Clinico-Pathological Correlation

Correlation between total serum bilirubin and clinico-laboratory parameters of babies admitted for neonatal jaundice in a resource-limited setting Uchenna Ekwochi, Chidiebere D.I Osuorah, Ikenna Kingsley Ndu International Journal of Clinicopathological Correlation 2018 2(2):21-26 Background: Neonatal jaundice (NNJ) is one of the most frequent reasons newborn babies in low- to middle-income countries visit the hospital during the neonatal period. If not promptly managed, it could lead to serious neurological sequela and mortality. The level and type of bilirubin in serum are an important determinant of the management option in NNJ. Unfortunately, this simple but fundamental investigation is not readily available in many hospitals in low- to middle-income countries, and where available, needs to be done serially, an expenditure most clients cannot afford. Methodology: This study enrolled 83 newborns admitted and managed for NNJ at the Enugu State University Teaching Hospital during an 18-month period. We report correlation between total serum bilirubin (TSB) and selected newborn clinical and laboratory parameters. Results: A total of 83 newborns were admitted for NNJ during the study. The mean TSB (mTSB) was 307 ± 145.2 μmol/L. Preterm infants (T = 0.462, P = 0.500), neonates with birth weight <2.5 kg (T = 0.219, P = 0.804), female neonate (T = 0.314, P = 0.578), and those that presented with skin level at the lower body region (T = 28.52, P = 0.001) had a higher mTSB at presentation to the special care baby unit. Similarly, mTSB at presentation was higher in neonates with PCV <40% (T = 0.005, P = 0.942), negative malaria parasite film (T = 0.01, P = 0.933), and those that were Glucose-6-Phosphate dehydrogenase deficient (T = 1.59, P = 0.221). Only skin level of jaundice at presentation was significantly correlated to the TSB (R = 0.818 P = 0.001) while gestational age (R = 0.096, P = 0.500), age at presentation (R = 0.197, P = 0.157), and birth weight (R = −0.107, P = 0.459) were not. Linear regression analysis showed that for every regional rise in skin level of jaundice (X), the TSB (Y) in μmol/L increases by a factor of 89.74 expressed in a regression equation as, Y = −10.66 + 89.74 X. Conclusions: The skin level of jaundice can be used as a rough guide in the estimation of total bilirubin in newborns with jaundice. This is especially useful in resource-limited setting where facilities for testing bilirubin level are lacking.

Bilateral oral leukoplakia: A case report and review on its potential for malignant transformation K Tupakula Pavan, Ankita Kar, S Reddy Sujatha, BK Devi Yashodha, Nagaraju Rakesh, V Shwetha International Journal of Clinicopathological Correlation 2018 2(2):27-30 Oral leukoplakia (OL) is considered as a most common potentially malignant disorder (PMD) affecting the mucosa of the oral cavity. With the passage of time, the definitions of OL kept evolving. Leukoplakia usually presents after the fourth decade of life and is one of the most common oral PMDs affecting the oral cavity. Based on the macroscopic features of OL, it can be classified into two subtypes: homogeneous and nonhomogeneous.

Clopidogrel-induced thrombotic thrombocytopenia after years of medication Rateesh Sareen, Menka Kapil, Piyush Mathur, Madhulika Sharma International Journal of Clinicopathological Correlation 2018 2(2):31-33 Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized by fever, microangiopathy hemolytic anemia, thrombocytopenia, neurological signs and renal insufficiency. The real culprit is agglutinated platelets and fibrin which form micro thrombi, gets deposited in arterioles and capillaries without eliciting inflammatory response. The idiopathic cases of TTP are characterized by deficiency of ADAMTS-13 (a disintegrin and metalloprotease, with thrombospondin -1 like domains) metalloprotease activity. The use of antiplatelet drugs, the thienopyridine derivatives Clopidogrel & Ticlodipine, is associated with drug induced TTP. The literature studies indicate that most cases of thienopyridine associated TTP involve an antibody to ADAMTS-13 metalloprotease that cause thrombocytopenia and respond to therapeutic plasma exchange (TPE). We report a case of 59 year old male who was on Clopidogrel post coronary angioplasty since past five years. He presented to us with complaints of nose bleeding and renal insufficiency. The evaluation of this potentially fatal drug complication should be borne in mind by physicians for all patients receiving Clopidogrel treatment.

Endometrial osteocartilaginous metaplasia: A case report and review of the literature Yeo Yen Ching, Mihir Gudi, Josefa E.O Vella International Journal of Clinicopathological Correlation 2018 2(2):34-36 Rare cases of osseous metaplasia and a single case of cartilaginous metaplasia have been reported previously but no previously reported cases of osteo-cartilagenous metaplasia were found on searching the literature. Osteo-cartilagenous metaplasia is a benign lesion which may be treated successfully with hysteroscopy. Awareness of this condition by histopathologists is important in order to avoid misdiagnosis of endometrial malignant mixed mullerian tumour. The authors report a patient with endometrial osteo-cartilagenous metaplasia, describe the clinical and histological features and review the literature on this condition.