Annals of Pathology and Laboratory Medicine

Bacteria Contamination and Distribution in Patient Care Environment at Mbagathi Hospital Surgical and New-born Units

Enock Ongeri Magori — 2021-03-31

Background: Hospital environment can serve as an important reservoir and thus a critical element in the transmission of bacterial infections especially in critical care settings such as Surgical and new-born units. Contact with contaminated surfaces may lead to Hospital Acquired Infections (HAIs) among healthcare workers, visitors and patients. Further, HAIs may contribute to the spread of drug-resistant bacterial infections. This study sought to determine bacteriological characteristics and distribution in patient care environmental surfaces (Surgical and new-born units) at Mbagathi hospital Nairobi Kenya.

Methods: A total of 700 samples were obtained from different surfaces: beds, bedside tables, sink taps handle, door handles, nursery incubators, paediatric weighing scale and new-born resuscitation machine by means of repeated screens over a period of three months. Microbiological isolation and identification were done by following standard laboratory methods established at Aga Khan University Hospital. Antibiotic susceptibility testing was carried out by using Vitek 2 system.

Result: Five bacterial genera were isolated, S. Aureus was 3% (19/700), E. coli 0.9% (6/700), Acinetobacter species was 1.4% (10/700), Pseudomonas species 0.1% (1/700) and coagulase negative staphylococcus (CoNS)13.0% (88/700). Trimethoprim/Sulfamethoxazole and Benzylpenicillin were the most resistant antimicrobial agents while Oxacillin, Cefoxitin, Levofloxacin, Linezolid was most sensitive.

Conclusion: All S. aureus were methicillin sensitive (MSSA). Patient beds surfaces were the most contaminated among the selected items while the nursery incubator was the least contaminated.

Factors Affecting Lymph Node Yield in Surgically Resected Colorectal Cancer Specimens

Deepa Nagarajan — 2021-03-31

Background: Currently, the CAP protocol mandates evaluation of ≥12 Lymph nodes as a quality indicator for the adequacy of pathologic examination of colorectal cancer resection specimens. Aim: To identify factors that may influence the lymph node yield in colorectal cancer specimens and to compare with the relevant publications.

Methods: The retrospective study of seventy patients with loco-regional colorectal adenocarcinomas treated by standard surgical resection from April 2015- April 2017 was included. All cases with inadequate lymph nodes had been re-grossed by another pathologist. Variables like age, gender, primary site, type of surgery, specimen length, tumour size, grade and stage, neoadjuvant therapy and tumour site perforation were evaluated for their impact on the average total number of nodes examined.

Results: Out of seventy, eleven [15.71%] patients had inadequate mean nodal yield [MNY]. Of these eleven patients, MNY was greater in males [6.6] than in females [6.4]. MNY was lesser in patients with age >50years [5.71] than patients ≤ 50 years [8]. The yield increased exponentially with increasing tumour stage and tumour size. Yield was higher in tumours with perforation. Specimens longer than 20cm had a higher yield [7.29] than in shorter specimens [5.25]. The yield was lesser when tumour is located more distally [APR:4.5 and AR &sigmoid colectomy:7.7]. Seven patients had taken neoadjuvant therapy [63.6%] of whom, six had moderately differentiated adenocarcinoma & one had no tumour.

Conclusion: Factors like neoadjuvant therapy, age & gender of the patient, type of surgery, length of the specimen, tumour size, grade, stage, site & perforation, affect the MNY in colorectal cancers.

Bacteriological Profile of Healthcare Workers and Patients’ Hands at Aga Khan University Hospital, Nairobi Outreach Centres

Martin Wanyama Wamalwa — 2021-03-31

Background: Hand hygiene is the precursor to improved health standards among healthcare workers and patients seeking outpatient services. Unhygienic hands may escalate the transmission of multi-drug resistance bacteria that poses serious pathological manifestation to the vulnerable and susceptible patients. The study aims at establishing the possible pathogen and susceptibility pattern of Staphylococcus aureus carried on hands of healthcare provider and their patients.

Methods: Cross sectional study design and random sampling of patients and convenient sampling of healthcare workers was carried out between May to August 2020 at Aga Khan University hospital Nairobi satellites. The participant’s hands palm and finger tips imprints were made on Blood agar during sample collection. The antimicrobial susceptibility pattern of Staphylococcus aureus was established using Vitek-2 automated system.

Result: The study had 374 participants out of which 14% were colonized by possible pathogens. The overall Staphylococcus aureus hand carriage prevalence 6.9% (26/374) isolated from healthcare provider and patient at outpatient facility. The methicillin resistant staphylococcal in this study was 0.56% (2/374) showing resistance to both Oxacillin and Cefoxitin. Healthcare workers are prone to colonization with possible pathogens as compared to patient P-value .049. Staphylococcus aureus isolates were all resistant to penicillin.

Conclusion: Hand hygiene mitigating measures in outpatient healthcare facilities should be sustained on the counts that 14% of possible pathogens in this study were isolated. Healthcare providers at the point of care in outpatient should strictly follow the hand hygiene protocols provided by WHO to curb the transmission of possible pathogenic bacteria.

Histopathological Study of Gastric Lesions and its Correlation with Mucin Histochemistry and Helicobacter Pylori Infection

Alankrita Deka — 2021-03-31

Background: Gastric disorders are responsible for a great deal of mortality and morbidity and are one of the most common encountered problems in clinical practice. H. Pylori infection is responsible for majority of acid peptic disease and is also a known carcinogen. Intestinal metaplasia is considered a precancerous lesion. We studied the incidence of H. pylori infection and mucin histochemistry of different gastric lesions.

Methods: This study was conducted for a period of 1 year, in 50 gastric specimens received for histopathological study in the Department of Pathology, AMCH. Slides were stained with routine H&E and Giemsa for H. pylori detection. PAS/AB stain (at pH 2.5 & pH 1.0) was done to study mucin histochemistry.

Results: Out of 50 cases, 58% cases were malignant and 42% cases were benign. H. Pylori was seen in 42% cases. IM was observed in 40% of gastric lesions. IM was more common in malignant lesions. On subclassification, Type 1 and 2 IM were seen almost equally in both benign and malignant gastric lesions, but Type 3 IM was more common in malignant lesion. Incidence of IM was higher in intestinal than diffuse adenocarcinoma. A statistically significant association was seen between H. Pylori infection and IM.

Conclusion: Routine detection of H. pylori by special stains and mucin study in all gastric biopsy specimens helps in early detection of precancerous gastric lesions.

Impact of Haemodialysis on Coagulation Profile in Chronic Kidney Disease

Veena Raja — 2021-03-31

Background

Chronic kidney disease (CKD) with its high prevalence, morbidity and mortality is an important public health problem. Considering the nature of the haemodialysis process, it has a considerable impact on the coagulation profile. To find out the variations in Platelet count, Prothrombin time (PT), International Normalised Ratio (INR) and Activated Partial Thromboplastin Time (aPTT) before and after haemodialysis patients.

Materials and Methods:

This prospective observational study of Coagulation profile and platelet count in pre and post hemodialysis patients with chronic renal failure was conducted on 150 CKD patients in the Department of Pathology, SRM Medical College Hospital & Research Centre. p value <0.05 was considered to be statistically significant.

Results

In this study, there was significant reduction in platelet count from mean 2.29 cells/cu.mm in pre dialysis to 2.03 cell/cu.mm in post dialysis. There was a significant prolongation in both PT and aPTT values in post dialysis

Conclusion

These findings expose CKD patients to higher risk of bleeding disorders, which may have a role in increasing the rate of patient mortality and morbidity. In the light of this study, there is a need for nephrologist to monitor the coagulation profile and platelet count of CKD patients on dialysis, and treat any derangements in the same, so as to improve outcome for these patients.

Pattern of Leprosy: A Histomorphological Study with Clinical Correlation in Ajmer District

Bhawika Menghani — 2021-03-31

Background:

Leprosy (Hansen’s disease) still continues to be an important public health problem. The present study was carried to correlate histological diagnosis of skin biopsies of untreated leprosy cases with clinical diagnosis using Ridley- Jopling classification.

Material and Methods:

124 skin biopsies of untreated leprosy cases over a period of 6 years were included. Paraffin sections of biopsies were stained with Haematoxylin & Eosin, Ziehl- Neelsen’s & Fite stains examined and classified histopathologically according to Ridley- Jopling scale and then correlated with clinical diagnosis.

Results:

Prevalence rate of leprosy in Ajmer district is 0.16 per 10,000 population per annum. Among the 124 biopsies, most cases were of indeterminate type (39.51%), followed by LL type (17.74%), TT type (16.93%), BT type (10.48%), BL type (07.25%), BB type (05.64%), histioid type (2.41%). Most commonly the patients were affected in 4^th decade of life. Male and female ratio was 2.26:1. Most common clinical presentation was anesthesia.

Conclusion:

Correlation of clinical and histopathological features along with bacteriological index appears more useful for accurate typing of leprosy than considering any of the single parameters alone. This helps the clinician for better care and management of the patients.

A Rare Cause of Lower Abdomen Pain – Primary Urinary Bladder Amyloidosis

Kalpesh Parmar — 2021-03-31

Primary urinary bladder amyloidosis is a rare disease. Its importance lies in the ability of the disease to masquerade the carcinoma urinary bladder in clinical presentation and imaging but with a distinctively contrasting treatment. The commonest presentation is painless hematuria. Definitive diagnosis is made on histopathology and by ruling out systemic amyloidosis. Here, we report a 60-year-old male presenting with lower abdomen pain diagnosed with primary urinary bladder amyloidosis and discuss the management based on current literature.

Choroid Plexus Carcinoma of Third Ventricle: A Rare Case Report

Shivali Awasthi — 2021-03-31

Choroid plexus tumors are very rare tumors accounting for 0.5% of all brain tumors. They most commonly occur in childhood and present with features of raised intra-cranial pressure. World Health Organization (WHO) classifies them into 3 broad categories namely papilloma (grade 1), atypical papilloma (grade 2) and carcinoma (grade 3). These tumors are most commonly seen in the supratentorial compartment with lateral ventricle followed by third ventricle, being the most common site. Rarely, they may present in infratentorial region in adults. Dissemination through cerebrospinal fluid space is the inevitable natural course of the disease. Treatment requires total surgical resection with adjuvant chemoradiotherapy being controversial. In this study, we present a case of 7-year-old child who visited to the out-patient department of our center with progressive quadriparesis and altered sensorium and on imaging was found to have a well-defined, lobulated mass lesion with intense post contrast enhancement in posterior part of third ventricle with resultant obstructive hydrocephalus. The patient underwent craniotomy and on immuno-histopathological examination was diagnosed as a case of choroid plexus carcinoma. However, the patient succumbed to his illness a month after his surgery. The aim of this report is to highlight a rare entity, its diagnostic challenge and effect of early management in the form of surgery and chemo-radiotherapy.

Low Grade Appendiceal Mucinous Neoplasms- A Short Case Series with Review of Literature

S Salapathi — 2021-03-31

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare malignancy and is found in less than 0.3% of appendectomy specimens. Patients with LAMN can present with abdominal pain and mimic clinically as appendicitis, intussusception or obstruction, hence high clinical suspicion is needed for correct diagnosis and management. The exact nature and nomenclature of these tumors when they disseminate into the peritoneum is controversial. The prognosis of LAMN is highly dependent on the presence or absence of neoplastic epithelium outside the appendix. Tumors with extra appendiceal acellular mucin in the right lower quadrant only rarely recur but tumors with extra appendiceal mucin and neoplastic epithelium recur more often. LAMNs with diffuse peritoneal seeding of neoplastic epithelium and mucin have a progressive clinical course that frequently results in death of the patient. Hence whenever a case of mucinous neoplasm of the appendix is encountered, it is essential that the entire appendix be submitted for histopathologic examination and should be thoroughly evaluated for presence of extra appendiceal mucin and neoplastic epithelium, and also for the type of invasion in order to obtain the correct diagnosis and to predict the risk of recurrence. We present here three cases of low grade appendiceal tumors with their varied clinical presentation and histopathological findings, for their rarity and clinical importance.

Glomeruli Sparing Pattern of Unclassified Renal Cell Carcinoma: A Rare Neoplasm

Deepa Nagarajan — 2021-03-31

Unclassified renal cell carcinoma (URCC), an aggressive form of renal cell carcinoma (RCC), represents 0.7– 5 .7% of renal tumours. Glomerular sparing in renal neoplasms (GS) is defined as a unique growth pattern in which tumour cells overrun intact glomeruli.

An elderly woman presented with symptoms of left flank pain for three months along with fullness in the abdomen. On clinical and radiological examination, a renal mass was revealed and operated upon. A diagnosis of URCC with a glomerular sparing pattern was made on histopathological examination. The pathological details of this rare neoplasm are presented in this article.

Leptomeningeal Metastasis from Carcinoma Breast: A Case of Unknown to Known

Princy S Soman — 2021-03-31

Leptomeningeal metastasis is known to occur as an initial presentation in solid tumors. The presentation of meningeal symptoms before the diagnosis of primary tumor is seen in 10-20% cases. Though the sophisticated radiological imaging is available, Cerebrospinal Fluid (CSF) analysis for tumor cells remains the gold standard method for diagnosis. Incidence of brain metastasis from primary carcinoma breast is about 3-8% only.

We present a case of young female who presented with neurological symptoms and misdiagnosed as meningitis on Magnetic Resonance Imaging (MRI), but later after CSF analysis it was diagnosed as metastases from carcinoma breast.

Intravascular Papillary Endothelial Hyperplasia: The Diagnostic Challenges

Kaushika P — 2021-03-31

Masson’s tumor or intravascular papillary endothelial hyperplasia is a benign lesion of the skin and subcutaneous tissue. It is due to reactive proliferation of endothelial cells with papillary formations related to a thrombus. It poses an interesting diagnostic differential as the clinical signs and symptoms are nonspecific. The diagnosis is based on histopathology. We report a case of Masson’s hemangioma occurring on the right ring finger.