Morphologic features are useful in distinguishing Barrett esophagus from carditis with intestinal metaplasia

Barrett esophagus (BE) and carditis with intestinal metaplasia (CIM) differ in their risk of malignancy and implications for patient management, but are difficult to distinguish in mucosal biopsies from the gastroesophageal junction region. The present study was performed to evaluate the role of routine morphology in distinguishing BE from CIM in mucosal biopsies and to assess the degree of interobserver variability in recognizing morphologic parameters that are of significance in making this distinction. Several morphologic features, including presence of crypt disarray and atrophy, incomplete and diffuse intestinal metaplasia, multilayered epithelium, squamous epithelium overlying columnar crypts with intestinal metaplasia, hybrid glands, and esophageal glands/ducts, were significantly associated with a diagnosis of BE. The latter 3 features were observed exclusively in BE biopsies. Furthermore, multiple BE-associated morphologic features were often present together in BE but not CIM biopsies. There was substantial agreement (kappa=0.6) among expert gastrointestinal pathologists for distinguishing BE from CIM even in the absence of clinical/endoscopic information. The interobserver agreement in recognition of BE-associated morphologic features ranged from almost perfect for some features like esophageal glands/ducts (kappa=0.83) to slight for multilayered epithelium (kappa=0.17). In conclusion, our findings indicate that several morphologic features are helpful in distinguishing BE from CIM. The combined presence of multiple BE-associated morphologic features can be used in making this distinction with a high degree of accuracy. Larger prospective studies need to be performed to validate these findings and evaluate the reproducibility of this approach in routine clinical practice.     

Ceftriaxone-induced hemolysis

Immune hemolytic anemia is a rare adverse effect of ceftriaxone, a third-generation cephalosporin, which is a commonly used antibiotic. We describe a 60-years-old lady, a case of community-acquired pneumonia, who developed severe hemolysis after the first dose of ceftriaxone. Her hemoglobin dropped from 9.6 g /dl to 5.5 g /dl. However, she improved after discontinuation of the drug and blood transfusion. This report serves as a reminder to medical fraternity that life-threatening hemolysis can rarely follow administration of ceftriaxone.KEY WORDS: ADRs, ceftriaxone, hemolysis     

Cutaneous manifestations of HIV—a detailed study of morphological variants,markers of advanced disease,and the changing spectrum

Background

Cutaneous manifestations are early and easily identifiable markers of human immunodeficiency virus (HIV) infection. They can help in predicting severity and progress of the disease and can be correlated well with CD4 counts. This study was undertaken to study the cutaneous manifestations of HIV infection and to correlate them with CD4 counts. It also aimed to study the changing spectrum of these manifestations and describe cutaneous manifestations seen in advanced disease.

Method

A total of 234 HIV-positive patients not on anti-retroviral therapy, who attended the outpatient department or were admitted as inpatients at Military Hospital, Shillong during the period between May 2008 and October 2009 were included. Cutaneous, mucosal, and genitourinary manifestations in these patients were studied in detail and were correlated with CD4 counts.

Results

Infections were the most common group of mucocutaneous manifestations, while onychomycosis was the commonly observed individual manifestation. A different set of cutaneous markers for advanced HIV disease was observed and new parameters for therapy were also arrived at.

Conclusion

Specific morphological variants of cutaneous markers may provide a better clue to early diagnosis of HIV and can help in diagnosing advanced stages of the disease. Fresh cutaneous markers are required for indicating cut-off levels of CD4 count at 350/μL for starting therapy.