Comparative Analysis of Bone Marrow Aspiration Smears, Touch Imprints and Trephine Biopsy in Haematological Malignancies

Introduction: Inspection of the bone marrow is considered oneof the most valuable diagnostic tool to evaluate hematologicmalignancies. This study compares all three techniques ofbone marrow aspiration (BMA), bone marrow imprint (BMI)and bone marrow biopsy (BMB) in morphological diagnosisof hematological malignancies.Material and methods: The study was conducted on 63selected cases of various hematological malignancies. Onlythose cases in which bone marrow examination was done byusing all the three techniques were included in the study.Results: Out of total 63 cases,53 cases were diagnosed onbone marrow aspirate smears with diagnostic accuracy of84.12%, 60 cases were diagnosed on bone marrow imprintsmears with diagnostic accuracy of 95.23% and all 63 caseswere diagnosed on bone marrow biopsy with diagnosticaccuracy of 100%.Conclusion: It is concluded that bone marrow imprintsare equally useful as bone marrow biopsy in diagnosinghematological malignancies. Imprint cytology shouldtherefore be a standard practice for evaluating bone marrow incases of hematological malignancies.

Clinicopathological spectrum of hairy-cell leukemia: A single-center study with brief review of Indian literature

Objective: The presence of specific chemotherapeutic protocols for hairy cell leukemia (HCL) makes it essential to discriminate this entity from other lymphoproliferative disorders. Hence, awareness of the variations in clinical presentations and immunophenotypic aberrancies is requisite to ensure diagnostic accuracy. Materials and Methods: A retrospective study was carried out to analyze the clinical-pathological profile of patients with HCL diagnosed over a period of 81 months (2010–September 2017) in our institute. Flow cytometry was performed in all the patients, and further, BRAFV600E mutation analysis was performed by real-time polymerase chain reaction in a limited number of samples. Result: A total of 353 lymphoproliferative disorders were assessed during the period, of which 16 (4.5%) were diagnosed as HCL, which included 15 cases of classical HCL and single case of HCL-v. Striking male predominance was noted with a median age of 52 (range 22–90 years). 47% patients presented with pancytopenia, while 20% cases had leukocytosis. Three patients presented with bleeding diathesis in the form of melena and purpuric spots. The absence of splenomegaly was observed in 20% patients (4/15) while 2 (13.3%) cases had lymphadenopathy. Hypocellular marrow was observed in 13% cases. Bright expression of CD20/CD22 along with CD25/CD103/CD123/CD11c was noted in all the patients of classical HCL. Aberrant expression of CD23 and CD5 was seen in 33% ( n =5) and 6.7% ( n =1) cases respectively. CD200 was positive in all the 5/15 cases tested. The case of HCL–v presented with very high leukocyte count and exhibited a CD103/CD11c+ and CD123/CD25- profile. BRAFV600E, mutation was present in all the four patients tested who included patients with a hypocellular marrow and absent splenomegaly. Conclusion: HCL has characteristic profiles, yet it may exhibit unusual clinical and immunophenotypic presentations. Perspicacious use of flow cytometry and BRAFV600E mutation analysis will aid in the diagnosis in unprecedented cases

Quality Control of Fresh Frozen Plasma using Factor VIII and Fibrinogen Levels as Measure: One Year Study in a Tertiary Care Hospital

Introduction: Quality control of blood and its componentsensures the availability of high quality product with maximumefficacy and minimal risk to recipients. As per standardguidelines, for quality assurance of FFP, 1% of all the unitsprepared or 4 units per month are tested for stable coagulationfactors: Factor VIII and Fibrinogen levels.Material and methods: The retrospective data was collectedfrom archives of blood bank from the period of 1st January2017 to 31st December 2017 in AIMSR, Bathinda. Out oftotal 3476 units collected, 2155 were processed for componentseparation. 1.9% of Fresh Frozen plasma (41/2155) were testedfor total volume, fibrinogen content and factor VIII levels forquality control with the help of semi-automated coagulometer.Results: 97.5% of FFP samples tested had factor VIII levelsabove 0.7 IU/mL and 100% of samples had fibrinogen content>200mg/dl.Conclusion: It is concluded that quality of FFP being preparedat our blood bank meets the international standards. Regularquality evaluation and maintenance of records helps to keepup the working standards and any deficiency can be checkedand curtailed.

Study of Cytomorphology Patterns of Breast Lesions and their Correlation with Thyroid Profile Over a Period of One and Half Years in a Tertiary Care Centre of Malwa Region

Introduction: Fine needle aspiration cytology (FNAC) has become an increasingly popular technique for assessment and initial diagnosis of breast lumps as it is the least invasive technique for obtaining a cytological diagnosis and is of high accuracy if done by experienced personnel. Thyroid hormone receptors affect both the normal breast cell differentiation and breast cancer cell proliferation, with effects of thyroid hormones similar to those caused by estrogens. Relationship between thyroid disease, such as nodular hyperplasia, hyperthyroidism and thyroid cancer, with breast cancer was demonstrated in several studies. In the present study, we have evaluated the correlation of cytomorphological diagnosis of breast lesions with thyroid profile. Material and Methods: Total of 80 cases were included in the study and all necessary statistical analysis was done including the percentages, means, standard deviations, ranges and p values. Results: Triiodothyronine (T3) and Tetraiiodothryronine (T4) levels were statically significantly lower among participants with malignant breast lesions as compared to benign breast lesions.(p < 0.01).However mean values of both were normal in both these groups. Thyroid stimulating hormone (TSH) levels among study participants with malignant breast lesions were statistically higher than those of benign breast lesions. However mean in both these groups was within normal range. Conclusion: No significant correlation between thyroid profile and breast lesions was established. But the effect of thyroid hormone on breast cancer clearly requires further research

Evaluation of Causes of Failures in Endodontic Treatment: A Clinical Study

Endodontic treatment or root canal treatment is a treatment sequence for the infected pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. The present study was conducted to assess the causes of endodontic failures. Methods: The present study was conducted on 100 patients of both genders. A total 220 endodontic treated teeth were evaluated. Intraoral periapical (IOPA) radiograph was used for assessment of presence or absence of periapical radiolucency, quality of obturation, missed canal, dislodged/fractured restorations, iatrogenic problems: perforation, file separation, ledges etc. Results: Out of 100 patients, males were 40 and females were 60. The difference was non- significant (P-0.5). Common cause of failure was missed canal (maxilla- 40%, mandible- 45%), inadequate obturation (maxilla- 45%, mandible- 50%) and fractured coronal obturation (maxilla- 15%, mandible- 5%). The difference was significant (P<0.05). Conclusion: Endodontic failure is not uncommon phenomenon. Common causes are missed canal, inadequate obturation and fractured coronal obturation. Periodic evaluations of cases are required to prevent developing complications.

Consideration of Risk Factors Allied with Dry Socket: A Clinical Study

Dry socket (DS) is frequent complication seen in patients undergoing extraction. The present study was conducted to evaluate the risk factors associated with DS. Methods: This study was conducted in department of dentistry. It consisted of 520 teeth in 840 patients requiring extraction of teeth. General information such as name, age, gender, smoking status and systemic diseases were recorded. Patients were divided into 4 age groups. Patients were divided into medically fit and with systemic disorder. Results: Out of 840 patients, 480 were males and 360 were females. The difference was non- significant (P- 0.1). 50 patients had DS, the prevalence was 6%. The number of patients with DS in <18 years was 8, 18-30 years (20), 31-50 years (15) and >50 years (7). The difference was nonsignificant (P>0.05). 10 patients had DS among 150 patients medically fit and 40 patients had DS among 640 systemic ill patients. The difference was significant (P< 0.05). Smokers were 210 out of which 18 had DS. Nonsmokers were 630 out of which 32 had DS. The difference was significant (P<0.05). Conclusion: Dry socket is one of the complications seen following extraction of teeth. Medical condition affects the outcome of the treatment. Smoking is one of the contributory factors leading to DS.

A comparative study of granisetrone, dexamethasone and combination of granisetrone-dexamethasone as prophylaxis for postoperative nausea vomiting during laparoscopic surgeries

Background: In laparoscopic surgeries, insufflation with carbon dioxide triggers vagal afferents on the bowel and peritoneum which induces emesis by activating the vomiting center. It is hypothesized that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. So, the present study was planned to compare the efficacy of granisetron, dexamethasone and combination of granisetron with dexamethasone to prevent PONV.Methods: This randomized prospective double-blind study was performed on 120 patients, aged between 18 and 58 years of ASA physical status I and II of either sex undergoing laparoscopic surgeries under general anesthesia. Patients were randomized in three groups, group I (granisetrone 2 mg I.V.), group II (dexamethasone) 8 mg I.V., group III (granisetrone+dexamethasone) 2 mg+8 mg I.V. with 40 patients in each group. Complete response, incidence of nausea, vomiting, and rescue antiemetic were recorded at specified intervals.Results: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 75% of the patients given granisetron, 70% in dexamethasone and in 92.5% of the patients given granisetron plus dexamethasone (P <0.05). The overall cumulative incidences (0-24 hours) of PONV were 10 (25%) in the granisetron, 12 (30%) in the dexamethasone and 3 (7.5%) in the combination group. No difference in adverse events were observed in any of the groups.Conclusions: The prophylactic therapy of granisetron 2 mg plus dexamethasone 8 mg just before induction of anaesthesia is significantly effective in prevention of PONV in patients undergoing laparoscopic surgeries.

Music: an effective anxiolytic during caesarean section under spinal anaesthesia

Background: Parturient undergoing repeat caesarean section (CS) under spinal anaesthesia usually experience anxiety due to unpleasant operative environment. Music therapy has been found to have positive psychological impact to relieve anxiety, improve patient satisfaction and provide stable haemodyanamics.Methods: Sixty patients without any co morbidity having history of previous CS, scheduled for another caesarean under spinal anaesthesia were included in the study. Patients were divided into two groups of 30 each. Group(M) patients were subjected to hearing music of their choice with the help of headphones after administration of spinal anaesthesia till the end of surgery. Group(N) patients were not made to listen to any music but headphones were applied. Haemodyanamic parameters including mean arterial pressure (MAP) and heart rate (HR), visual analogue score for anxiety (VASA) after administering spinal block and at the end of surgery, patient satisfaction score (PSS) and comparison of anxiety with previous CS were observed and recorded.Results: Both MAP and HR in Group M started falling after 10 minutes of spinal anaesthesia as compared to Group N and difference was significant (P <0.005), VASA 2 (2.2±1.8) in Group M was significantly lower than VASA 1 (5.4±1.7). PSS was also in favour of music group (Group M) and difference was highly significant as compared to group N (p=0.018). Patient’s anxiety as compared to anxiety with previous CS was lesser in Group M as compared to Group N(p=0.009).Conclusions: Music is a non-invasive tool to relieve anxiety during intraoperative period along with higher patient satisfaction and stable haemodyanamics.

Descriptive statistics and normality tests for statistical data

Descriptive statistics are an important part of biomedical research which is used to describe the basic features of the data in the study. They provide simple summaries about the sample and the measures. Measures of the central tendency and dispersion are used to describe the quantitative data. For the continuous data, test of the normality is an important step for deciding the measures of central tendency and statistical methods for data analysis. When our data follow normal distribution, parametric tests otherwise nonparametric methods are used to compare the groups. There are different methods used to test the normality of data, including numerical and visual methods, and each method has its own advantages and disadvantages. In the present study, we have discussed the summary measures and methods used to test the normality of the data.

Assessment of Denture Stomatitis Cases among Complete Denture Wearers

Background: Denture stomatitis (DS) is a common oraldisease in denture wearers and quite characteristic ofadvanced age. The present study was conducted to assess thecases of denture stomatitis among complete denture wearers.Materials & Methods: The present study was conducted on445 completely edentulous patients wearing completedentures. In all patients, careful examination was done toevaluate the degree of the DS-modified Newton’s index (NI): 0= no inflammation; 1 = pin-point hyperemia; 2 = diffuseerythema; and 3 = papillary hyperplasia) 4, 5 in the completedenture wearers.Results: Out of 445 patients, males were 245 and femaleswere 200. The difference was non- significant (P- 0.1). Out of445 cases, DS was seen in 210 (47.1%) cases. 52% ofmaxillary and 43 % of mandibular dentures showed 0 grading,25% maxillary and 20% mandibular dentures showed 1grading, 13% maxillary and 25% mandibular dentures showed2 grading and 10% maxillary and 12% mandibular dentureshad 3 grading. The difference was significant (P< 0.05).Conclusion: Denture wearing habits, denture hygiene habits,denture cleanness and oral hygiene instructions madesignificant influence on the degree of DS in CD wearers. Hencein complete denture wearers, education is must to ensureproper cleanliness of the denture to prevent DS.

Scales of measurement and presentation of statistical data

Measurement scale is an important part of data collection, analysis, and presentation. In the data collection and data analysis, statistical tools differ from one data type to another. There are four types of variables, namely nominal, ordinal, discrete, and continuous, and their nature and application are different. Graphs are a common method to visually present and illustrate relationships in the data. There are several statistical diagrams available to present data sets. However, their use depends on our objectives and data types. We should use the appropriate diagram for the data set, which is very useful for easily and quickly communicating summaries and findings to the audience. In the present study, statistical data type and its presentation, which are used in the field of biomedical research, have been discussed.

Functional Outcome of Surgically Treated Sanders Types II, III, IV Calcaneal Fractures: An Observational Study.

Background: Management of calcaneal fractures has always been in controversy. Many treatment techniques have been described, but specific indications are vague. In this prospective study, we studied the functional outcome of surgically treated intra-articular calcaneal fracture. Aim and Objective: To study the outcomes in terms of mechanism of injury, intra-operative difficulties, post-operative complication, infection, the range of motion in the surgically managed calcaneal fracture. Materials and Methods: A total of 32 Patients with 34 calcaneal fractures operated in NCH Surat from September 2012 to December 2014 were included in the study. Pre-op computed tomography (CT) scan carried out in all patients. Maryland foot score was used to evaluate to assess the functional outcome. Results: Incidence is much more common in males (90.6%), most of the patients being in their 3rd decade of life. The spinal fracture was the most common associated injury (30%). Results according to Maryland foot score were excellent in 26.4%, good in 61.64%, and none of the patients had poor results. Complications include synovitis, broadening and superficial infection. Pre-op CT scan is very useful tool in calcaneal fractures. Conclusion: Open reduction internal fixation is the ideal treatment for Sanders type 2/3/4. Even Sanders Type IV (which was thought to be associated with poor results) had a good outcome in short-term follow-up. Use of proper surgical timing/technique/asepsis can lead to good or excellent results in more than 90% of patients and avoiding the majority of the complications. Use of beta-tricalcium phosphate is not a cost effective measure as results are similar in all patients. Earlier mobilization, early return to work, good cosmesis, better subtalar motion are all advantages of surgery.