Original Research ArticleA study in prevalence of diabetic nephropathy in recently detected cases of type 2 diabetes mellitus as evidenced by altered creatinine clearance, urinary albumin and serum creatinine, with special emphasis on hypertension, hypercholesterolemia and obesity Vitan Patel, Minal Shastri*, Nisha Gaur, Prutha Jinwala, Abhishek Y. Kadam INTRODUCTIONDiabetes Mellitus (DM) is one of the commonest diseases in the world, especially the industrialized world. But recently, the "Silent epidemic" of diabetes has been spreading like a wild fire through the developing world. India has earned the dubious distinction of being termed the "Diabetes capital of the world" with number of patients expected to cross 79.4 million by year 2030. 1The dangerous fact about diabetes is that it is a "Silent killer". By the time patient is diagnosed to have diabetes, he/she is already affected with complications like diabetic nephropathy, retinopathy and neuropathy. This is especially worse in India, where various factors delay the ABSTRACT Background: Diabetic nephropathy is one of the commonest and most dreaded complications of Diabetes. The Aim was to evaluate the significance of microalbuminuria and creatinine clearance for detecting incipient diabetic nephropathy, and to find out the prevalence of nephropathy among freshly detected Type 2 diabetic patients with vs. those without hypertension, hypercholesterolemia and/or obesity. Methods: In this prospective study, 100 recently diagnosed diabetics were studied. Group A had 50 patients with at least one risk factor are hypertension, hypercholesterolemia and obesity. Group B had 50 patients without any of the aforementioned factors. Patients were investigated for presence of Diabetic nephropathy with abnormal serum Creatinine, creatinine clearance and urinary albumin levels. Results: As many as 43 out of 100 patients were found to have Diabetic nephropathy. The number was significantly higher in group A compared to group B (34/50 vs. 9/50). Incidence of nephropathy was higher with higher number of associated risk factors. Urinary microalbuminuria was the commonest abnormality, Serum creatinine was found in only 30.23% of total positive cases. Conclusions: Incidence of diabetic nephropathy is much larger than imagined in freshly diagnosed/new onset cases of DM type 2. Author also conclude that hypertension, obesity and hypercholesterolemia can contribute to development of nephropathy (68% vs. 18% in those who had the factors vs. those who didn't). Also, urinary microalbuminuria appears to be much more sensitive than serum creatinine as screening tool. While prevalence of nephropathy in diabetes has been extensively studied in past, very few studies have taken to determine how much prevalence is at the time of detection already. This becomes even more important when we take into account how delayed the diagnosis is in Indian patients. And presence of other complicating factors may worsen this. A study is indicated looking for how these factors impact the prevalence of di...

Systemic mastocytosis (SM) is a rare blood disorder that can affect multiple body organs. There are some patients of SM with coexpression of hematological neoplasm designated in the World Health Organization classification as SM with an associated hematological neoplasm (SM-AHN). A 13-year-old female was referred for immunophenotyping since blasts were reported in the bone marrow aspirate. On performing flow cytometry, abnormal myeloid blasts (>20%) were obtained on flow cytometry suggestive of acute myeloid leukemia with aberrant expression of CD19. Furthermore, there were increased mast cells abnormally expressing CD25. The aspiration slides reviewed showed atypical mast cells Type I and Type II. Molecular analysis revealed RUNX1::RUNX1T1 fusion as well as KIT D816V mutation. Karyotyping revealed a three-way translocation involving chromosomes 8, 12, and 21 consistent with RUNX1::RUNX1T1 fusion. Fluorescence in situ hybridization (FISH) performed using a dual color dual fusion probe for RUNX1::RUNX1T1 showed atypical abnormal pattern consistent with RUNX1::RUNX1T1 fusion. This rare diagnosis could be reached as a result of a strong correlation between morphology, immunophenotyping, cytogenetics, and molecular analysis, leading to a better treatment plan for the patient.

Introduction Patients undergoing intensive chemotherapy for hematological malignancy and stem cell transplantation are at increased risk of neutropenia.Neutropenia is among the frequent side effects of intensive treatments, and when absolute neutrophil count (ANC) falls < 500/µL, the risk of microbial and fungal infection increases significantly.As neutropenia is the main cause of these infections, transfusion of granulocyte immediately as a replacement is a life-saving therapeutic option to support these patients by restoring neutrophil counts and aiding in the resolution of infection. Objective The present study is a retrospective single institutional analysis of granulocyte transfusion therapy in children and young adults with cancer who received treatment with GT during prolonged and profound life threatening neutropenia. Materials and Methods This study was a retrospective analysis of 66 granulocyte transfusions in 36 patients of hematological and solid malignancy with severe and prolonged neutropenia in the department of Medical Oncology, Sri Aurobindo Institute of Medical Sciences Indore, between September 2019 and March 2022.Donors were either patients' relatives or voluntary donors without comorbidities.All granulocyte concentrates were collected by centrifugation leukapheresis and irradiated with 2500 centigray and immediately transfused in full, to the patient over 60 ot 120 minutes with appropriate premedication. Results A total of 36 patients (M:F, 19:17) with a median age of 16 years (2–43) received 66 granulocyte transfusions. The diagnosis of patients included acute myelogenous leukemia (n = 17), B cell acute lymphoblastic leukemia (n = 10), non-Hodgkin lymphoma (n = 3), Ewing's sarcoma (n = 2), neuroblastoma (n = 1), malignant melanoma (n = 1), aplastic anemia (n = 1), osteosarcoma (n = 1). All had severe neutropenia with absolute neutrophil count < 0.5 × 109/L. The median duration of severe neutropenia was 16 days. Patients received a median cell dose of granulocytes 2.9 × 1010/L. A favorable response was seen in 28 (78%) patients, whereas an unfavorable response was seen in 8 patients (23%). Conclusion A granulocyte therapy was effective in many critically sick patients with prolonged and profound neutropenia. Granulocyte transfusions may be more beneficial in selected patients where it provides more time to overcome refractory infections with broad-spectrum antibiotics. Granulocyte transfusion are at best a “bridge” that gives time to marrow recovery. The challenges to using GT are clinical, finding patients who may get benefitted, and logistical, selection of donors and harvest technique. Randomized trials with large numbers of patients are required to prepare guidelines for granulocyte use.

Fever and extensive necrosis with 30% or more epidermal involvement along with mucous membrane is known as toxic epidermal necrolysis (TEN). It is a life-threatening mucocutaneous disease and is usually drug induced. We report a rare case of docetaxel-induced TEN. A patient with metastatic breast carcinoma received single agent docetaxel and developed severe skin and mucous membrane reaction involving more than 30% of the skin, and managed conservatively in intensive care unit but she succumbed to her illness. Although common toxicities reported with docetaxel include alopecia, nail damage, myelosuppression, and erythema multiforme major, TEN after docetaxel is very rare and can be a life-threatening complication as in our case.

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