaishnavi B Manasa <p><strong>Background </strong></p> <p>Breast cancer is the second most common malignancy in women, affecting more than 1 million worldwide annually and is the most frequent cause of cancer related deaths in women. Dynamic interactions between neoplastic epithelial cells and the surrounding stroma can select stromal cells that modulate tumor behavior. &nbsp;The interplay between a tumor and its environment is exemplified by the morphological changes observed in the stroma of human breast cancer. Hence in this study we tried to evaluate a grading system for tumor desmoplasia and its role as a prognostic marker for breast cancer.</p> <p><strong>Methods </strong></p> <p>This is a retrospective study including 102 primary invasive breast malignancy diagnosed at a tertiary care hospital between January 2015 to September 2017. The cases with prior chemotherapy and radiotherapy were excluded. In all the cases hematoxylin &amp; eosin stained slides were retrieved and assessed for desmoplastic stromal categorization, tumor grade and axillary lymph nodal involvement. The status of immunohistochemistry for ER, PR &amp;, Her2 neu were tabulated. The association of desmoplastic stroma was evaluated with other known prognostic factors. p value calculated, p &lt; 0.05 considered significant.</p> <p><strong>Results:</strong> There was statistically significant association of the type of desmoplastic stroma with the tumor grade, tumor size and metastatic axillary lymphnode.</p> <p><strong>Conclusion:</strong> This emphasizes the role of stromal desmoplasia in tumor progression and prognosis. Hence we conclude that a special mention to be made on the type of desmoplasia in the histopathology report of all breast cancer.</p> 2019-10-25T12:05:54+00:00 ##submission.copyrightStatement## Hematological Patterns of Anemia in Geriatric Patients 2019-10-25T12:12:54+00:00 Choukimath S M Adithyan P Sujata S Giriyan <p><strong>Background:</strong> Anemia in the elderly is a significant health problem in India and many parts of the World, since it signifies an underlying disease and is associated with poor clinical outcomes. In elderly patients, in whom anemia has a higher prevalence; neither the hemoglobin threshold for concern nor the identity of the anemia causing disease is easily established. Hematological patterns of anemia in elderly are manifold, hence, this study was undertaken to determine them</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>Methods:</strong> The present study was conducted on a sample size of 350 patients who were 60 years and above and clinically diagnosed as anaemic. Routine haematological investigations including Peripheral blood smear examination and complete haemogram were done. Special investigations like Bone-marrow examination, Iron studies, Stool and Urine examination were done wherever possible.</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>Result:</strong> In the present study Males were more affected than females and patients in the age group of 60-69 years were affected the most. Normocytic normochromic anemia was the most common morphological type of anemia and chronic diseases were the commonest etiological factors.</p> <p><strong>&nbsp;</strong></p> <p><strong>Conclusion: </strong>Despite modern diagnostic advances, geriatric anemias still remain under-reported and inadequately investigated; necessitating evaluation of even mild anemias. Prompt diagnosis and definite categorization helps in appropriate management of anemias.</p> 2019-10-25T12:12:54+00:00 ##submission.copyrightStatement## Study of Serum PSA, AMACR, P63 And PTEN in Prostatic Adenocarcinoma 2019-11-19T13:38:06+00:00 Prashant Sengupta Nishant Taur Richa Ranjan Rig Vardhan <p><strong>Background:</strong> Prostatic adenocarcinoma is the most common malignancy in older males. The present study was planned with an aim to evaluate serum PSA, expression of P63, AMACR and PTEN in prostatic carcinoma and to correlate them clinico-pathologically. It is a descriptive analytical study which includes patients of prostatic adenocarcinoma reporting to a large tertiary care hospital in Lucknow during the period of 2015-to 2017.</p> <p><strong>&nbsp;</strong></p> <p><strong>Methods: </strong>Clinical details and complete hematological workup was done in 50 cases of prostatic adenocarcinoma during our study period of two years. &nbsp;Routine histopathology with hematoxylin and eosin (H &amp; E) staining was done. Gleason grading was performed. Relevant sections were taken for Immunohistochemistry (IHC) to study PTEN, AMACR and P63.</p> <p><strong>Result:</strong> Serum PSA levels ranged from 7.5 to 60 ng/ml. Half the patients had S. PSA in range 10-20 ng/ml (50%) followed by &lt;10 ng/ml (32%) and &gt;20 ng/ml (18%) respectively. Mean S. PSA levels were 17.25<u>+</u>14.01 ng/ml.</p> <p>p63 assessment was conclusive in 48 cases. Expression of p63 was seen in 20 (41.7%) cases only (Score 1 or above). Maximum number of cases showing p63 expression had score 1 (35.4%) followed by score 2 (n=2; 4.2%) and score 3 (2.1%) respectively.</p> <p>AMACR assessment was conclusive in 48 cases. Expression of AMACR was seen in 47/48 (97.9%) cases. Maximum had score 2+ (n=22; 45.8%) followed by Score 3+ (n=18; 37.5%), score 1+ (n=7; 14.6%) and score 0 (n=1; 2.1%) respectively.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; PTEN assessment was conclusive in 46 cases. There were 21 (45.7%) cases with score 0, 16 (34.8%) with score 1 and 9 (19.6%) with score 2.</p> <p><strong>Conclusion:</strong> In present study, serum PSA levels of patients ranged from 7.5 to 60 ng/ml&nbsp;&nbsp; with half having S. PSA in 10-20 ng/ml range (50%). According to AJCC criteria, S. PSA levels &lt;10 ng/ml are in general indicators of lower severity of prostate cancer while those in 10-20 ng/ml range indicate an intermediate severity of prostate cancer.</p> 2019-11-19T13:38:06+00:00 ##submission.copyrightStatement## The Haematological Profile of Patients of Pulmonary 2019-11-01T10:30:57+00:00 Jitendra Dhanjibhai Padhariya Shaila N Shah <p><strong>Background:</strong> Tuberculosis is a major public health problem in India having variety of hematological manifestations. Though tuberculosis is a common condition, there is a paucity of literature in the hematological changes associated with tuberculosis. Study done to evaluate the presence, extent and severity of haematological abnormalities in Pulmonary Tuberculosis.</p> <p><strong>Methods:</strong> One hundred patients of fresh pulmonary tuberculosis with sputum positive for acid fast bacilli (AFB) were included and AIDS patients, disseminated tuberculosis and patients receiving ATT drugs were excluded in this study. The various hematological parameters were studied by means of hemogram by automated cell counter and peripheral smear examination.</p> <p><strong>Result:</strong> Anemia was seen in 88% of patients. In spite of the infection, 51 patients had a normal leukocyte count. Leucocytosis as a response to infection was observed in 46 patients. Three patients had leucopenia. Thrombocytosis was observed in 17 patients while thrombocytopenia was observed in 4 patients. 99% patients had increased erythrocyte sedimentation rate (ESR).</p> <p><strong>Conclusion:</strong> Variety of hematological abnormalities has been demonstrated in patients with pulmonary tuberculosis in the present study. The degree of anemia is directly proportional to the severity of tuberculosis and severe anemia in turn increases the morbidity and the mortality in tuberculosis. Patients infected with TB should be monitored haematologically.</p> 2019-11-01T10:30:57+00:00 ##submission.copyrightStatement## Morphological spectrum of lesions in renal biopsies with diagnostic role of Immunofluorescence 2019-11-01T10:46:02+00:00 Veenaa Venkatesh Vinuta Malaichamy Vasanthan M K <p><em>Background:</em>&nbsp;&nbsp; Renal diseases are common causes of morbidity in clinical practice and their incidence is on rise. Glomerulonephritis constitutes nearly 60% of all non-surgical renal diseases and accounts for a substantial number of cases of end stage renal disease.</p> <p><em>Objectives:</em> This study was done to analyse the histomorphology of renal diseases. Specific immunofluorescence patterns were also studied as an aid to diagnose various lesions.</p> <p><em>Materials and methods:</em> This study was done for a period of six months between January 2017 and June 2017. A total of 30 renal biopsies were received in the Department of Pathology, Coimbatore Medical College, Coimbatore. The tissues were subjected to light microscopic examination and immunofluorescence studies.</p> <p><em>Results:</em> Among the total 30 renal biopsies, the most common age group affected was between 31 years and 40 years. The most common age group affected was between 31 years to 40 years.&nbsp; Females (51.72%) were slightly more affected than males (48.27%). Out of 30 cases, 23 (79.31%) showed primary glomerular lesions, 5 (17.24%) showed secondary glomerular lesion and 2 (3.45%) showed tubulointerstitial nephritis. Diffuse proliferative glomerulonephritis was the most common primary glomerular lesion with a total of 6 out of 30 cases (22.41%). Lupus nephritis was the most common secondary glomerular lesion with a total of 4 out of 30 cases (12.07%). Immunofluorescence studies showed positivity in 21 patients accounting for 72.41%. The predominant pattern was granular glomerular basement membrane which was noted in 9 patients (31.03%). The diagnostic utility of IF was noted in 2 cases (6.90%) whose diagnoses included IgA nephropathy and C1q nephropathy. The IF studies helped in modification of the final diagnosis in 1 case (1.72%) whose final diagnosis was lupus nephritis class I.</p> <p><em>Conclusion:</em> Immunofluorescence studies have complemented the clinical, histomorphological findings in patients both in primary and secondary glomerular diseases. However, it was even more of diagnostic importance in 5 patients including IgA nephropathy, C1q nephropathy and Lupus nephritis class I where a confident diagnosis could be rendered only because of availability of immunofluorescence studies. Hence, immunofluorescence studies when combined with histomorphologic findings by light microscopy, clinical, biochemical and serological markers can yield a better and precise diagnosis.</p> 2019-11-01T10:46:02+00:00 ##submission.copyrightStatement## Clinicopathological Profile of Chronic Myelomonocytic Leukemia Cases 2019-11-01T10:48:57+00:00 Nabeel Azeez Venkatesan Somasundaram Isha Sharma Sanjeevan Sharma Ajay Malik <p><strong>Background: </strong>Chronic myelomonocytic leukemia (CMML) is a clonal hematological neoplasm with features of both myeloproliferation and myelodysplasia with an incidence 0.4 per lakh population. A number of prognostic risks scoring systems have attempted to predict survival and risk of CMML patients, like International Prognostic Scoring System (IPSS), the Spanish Score, the modified Bournemouth Score, the Dusseldorf Score and the MDAP Score. But no prognostic system has been widely accepted. More data from different regions are required to create a widely accepted working prognostic system for CMML. No case series on CMML has been published in literature from India in our knowledge. This article attempts to put to light the various clinicopathological parameters of CMML cases from India and the impact of these parameters on final outcome.</p> <p><strong>Methods: </strong>All admitted patients in a tertiary center in western India, with a diagnosis of either a chronic myeloproliferative disease or a myelodysplastic disease over a period of 3 years (2015-2018) were evaluated, out of which nine(n=9) cases fulfilled the diagnostic criteria of CMML. All patients underwent peripheral blood examination, bone marrow aspirate, bone marrow biopsy and cytogenetic studies.</p> <p><strong>Result: </strong>All patients (n=9) were between 50 and 80 years and most were males (n=8). Five patients presented with hepatosplenomegaly. Renal and liver function of one patient was deranged who had pleural effusion, ascites. Most patients (n=8) had total leukocyte count above 13000/cumm, while three had low platelet counts. Two out of three patients classified as CMML-II with increased blasts in peripheral blood and bone marrow had fatal outcomes. Patients whose karyotypes were available had normal karyotypes without any additional cytogenetic abnormalities. All were negative for JAK2 and BCR-ABL1.</p> <p><strong>Conclusion: </strong>The study concluded that altered biochemical tests (LDH, LFT), blast percentage, CMML II, relative lymphocytosis and transformation to AML were associated with poor outcome.</p> 2019-11-01T10:48:57+00:00 ##submission.copyrightStatement## A Descriptive Study of Hematologic Characteristics of Malaria Patients Attending A Tertiary Care Hospital in The Region of Kutch 2019-11-01T10:55:10+00:00 Nidhi N Shah Riti T. K Sinha <p><strong>Background: </strong></p> <p>In India, the epidemiology of malaria is complex because of geo-ecological diversity, multi-ethnicity, and wide distribution of nine anopheline vectors transmitting two commonest plasmodia species. Considering the fact, it is vital that every centre has its own demographic and pathological data about the profile of malaria patients in its catchment area<strong>.</strong></p> <p><strong>Methods:</strong></p> <p>The present retrospective study was carried in the Department of Pathology, Gujarat Adani Institute of Medical Sciences (GAIMS), Bhuj for a period of one year. A total of 102 cases were included in the study. The blood samples were collected in Ethylenediamine tetra-acetic acid (EDTA) vacutainers and smears were prepared. Leishman staining and field staining on thick smears was done according to the published protocols. The diagnosis of malaria parasite was confirmed by a positive peripheral smear examination. Rings, schizonts and gametocytes of the malaria parasites (plasmodium vivax and plasmodium falciparum) were viewed for diagnosis. Thrombocytopenia was considered when the platelet count was less than 150 x 10<sup>9</sup>/<sup>L</sup> and leucopenia when the total leucocyte count was less than 4,000 cells /cu mm.</p> <p><strong>&nbsp;</strong></p> <p><strong>Result:</strong></p> <p>In our study, 102 malaria positive cases were investigated for platelet count and total leucocyte count. Out of the 102 cases, male population was affected more than female. Out of the various malaria species, plasmodium vivax was the most prevalent (82.35%). The most common age group affected by various species varied, with age group of 1-10 years being most common for plasmodium falciparum cases, 21 to 30 years being most common for plasmodium vivax and 11 to 20 years being most common for mixed infection. All the cases of plasmodium falciparum were found to be with normal leucocyte count whereas in plasmodium vivax 82.14% cases were with normal leucocyte count and only 17.85% cases with leucopenia. Mixed infection had almost similar scenario with 71.42% cases with normal leucocyte count and 28.57% with leucopenia. In our study more number of cases of plasmodium falciparum was associated with thrombocytopenia (25%) as compared to plasmodium vivax (11.9%) and none in mixed infection.</p> <p><strong>Conclusion: </strong></p> <p>The high prevalence of malaria suggests the importance of timely diagnosis . The early identification of thrombocytopenia and leucopenia aids in timely management. This helps to decrease complicated malaria cases and its related mortality.</p> 2019-11-01T10:55:10+00:00 ##submission.copyrightStatement## Distribution of TNF-α Among Antenatal Women with Varying Levels of Vitamin D 2019-11-08T10:54:11+00:00 Bineeta Kashyap Nisha Goyal Neha Gupta Sapna Jhanjhria Mohd Tajuddin NP Singh <p><strong>Background and objective: </strong>Vitamin D deficiency in antenatal mothers adversely affects not only the health of pregnant mother but also her child. Vitamin D is crucial for proper immune system functioning and management of cytokine environment. Relationship between vitamin D deficiency and TNF-α may prove useful in early detection of inflammatory conditions in pregnant mothers. Therefore, this study assessed serum vitamin D and TNF-α levels in antenatal mothers.</p> <p><strong>Materials &amp; Methods:</strong> 78 serum samples of healthy pregnant mothers were included. Serum 25-OH Vitamin D and TNF-α levels were estimated using commercially available ELISA kits.</p> <p><strong>Results:</strong>25-OH Vitamin D levels were inadequate (&lt;32ng/ml) in 94.9% of antenatal cases. Majority (74.4%)had an insufficient (11-32 ng/ml)25-OH Vitamin D level. Mean and median vitamin D levels were 16 ± 7.5 SD and 14.5 ng/ml (3.5-39.5) respectively in antenatal mothers. None or a very weak positive linear relationship was observed between serum 25-OH Vitamin D and TNF-α levels (r: 0.13). No correlation was seen between 25-OH Vitamin D &amp; age and TNF-α &amp; age (r: 0.04; r: 0.06 respectively).</p> <p><strong>Conclusions: </strong>In settings where subnormal vitamin D levels are prevalent in antenatal mothers, screening for vitamin D deficiency in early pregnancy with subsequent supplementation if needed is recommended. No correlation was observed between serum vitamin D and pro-inflammatory marker TNF-α levels. Further elaborate studies are required to investigate the effects of vitamin D on cytokine environment especially in pregnant mothers.</p> 2019-11-08T10:54:11+00:00 ##submission.copyrightStatement## The Utility and Validation of Intraepithelial Lymphocyte Count in Duodenal Biopsies in A Tertiary Care Centre in South India 2019-11-08T11:25:15+00:00 Priyavadhana Balasubramanian Bhawana Ashok Badhe Rajesh Nachiappa Ganesh Lakshmi C Panicker Pazhanivel Mohan <p><strong>Background: Intraepithelial lymphocytes (IELs) are seen in between the epithelial cells in small and large intestine with the functions of </strong>immune surveillance and activation. Increased IELs can be the sole histological finding in latent celiac disease (CD).</p> <p><strong>Aims:</strong> To study the utility and clinical relevance of IELs in diagnosing non-neoplastic lesions of duodenum and to determine a cut off for IEL to differentiate CD from other conditions.</p> <p><strong>Materials &amp; methods</strong>: This was a prospective descriptive study. Duodenal biopsies from 106 patients with symptoms of malabsorption were studied. Informed written consent was taken. Clinical details were collected. Histomorphological parameters were studied on hematoxylin and eosin stained sections. Intraepithelial lymphocyte counts were done on CD3, CD4 and CD8 IHC stained sections. Statistical analysis was done using IBM- SPSS software version 21. P value &lt;0.05 was considered statistically significant. The threshold score of IELs with maximum sensitivity and specificity was validated using the Receiver operator characteristic curve to distinguish CD from non-celiac disease conditions.</p> <p><strong>Results</strong>: We studied 101 duodenal biopsies. Our spectrum included 16 patients of CD (15.8%), 15 of autoimmune duodenitis (14%), 13 of nutritional deficiency associated duodenitis (12.8%), 5 of infectious duodenitis (5%) and 41 patients of non-specific duodenitis (40.6%). The threshold levels were 5/20 villous tip IELs, 24 IELs/100 enterocytes on H&amp; E and &gt;31 IELs by CD3 IHC staining.</p> <p><strong>Conclusion</strong>: Our study proposes IEL counts of &gt;31/100 enterocytes in CD3 IHC staining to be significant in South Indian population to differentiate CD from other conditions.</p> 2019-11-08T11:25:15+00:00 ##submission.copyrightStatement## Cystoscopic Biopsies of Bladder Neoplasms 2019-11-08T11:50:57+00:00 Rajeshwari K Karibasappa G N N V Dravid Ashish Patil <p><strong><em>Introduction:</em></strong> Urinary bladder neoplasms constitute an important source of clinical signs and symptoms which are more disabling than lethal. The present study aimed to study the prevalence of bladder neoplasms and to study the clinico-histomorphological features of various bladder neoplasms along with special emphasis on grading and staging of the bladder tumours.</p> <p><strong><em>Materials and methods:</em></strong> The present study is a five years retrospective study. All patients who visited to urology outpatient department with lower urinary tract symptoms and obstructive bladder symptoms were subjected to cystoscopy. The detailed clinico-histomorphological features of cystoscopic biopsies are studied using WHO/ISUP 2004 histological grading and TNM staging were used in classifying the bladder tumours.</p> <p><strong><em>Results:</em></strong> Out of 239 cystoscopic biopsies, the neoplastic lesions constituted 76.6%&nbsp;&nbsp; of the cases Among the neoplastic, benign lesions accounted for 12.9% of the cases and malignant lesions accounted for&nbsp; 83 % of the cases. Among the malignant lesions, urothelial carcinoma was the commonest accounting for 75.9% of the cases with increased prevalence of high grade papillary urothelial carcinoma (74.1%) and invasive papillary urothelial carcinoma accounting for 73.75% of the cases.</p> <p><strong><em>Conclusions:</em></strong> The present study has stressed the importance of histopathological examination with special emphasis on the study of serial sections and the importance of inclusion of detrusor muscle in the biopsy for accurate grading and staging so as to decrease the morbidity and &nbsp;mortality and initiate the early management of bladder tumours.</p> 2019-11-08T11:50:57+00:00 ##submission.copyrightStatement## Yearly Trend of Syphilis Seroprevalence Among STD, ART and ANC Attendees 2019-11-08T11:57:28+00:00 Bineeta Kashyap Nisha Goyal Krishna Singha Mohd Tajuddin N P Singh <p><strong>Background &amp; Objective:</strong>&nbsp;Despite the several ongoing campaigns highlighting the importance of safe sexual practices and public awareness activities about sexually transmitted diseases (STDs), syphilis still constitutes a significant public health problem in the developing countries. The present study was initiated to understand the current trend of syphilis among the (STD) clinic patients, patients receiving anti-retroviral treatment (ART) and antenatal mothers.</p> <p><strong>Methods</strong>:This study extended over a period of six years from 2013-2018.All the samples that were sent for routine VDRL testing were included in the present study.Samples were screened by qualitative and quantitative VDRL test.</p> <p><strong>Results:</strong>&nbsp;A total of 77,634 serum samples were screened for syphilis by VDRL testing over a period of six years. Out of these, 762 samples were reactive. Syphilisseroprevalence ranged from 0.33% to 2.19% with the highest seroprevalence in the year 2018. 75.6% of the cases belonged to 18-35 years age group. An overall upward trend of the VDRL reactive cases was recorded among all the three groups of STD, ART and antenatal clinic cases.</p> <p><strong>Conclusions:</strong>&nbsp;It is crucial to understand the current trend and epidemiology of syphilis among ART, STIs and ANC clinic attendees for the proper planning andimplementation of preventive and control strategies.</p> 2019-11-08T11:57:28+00:00 ##submission.copyrightStatement## Tranexemic acid induced bilateral acute renal cortical necrosis 2019-11-01T11:00:58+00:00 Mangesh Machindra Londhe Nitin M Gadgil Anitha Padmanabhan Leena Pravin Naik <p>Acute renal cortical necrosis (RCN) most commonly occurs from obstetric complications<strong>.</strong> However other rare cause includes medications like antifibrinolytics like tranexamic acid, which is used for acute bleeding. We report a case of 17 years female, operated for left cheek arteriovenous malformation and managed post-operatively by intravenous fluids, diuretics, antibiotics and antifibrinolytics (tranexemic acid). Postoperatively she started complaining of severe abdominal pain, breathlessness, weakness and loss of orientation with increasing levels of serum creatinine and blood urea nitrogen (BUN). Patient succumbed to death on day 6 post operative and complete autopsy was performed. All organs were unremarkable except bilateral lungs showed pulmonary edema and bilateral kidneys showed features of diffuse pattern of cortical necrosis both on gross and histopathological examination. As patient had no obstetric or other related history the cause of RCN was attributed to tranexemic acid. Thus patients on antifibrinolytics must be screened for RCN to avoid its fatal complication.</p> 2019-11-01T11:00:58+00:00 ##submission.copyrightStatement##