Fluid Examination Research Articles

THERAPEUTIC MANAGEMENT OF ASCITES IN SPITZ DOG IN BANGLADESH WITH A BRIEF REVIEW ON CANINE ASCITES

Background: Ascites is one of the most important clinical syndromes, caused by multiple organ disorders, characterized by abdominal distension with accumulation of fluid of various colors and consistencies depending on the etiology that are encountered commonly in canine practice worldwide. Although it has been reported from different countries including India but it has not yet been documented from Bangladesh. Objectives: To evaluate the successful therapeutic management of a clinical case of ascites in dog supported with its brief review for its appropriate application Materials and Methods: A female Spitz dog two and half years old brought for treatment with the history of abdominal distension on 1st November 2009. Clinical examination, abdominocentesis and laboratory examination of ascitic fluid were used for the diagnosis of ascites in dog. Results: Clinical examination revealed dyspnea, discomfort, lethargy, weakness, pale mucous membrane, normal rectal temperature 103.2 0F and distended abdomen with fluid thrill on palpation. Examination of ascitic fluid revealed clear white fluid (pure transudate) which is mainly hepatic origin resulting portal hypertension and hypoproteinaemia. Treatment with restricted sodium diet, antibiotic (amoxicillin), diuretic (furosemide; Lasix, Sanofi Aventis) and vitamin B-complex and C- vitamin supplement with regular monitoring assisted in successful recovery. The recovered dog survived for next five years up to 2014 and then died due to other reasons. Conclusions: This clinical case record on canine ascites with successful treatment along with review especially on the methods of diagnosis and cause-wise treatment would certainly help the clinician for proper management of the clinical cases of canine ascites. Keywords: Ascites, Spitz dog, Diagnosis, SAAG, Therapeutic management, Brief review

The Role of the Complex Clinical-Anamnestic and the Laboratory Examination in Establishing the Etiology of Endogenous Uveitis

Purpose: to estimate the results of the clinical and laboratory survey among patients with uveites for refinement of the disease’s etiology.Patients and Methods. 107 patients with uveites (114 eyes) were under control. A standard ophthalmologic survey was done with them; a serodiagnosis (immunoassay analysis) towards Toxoplasma gondii, Herpes simplex virus Ist, IInd types, Citomegalovirus, Chlamidia trachomatis; a bacteriological examination of tear fluid, some material from nose and cavity to definite factors of virulence and antibiotic sensitivity of exuded microorganisms. A molecular and genetic survey (PCR) of tear fluid towards Toxoplasma gondii , Herpes simplex virus Ist, IInd types, Citomegalovirus was done among 30 people.The results. Provocative factors of the disease were detected in 42 % of cases. Concomitant diseases were in 77 %. Diseases of cardiovascular system prevailed in 49 %; ceiling of mouth cavity in 42 %; systemic diseases in 29.3 %. The most widespread were anterior uveites in 60.5 %; recur character prevailed in 51 %; deteriorations progressed in 58.8 % of cases. A chronic infection with herpes viruses was among almost all the patients (HSV I, II — 100 %, CMV — 96.3 %). To Toxoplasma gondii specific IgG were detected in 44.9 %, IgM in 2.8 %; to Clamidia trachomatis specific IgG in 21.5 %. 66 strains of bacteria were selected: from tear fluid — 34, from mouth — 17, from nasal cavity — 15; gram-positive bacteria of Staphylococcus prevailed in 83.3 %. In some cases of revealing S. aureus, which were isolated from all three biotypes, they were close to their phenotypic characteristics, which indicates to their etiologic importance in uveites’ progress. The research of tear fluid in PTSR turned to be less informative. Based on the anamnesis and the results of a complex survey it managed to become possible to decipher the etiology of the disease in 74.6 %. Among them were 67.1 % of infectious and infectious-allergic uveites; 80.7 % of bacterial uveites; 15.8 % of virus uveites and 3.5 % of parasitic uveites. 28.2 % of inflammations occurred on a background of system and syndromic diseases, the majority of diseases were on a background of Behterev’s disease and rheumatoid arthritis, 45.5 % for each. Non-infectious autoimmune and toxical-allergic reasons were set in 4.7 % of cases.Conclusion. It is more expediently to use a complex diagnostic approach with taking into account clinical and anamnestic information and laboratory information of the survey in the investigation of uveitis etiology.

A COMPARATVE STUDY ON DIAGNOSTIC YIELD BETWEEN CENTRIFUGED METHOD OF CYTOLOGY AND CELL BLOCK TECHNIQUE

Cytological examination of serous fluids is of paramount importance in disease diagnosis. Cell blocks are particularly useful when the cytological abnormalities are misleading, such as in reactive mesothelial cells or obscure as in occasional well differentiated adenocarcinoma. In the present study, these methods are applied to pleural and peritoneal fluids to conclude the diagnosis as inflammatory, benign or malignant lesion. A sample of 110 fluids obtained during August 2011 to August 2012 in the Department of Pathology, Narayana Medical College, Nellore. Out of 110, 76 (69%) are pleural and 34 (31%) were peritoneal samples. Men were 56.4% and women were 43.6% and the mean age of the study was 50.19 with a standard deviation of 14.81. Among 110 fluids 15 were clinically diagnosed as malignant effusions. Out of which 11 were reported as positive for malignant cells and 4 cases were negative. 3 cases were reported as positive for malignant cells in which they were clinically not diagnosed. Out of 110 cases, 12 were reported as positive for malignant cells by smear whereas 14 cases were reported as positive for malignant cells by cell block. The diagnostic yield is increased by cell block technique. The cell block technique not only increased the positive results, but also helped to demonstrate better architectural patterns which could be of great help in approaching the correct diagnosis of the primary site.
 Keywords: Cell Block Technique, Cytospin smear, Diagnostic Yield, Adeno carcinoma

Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19\u20139 level: a case report

BackgroundNon-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19–9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19–9 level.Case presentationThe patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient’s serum levels of CA19–9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19–9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19–9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery.ConclusionLaparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.

P84-F Subacute polyneuropathy partially responsive to immunomodulatory treatment coexisting with POLG mutation

Background During the last few years, the correlation between mitochondrial disorders and autoimmune diseases has been reported. Autoimmune polyneuropathies were concomitant with symptoms related to the polymerase γ (POLG) mutations. POLG is involved in mitochondrial DNA (mtDNA) replication and maintenance. Material and methods We present a case of a16-year-old girl with W748S mutation of POLG region with a 1,5-year history of slowly progressive walking difficulties. Results In the neurological examination the girl had ataxic gait with sensory disturbances in lower extremities with areflexia. Nerve conduction studies (NCS) demonstrated axonal–demyelinating sensorimotor polyneuropathy of the lower limbs. Additionally, magnetic resonance imaging (MRI) of the lumbar spine revealed gadolinium enhancement of the spinal roots and an examination of cerebrospinal fluid showed dissemination. The immunomodulatory treatment with intravenous methylprednisolone and intravenous immunoglobulin (IVIg) was started. Conclusions The IVIg and IVMP treatment led to marked improvement of her abnormal gait and improved resolution of abnormalities of touch, temperature sensation and improved proprioception. The W748S mutations were commonly reported and associated with variable phenotypes, most often Alpers syndrome, but also polyneuropathy. However, electrodiagnostic features and partial response to immunomodulatory therapy suggest the autoimmune etiology of the patients’ subacute symptoms. We hypothesize that oxidative stress caused by impaired mitochondria function may trigger an autoimmune response.

Detection of varicella-zoster virus from cerebrospinal fluid using advanced fragment analysis in a child with encephalitis: a case report

BackgroundVaricella zoster virus (VZV) encephalitis is an infectious inflammatory disease of brain that can cause irreversible mental damage without timely treatment. In fact, many viruses can cause encephalitis, and the viral loads in cerebrospinal fluid (CSF) in the early stage of the disease are usually too low to be detected. Here we report a case of VZV encephalitis diagnosed by advanced fragment analysis (AFA), which could potentially to contribute to early diagnosis of VZV central nervous system (CNS) infections with a small volume of CSF samples.Case presentationA 10-year-old boy was admitted to the hospital with obvious neurological symptoms of headache, dizziness and vomiting for one day. Physical examination showed left facial paralysis. Complete blood count (CBC) test only showed an unspecific inflammation, and the culture of cerebrospinal fluid and microscopic staining examination were all negative. AFA was performed to screen the common 18 encephalitis related pathogens in CSF. Obvious VZV DNA fragments were observed by capillary electrophoresis at 160 nt, suggesting the existence of VZV CNS infection in children. The results were consistence with real-time quantitative PCR and concomitant symptoms in the acute stage of the disease.ConclusionsWe report a case of acute VZV encephalitis in a child without obvious skin manifestations, which was rapidly diagnosed by AFA. Overall, we would recommend the use of AFA analysis as the rapid screening system for the identification and differentiation of encephalitis pathogens in children.

Congenital toxoplasmosis and proposal of a new classification for the likelihood of primary maternal infection: analysis of 375 cases in Southeast Italy

Objective: The aim of this study was to propose a classification in order to stratify the probability of an acute Toxoplasma infection in pregnancy and to estimate the risk of vertical transmission.Study design: We evaluated the likelihood of a primary maternal infection according to the Lebech classification and to the modified-Lebech classification proposed for our group of 375 patients referred for a suspected primary maternal infection. Fetal diagnosis included the examination of amniotic fluid by PCR to detect Toxoplasma DNA as a confirmation test.Results: Differences between the old and new classification resulted statistically significant for old classes defined as probable and unlikely with a clear shift of cases from the unlikely to the probable class in the new classification. Transmission rate showed a significant (p < .05) increase of the transmission rate in the probable class in our new classification as compared with the Lebech one.Conclusions: Results obtained in the present study suggest that the new IgG avidity-based classification herein proposed could estimate more precisely the likelihood of a primary maternal Toxoplasma infection as well as the risk of fetal infection, when compared with the historical Lebech Classification.

The correlation between cytological examination of ascitic fluid and serum ascites albumin gradient in the differential diagnosis of Ascites

Aim: The accumulation of fluid in pathological quantities in the peritoneal cavity is called ascites. In every newly diagnosed ascites, necessary investigations should be conducted by puncturing ascitic fluid. In this study, we aimed to investigate whether there is any correlation between cytological examination of ascitic fluid and serum ascites albumin gradient (SAAG) in the determination of etiologic causes of ascites. Material and Method: The files of the patients who were admitted to our clinic for the investigation of their ascites etiology between May 2014 and May 2018, were analyzed retrospectively. Pathology reports of the patients whose SAAG was calculated by taking the difference between serum albumin values and simultaneously taken ascitic fluid albumin and whose ascitic fluid cytology examination was performed, were recorded. The data of 248 patients with clinical diagnosis were included in the study. Patients with SAAG

Ascites-tap Simulator for Abdominal Examination and Removal of Ascites Fluid.

Ascites-tap Simulator for Abdominal Examination and Removal of Ascites Fluid.

Etiologies of Bacterial Meningitis in Context of Conflict in Central African Rural Areas

Bacterial meningitis is a health problem because of its high frequency and severity. They are endemic and epidemic in the Central African Republic (CAR). The objective of this work was to describe the etiologies of bacterial meningitis in the northern part of the Central African Republic. This was a retrospective descriptive study, conducted at the district hospital in Paoua, covering the period from 1 January 2011 to 30 September 2016. We included in the study, all suspected cases of meningitis (neuro-meningeal and infectious signs) confirmed by isolation of a bacterium from cerebrospinal fluid (CSF) analysis. An anonymous questionnaire collected sociodemographic and biological data that were entered and analyzed with the Epi Info7 software. We included 274 patients whose median age was six years with extremes of 6 months and 54 years. In 75% of the cases, the patients were under 9.5 years old. There were 156 men (56.93%) giving a sex ratio of 1.32. The prevalence of HIV was 4.74% (13/274). Examination of cerebrospinal fluid (CSF) had a turbid appearance in 80.66%, purulent in 7.66%, clear in 6.57%, hematic in 3.65% and xanthochromic in 1.46%. The bacteriological examination revealed the following main germs S. pneumoniae in 51.82%, 40.15% N. meningitidis, H. influenzae 7.30%. We found a case of E. coli (0.36%) and Streptococcus group B (0.36%). On an evolutionary level, the overall lethality was 14.96%. This lethality rate was 20.42% (29/142) for S. pneumoniae, 30% (6/20) for H. influenzae and 5.45% (6/110) for N. meningitidis. In our study, the main causes of bacterial meningitis were S. pneumoniae, N. meningitidis and H. influenzae against which there are effective vaccines. Increasing immunization coverage against these germs may help to reduce the magnitude and severity of these infections.

Cardiac Tamponade from Pericardial Mesothelioma Causing Acute Renal Insufficiency in Dog

Pericardial mesothelioma is a rare malignancy tumor in dog. Due to an aggressive tumor and low survival rates, mesothelioma is frequently diagnosed at an advanced stage. The objective of this clinical report is to highlight the characteristic of this malignancy tumor to help an early diagnosis and to improve the therapeutic outcomes of this neoplastic tumor. A 10-year-old crossbreed was referred to Kasetsart University Veterinary Teaching Hospital Kamphaengsaen for the evaluation of a history of abdominal distension, lethargy and weekness. During the physical examination, the dog was tachycardia and tachypnea. Ultrasonography imaging of spleen revealed an inhomogeneous appearance and thoracic radiograph showed cardiac enlargement. Electrocardigraphy examination revealed low voltage of QRS complex amplitude. A transthoracic echocardiogram showed a large pericardial effusion with cardiac tamponade and masses were visualized in pericardial sac. Pericardiocentesis was immediately performed to alleviate the cardiac tamponade and cytologic examination was performed to identify the characteristic of pericardial effusion fluid. Clinical symptoms of acute kidney injury were progressed from the second visit including azotemia, hyponatraemia, hyperkalemia and anuria. The dog died about 2 days after admission in the critical care unit. Histopathological examination of the pericardial fluid and pericardial mass confirmed the diagnosis of pericardial mesothelioma. Mesothelioma should be considered in the diagnosis of pericardial effusion in dog. An early stage detection of pericardial mesothelioma may significantly reduction in mortality and allow for more beneficial treatment.

Transsphenoidal Endoscopic Approach in Treatment of Spontaneous Nasal CSF-leak

Spontaneous nasal liquorrhea is a pathological condition associated with defects between the nasal cavity and the intracranial structures, which results in CSF leak from the nasal cavity. Diagnostic criteria include: anamnesis, examination of the nasal fluid, endoscopic examination of the nasal cavity, and CT - and MRI - cisternography. Conservative therapy is applicable to small fistulas. In the case of the inefficiency of this method, surgical method is then applied to the defect closure. Purpose of the study: To evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment. Materials and methods: For the period from 2008 to 2018 at the Pavlov First Saint Petersburg State Medical University, at the clinic of neurosurgery of the Kirov Medical Institute and the Medical Research Center Almazov, 38 patients with spontaneous nasal liquorrhea were treated. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal approach. Results: In 4 cases, there was a large defect requiring secondary surgical intervention 1-2 weeks after the initial operation. Conclusions: The use of auto tissues (muscle or fat) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in the case of a large size defect.

Fatty acids and selected endocannabinoids content in cerebrospinal fluids from patients with neuroinfections

Neuroinfections are a significant medical problem and can have serious health consequences for patients. Their outcome, if not fatal, can be associated with permanent residual deficits. Cerebrospinal fluid (CSF) examination is commonly used for meningitis confirmation. Fatty acids (FA) are precursors of lipid mediators with pharmacological activity. They actively modulate inflammation as well as contribute to its resolution. Therefore the aim of this study was to determine the FA and selected endocannabinoids (ECB) content in the CSF obtained from patients with bacterial (BM) and viral meningitis (VM) using chromatographic techniques. A significantly lower level of saturated FA was found in patients with BM and VM as compared to controls. There was a significantly higher concentration of long-chain monounsaturated FA and polyunsaturated n-6 FA in the CSF obtained from patients with neuroinfection. Moreover, a significant reduction of n-3 FA in CSF obtained from patients with BM and VM was demonstrated. The highest amount of ECB was detected in the CSF of patients with VM: eicosapentaenoyl ethanolamide (1.65 pg/mL), docosahexaenoyl ethanolamide (655.5 pg/mL) and nervonoyl ethanolamide (3.09 ng/mL). Results indicate the participation of long-chain monounsaturated and polyunsaturated FA and their derivatives in the inflammatory process and likely in the process of resolution of inflammation during neuroinfection. It seems that the determination of the FA and ECB profile in CSF may be a valuable biomarker of health and may allow the development of new pharmacological strategies, therapeutic goals and fatty acids supplementation necessary in the fight against inflammation of the central nervous system.

Balo's concentric sclerosis: a clinical case

This paper describes a case of Balo's concentric sclerosis, a rare demyelinating disease of the central nervous system (CNS), which is currently classified as multiple sclerosis. In recent years, there has been a more favorable clinical course of Balo's sclerosis. The significant polymorphism of clinical manifestations of the disease, its neuroimaging pattern, and laboratory tests cause difficulties diagnosing this pathology. Its differentiation with CNS tumors presents a particular challenge. So it also happens in the described clinical case, when computed tomography revealed the signs of space-occupying lesion, the histological pattern of concentric focus biopsy specimen indicated the presence of protoplasmic astrocytoma. However, immunohistochemical analyses of the biopsy specimen, immunological examination of cerebrospinal fluid, as well as the typical magnetic resonance imaging changes of Balo's sclerosis could suggest the demyelinating nature of the pathological process. The article shows that immunohistochemical techniques for examining a brain biopsy specimen and immunological assays of blood and cerebrospinal fluid are of great diagnostic value.

Guillain-Barré Syndrome and Low Back Pain: Two Cases and Literature Review.

Purpose. To describe the clinical, electrophysiological, and lumbar magnetic resonance imaging (MRI) features of two cases of atypical Guillain-Barré syndrome (GBS). Methods We reported two GBS variant cases with initial and prominent symptoms of low back pain. We analysed their clinical, electrophysiological, and lumbar MRI features. Results Two patients with GBS reported low back pain as the initial and prominent symptom, which was not accompanied by limb weakness. The electrophysiological study showed abnormal F-waves in the common peroneal and tibial nerves, and acute polyradiculoneuropathy in the cauda equina. Examination of the cerebrospinal fluid (CSF) showed albuminocytologic dissociation. Serum was positive for GQ1b-IgM antibodies. Lumbar MRI showed gadolinium enhancement of the nerve roots and cauda equina. A standard regime of intravenous immunoglobulin markedly alleviated the low back pain. Conclusions Low back pain caused by GBS should be differentiated from other diseases. This initial or early prominent symptom may delay the diagnosis of GBS; therefore, it is important to conduct a detailed electrophysiological, CSF, and gadolinium-enhanced lumbar MRI analysis.

Nivolumab induced encephalopathy in a man with metastatic renal cell cancer: a case report

BackgroundGreat progress has recently been made in the treatment of metastatic renal cell carcinoma, including the introduction of nivolumab, an immune checkpoint inhibitor. Despite promising results, this treatment brings a completely new spectrum of adverse events, distinct from those experienced with small-molecule kinase inhibitors. Neurologic immune-related adverse events may be serious and potentially life-threatening complications requiring immediate immunosuppressive therapy. Only a few cases of immune-related encephalitis induced by checkpoint inhibitors have been described and the data regarding the management of this serious adverse event are limited.Case presentationWe report the case of a 63-year-old white man with metastatic renal cancer who developed severe chorea-like dyskinesia during nivolumab therapy. The findings on brain magnetic resonance imaging and flow cytometry of cerebrospinal fluid, and the positivity of anti-paraneoplastic antigen Ma2 immunoglobuline G class autoantibodies were consistent with a diagnosis of immune-related encephalitis. High-dose intravenous corticosteroid therapy was started immediately, with no signs of improvement, even when infliximab was added. Our patient refused further hospitalization and was discharged. Three weeks later, he presented with signs of severe urosepsis. Despite intensive treatment, he died 4 days after admission.ConclusionsThe management of less frequent immune-related adverse events has not been fully established and more information is required to provide uniform recommendations. Immune-related encephalitis is a severe and potentially fatal complication requiring immediate hospital admission and extensive immunosuppressive therapy. The examination of cerebrospinal fluid for paraneoplastic antibodies, such as anti-N-methyl-D-aspartate receptor and anti-Ma2 antibodies, in order to distinguish autoimmune etiology from other possible causes is essential and highly recommended.

Role of fiberoptic bronchoscopy in the diagnosis of pulmonary infiltrates in patients with hematological malignancies

RationalePatients with hematological malignancies are a special challenge to health care providers as they undergo a wide variety of immune-suppressive therapies. Both disease and therapy can cause complications. The lungs may be directly injured through infectious or toxic insults. Early identification of the nature of infiltrates will result in better outcome in the management of these patients. Fiberoptic bronchoscopy (FOB) may be a good tool for indentifying the infiltrate nature by using different diagnostic techniques like transbronchial lung biopsy (TBLB) and bronchoalveolar lavage (BAL).Patients and methodsThis study was performed over 6 months, in Kasr Al-Aini Hospital, Cairo University. It included 30 patients with hematological malignancies presenting with pulmonary infiltrates confirmed by computed tomography of the chest. All patients underwent history taking, clinical examination, and investigations included complete blood count and coagulation profile, BAL for culture and sensitivity, cytology examination, and TBLB.ResultsOverall diagnostic yield of FOB was 73.3% in this study. The diagnostic yield of FOB was higher for infectious (43.3%) than both noninfectious (20%) and mixed (10%) etiologies. The combined diagnostic yield of BAL for bacteriological examination and TBLB was higher than that of BAL for cytology examination. Bacteriological examination revealed a predominance for gram-negative bacteria in 62.5% of total culture and sensitivity.ConclusionThis study supports the role of FOB as the initial procedure of choice for identifying the nature of pulmonary infiltrates in patients with hematological malignancies. Because our results suggest that BAL and TBLB are complementary, we recommend performing TBLB whenever it is deemed safe. On the contrary, cytological examination of BAL fluids was not helpful in reaching a final diagnosis.

Síndrome do cão tremedor

Background : : : : The Shaker Dog Syndrome manifests itself as generalized tremors that usually affect the head and body of the patient. The tremors increase with movement and decrease at rest, and it may cease during sleep. The disorder develops mostly in 1-year to 5-year-old animals weighing below 15 kg. The diagnosis is based on the exclusion of other possible causes of tremors and a positive response to treatment with corticosteroids. The treatment consists of immunosuppressant doses of corticosteroids and it can be associated to decreasing diazepam doses during 8 to 12 weeks. Literature data are very rare and cannot be found in Brazil. Consequently, this study aimed at describing a Shaker Dog Syndrome case that is responsive to corticosteroids. Case : A 2-year-old mongrel female dog, weighting 7.5 kg, was referred to the Hospital de Clinicas Veterinarias da Universidade Federal do Rio Grande do Sul, presenting generalized tremors for 5 days, which would cease during sleep. In the neurological examination, the cranial nerve exam and the test for postural reactions were considered normal. The hematological and biochemical profile did not show alterations. The cervical spine radiography did not display bone alterations. A density of 1.016 was observed at the physical examination of the cerebrospinal fluid. The chemical examination revealed a glucose level of 100 mg/dL, negative bilirubin, negative ketones, absence of occult blood, pH 8.0, presence of protein traces, normal urobilinogen, negative reactive protein C (PCR), normal creatine kinase (CK) and aspartate aminotransferase (AST). The result of Pandy’s test was negative. Oral treatment with prednisone at a dose of 1.5 mg.kg -1 BID and diazepam at a dose of 0.5 mg.kg -1 BID was instituted, this latter during 4 days. The corticoid dose was maintained until total disappearance of the tremors, which occurred within 24 days. Afterwards, a gradual reduction of 50% of the dose was made every 7 days, during 4 weeks. Discussion : During anamnesis, tremors induced by trauma and medication were ruled out. Myelin abnormalities were also improbable, as they cause congenital tremors and do not quickly respond to corticosteroids. A colorless aspect and absence of occult blood and bilirubin was observed in the LCR analysis. The absence of turbidity and the presence of protein traces in this sample demonstrate normality (38.7 mg/dL ± 15.49). Chemical and physical exams did not demonstrate alterations – pH 8.0 (8.30 ± 0.34) and a density of 1.016 (1007 ± 1.83), respectively. The glucose concentration in the cerebrospinal fluid was not reduced. The results obtained from Pandy’s and reactive protein C tests were negative. The analysis of AST and CK enzymes was normal. Since the values obtained from enzymatic and protein evaluations of the cerebrospinal fluid were normal, they suggest an absence of infectious and degenerative processes. The immunosuppressant prednisone dose recommended by literature is variable; thus, the smallest corticosteroid dose indicated was selected, which is 1.5 mg.kg -1 BID. An association with diazepam was made to reduce tremors. Usually, clinical improvement can occur within a few days, but the remission of clinical signs can take weeks. In the present case, the reduction of tremors occurred on the fourth day, with the complete disappearance in 24 days, without recurrence within a clinical follow-up period of 2 years.

Cytomorphologic Analysis of Body Fluids

Background: Many etiologies result in development of effusions in the serous cavities. Of these pleural, peritoneal, pericardial fluids and cerebrospinal fluid are the most common. Cytologic study is done to diagnose disease ranging from benign (infective and inflammation) to malignant effusion1. Setting and Study Design: Pleural, peritoneal, and cerebrospinal fluid were included and others were excluded. In this study the significance of fluid cytology in the diagnosis of various neoplastic and non neoplastic lesions in the cytology section was carried out. Materials and Methods: All samples received in the Department of Pathology - pleural fluid, ascitic fluid and CSF were evaluated. Gross Examination of fluids was done for total Volume, Colour and Clarity. Biochemical test correlation of fluid Adenosine De-Aminase (ADA) levels was done wherever necessary. Diagnosis was done by consultants who were posted in cytopathology section. Results: In this prospective study from August 2015-2017, total 146 cases were studied of which 65 cases were of ascitic fluid, 41 of pleural fluid and 40 cases of CSF. Of these 146 cases, benign cases were 134 (91.78%), malignant effusion 9(6.16%) and suspicious of malignancy were 3 (2.05%). Among 146 study cases, 136 (93%) cases were having similar cytomorphological pattern (singly scattered), other 10 cases showed various patterns such as 3-dimensional clusters, sheets, etc. Conclusion: Body fluid examination with correlation of various parameters like thorough clinical history and examination, different serum marker levels, primary malignancy if present and previous cytological diagnosis are very useful for the final diagnosis.

Correlations Between pH Values of Oral Fluid and Dental Caries Epidemiologic Indicators in Children Aged within 6-12 Years

The aim of this study was to evaluate the correlations between the pH values of oral fluid and the epidemiologic indicators of dental caries in children aged between 6-12 years. Clinical examinations were performed on 1517 children and the analysis was made in groups of 6-8 years old (n=701) [male (n=353), female (n=348)], and 9-12 years old (n=786) [male (n=426), female (n=360)]. The research included the record the pH values of the oral fluid and clinical examinations for evaluation of the state of oral health, in conformity to the codes of the OMS carious affection level. For the determination and the record of pH values of the oral fluid we used GC Saliva pH Indicator kit. The study followed defs, deft, dmfs, dmft epidemiologic indices of dental caries. The determined values of oral fluid pH were between 5.0 and 6.4. The obtained values of indices in all studied groups and subgroups demonstrated the significant statistical difference between at least two values (p [ 0.001). 72% of the studied group presented with at least a dental surface affected in deciduous teeth, while only 40% of the children presented a carious process on the permanent teeth. The occlusal surface was the most frequently affected by dental caries, followed by the proximal surfaces (mesial and distal) and last being smooth surface caries. The study demonstrated the correlation between acidic values of oral fluid pH and the dental caries in the study group.