Download Proforma for registration of subjects for PG DISSERTATION

SYNOPSIS FOR PG DISSERTATION FOR MD/MS,
UNDER RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU.
1.
Name and address of the
Dr. PRITHA AGGARWAL
candidate (in block letters)
PG IN PATHOLOGY
M.V.J. MEDICAL COLLEGE & RESEARCH
HOSPITAL,
BANGLORE- 562114
Permanent Address
HNO. – 453, SECTOR – 37/A,
CHANDIGARH-160036
2.
Name of the institution
M.V.J. MEDICAL COLLEGE & RESEARCH
HOSPITAL, BANGLORE- 562114
3.
Course of study and subject
M.D. (PATHOLOGY)
4.
Date of admission to course
31st July 2013
5.
Title of the Topic:
HISTOPATHOLOGY OF SKIN BIOPSIES IN HANSEN’S DISEASE
6.
Brief resume of the intended work:
6.1 : Need for the study:
Leprosy or Hansen’s disease is one of the most dreaded of all diseases because
even though one may recover clinically, nerve damage can result in lifelong crippling
deformities. In some communities, its sufferers are the victims of social prejudice,
discrimination and stigma. 1
India is one of 14 countries where leprosy is still endemic. 2 and India
contributes two third of leprosy burden of world.
The study of pathological changes in leprosy lesions has contributed a great
deal to understanding of the disease and clinico-pathological correlative studies have
provided further insights into the disease, its varied manifestations and complications.
Pathological examination helps to confirm a presumptive clinical diagnosis and also
helps for exact typing.3
Histopathological examination of skin or nerve biopsies or the demonstration of
lepra bacilli in skin smears are the only laboratory means of confirming a diagnosis of
leprosy. The histological changes in the skin in leprosy are protean, and it is essential
for a histopathologist dealing with skin biopsies from leprosy patients to be aware of
these diverse manifestations. The histological features are particularly useful in the early
stages when there is a sparsity of bacilli in skin smears. 4
Various methods have been employed to confirm a diagnosis, right from the old
ZN staining to the more sensitive modified Fite ferraco stain. Fluorescent microscopy
has been used by some to reduce fatigue and for rapid screening. Other sensitive
methods like IHC, ISH and PCR have also been utilized.5
Considering the public health problem the present study is an attempt to analyze
the histopathological features of leprosy with the available facilities at a rural hospital
setup and to identify subtle points that could have an impact on diagnosis and treatment.
6.2 Review of literature:
Leprosy could have occurred as early as 1550 B.C in Egypt. Many scholars
believe that leprosy appears in an Egyptian papyrus document written close to that year.
Indian writings portray a disease that resembles leprosy 950 years later in 600
B.C. Leprosy is described as Kushta - which was used for skin disease in general,
including leprosy. According to Vagbhata (600AD), the name Kushtha was derived
from “Kushnati” which means eating away in Sanskrit.6
Mouat, in 1854, described Chaulmoogra oil as medication for leprosy.7
Rudolf Virchow described foamy macrophage of leprosy and the histopathology
of leprosy in 1862. 7
G.H. Armauer Hansen (1841-1912) discovered the leprosy bacilli in 1873.7
Robert Cochrane (1899-1985), the ‘Mr. Leprosy of India’ contributed a lot to
leprology in India. He was first to realize in late 1940s that the intramuscular injection
of sulphone (dapsone, DDS) was an effective anti-leprosy drug.7
Laboratory research on lepromin test and clinical research had being carried out
by Dharmendra (1900-1991) and by S.N Chatterjee (1900-1990) at a school of tropical
Medicine in Calcutta.7
Kaiserling 8 in 1917 was the first to observe spontaneous whitish – blue
fluorescence of a suspension of tubercle bacilli. Bachmann and Finke in 1939 were the
first to apply fluorescence microscopy for the detection of acid fast bacilli in tissue
sections.
Jariwala and Kelkar
9
observed that fluorescence microscopy was superior to
modified Fite – Faraco method for detecting acid fast microorganisms in paraffin
sections of cases of leprosy The ease and speed of fluorescence microscopy appeared to
be a great advantage.
Various studies have analysed the clinical and histopathological correlation and
have found varing degree of parity. Jerath et al (1982) in 68.5% , Kar et al (1994) in
70%, Moorthy et al (2001)in 62.63%, Pandya et al (2008) in 68.3%, and Mathur et al
(2011)in 80.4%. In most of these studies like moorthy et al, Kar et al and Jerath et al
found parity in TT pole and Jha et al found parity in BT cases while deeptara et al found
parity in TT and Bt cases. Mathur et al found parity in in LL pole.11
6.3 Aims and Objectives of the Study
1. To study the histological spectrum of skin lesions in Hansen’s disease
2. To assess the concordance between clinical and histopathological diagnosis in
cases of leprosy using the Ridley- Jopling scale.
3. To identify histological distribution of bacilli in skin with modified fite ferraco
stain
4. To perform a mast cell count on the fite ferraco stained sections in the biopsied
cases and correlate it with the various types of leprosy.
5. Assess the role of Auramine Rhodamine staining, in addition to fite ferraco stain
in the indeterminate cases
7.
Materials and Methods:
7.1 Source of data:
Prospective study of skin biopsies over a two year period from November
2013 to October 2015 in patients clinically diagnosed as leprosy by the department of
Dermatology, received in the department of Pathology, MVJ Medical College Medical
College & Research Hospital, Hoskote
7.2 Method of collection of data (including sampling procedure, if any):
Skin biopsies from all cases clinically diagnosed as leprosy received in the
department of Pathology will be studied. The biopsies will be taken by the Department
of Dermatology only following an informed consent.
The specimen will be fixed in 10% formalin. Paraffin blocks will be made and
sections will be cut at 4-5µ thickness. The slides stained by Haematoxylin & eosin &
modified Fite – Faraco stains will be observed under light microscope.
Histopathological findings will be graded according to Ridley and Jopling scale
and mast cell counts will be performed on the fite ferraco stained slides. Auramine
Rhodamine stain will be utilised in cases categorized as Indeterminate Leprosy to
identify lepra bacilli using fluorescent microscopy.
Sample Size: A minimum 40 cases will be studied.
Inclusion criteria :
All untreated cases clinically diagnosed as leprosy and biopsied for the first
time, will be included in the study.
Exclusion criteria:
1. Inadequate biopsies which did no include the full depth of dermis together with
a portion of subcutaneous fat.
2. Biopsy specimen received in a poorly preserved or autolysed state.
7.3 Does the study require any investigation or interventions to be conducted on
patients or other humans or animals? If so, please describe briefly. (As explained
above).
No.
This study requires only analyses of skin biopsies received at the department of
pathology.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
8.
List of references:
1. Gupta AK. Integrated approach for leprosy elimination. Indian Journal of
Development and Social Transformation.2004;1:31-36.
2. Damien Foundation India. Prevalence of leprosy. Update continuing medical
education.2002;10:2-5
3. Moorthy B N, Kumar P, Chatura K R, Chandrasekhar H R, Basavaraja P K.
Histopathological correlation of skin biopsies in leprosy. Indian J Dermatol
Venereol Leprol.2001;67:299-301
4. Wiersema JP, Binford CH. The identification of leprosy among epithelioid cell
granulomas of the skin. Int J Lepr .1972;40:10-32
5. Trajkovic V, Natarajan K, Sharma P. Immunomodulatory action of
mycobacterial secretory proteins. Microbes. Infect.2004; 6:513–519
6. Jopling WH, McDougall AC. Definition: Epidemiology and World Distribution.
In: Handbook of Leprosy. 5th ed. Delhi: CBS Publishers and Distributors; 1996.
p67
7. Pandya SS. Leprosy Control in India – Historical Aspects. In: Textbook and
Atlas of Dermatology. Eds. Valia RG, VAlia AR. 2nd ed. Bombay: Bhalani
Publishing House; 1994. p1422-1426
8. Klaus WF, Teng KP. Demonstration of acid-fast bacilli in tissue sections by
fluorescence microscopy. Canadian Medical Association Journal .1962;87:837841
9. Jariwala HJ, Kelkar SS. Fluorescent microscopy for detection of M.leprae in
tissue sections. Int J Lepr. 1979;47:33-36
10. Singhi MK, Kachhawa D, Ghiya BC. A retrospective study of clinicohistopathological correlation in leprosy. Indian J Pathol Microbiol. 2003;
46:47-8.
9.
Signature of the candidate
10. Remark of the guide
More studies are required to make the WHO dream of
Leprosy
eradication
true
with
early
disease
recognition diagnosis and prompt treatment, and thus
limiting or preventing spread
11. 11.1 Name and
designation of Guide
Dr. RAJA PARTHIBAN.S.R, MD
PROFESSOR,
DEPARTMENT OF PATHOLOGY,
M.V.J. MEDICAL COLLEGE & RESEARCH
HOSPITAL, BANGALORE 562114
11.2 Signature
11.3 Name and
Dr.SUJATHA.C, MD
designation of Co-Guide
PROFESSOR AND HEAD,
DEPARTMENT OF DERMATOLOGY,
M.V.J. MEDICAL COLLEGE & RESEARCH
HOSPITAL, BANGALORE 562114
11.4 Signature
11.5 Head of the
DR. SHAMEEM SHARIFF, MD.Phd.,
Department
PROFESSOR AND HEAD
DEPARTMENT OF PATHOLOGY,
M.V.J. MEDICAL COLLEGE & RESEARCH
HOSPITAL, BANGALORE 562114
11.6 Signature
12.
12.1Remarks of the Principal
12.2 Signature