Comparison of blunder lecture with tutorial for small-group discussion among Phase I M.B.B.S. students in a medical college in North India

Background: Small-group discussion (SGD) plays an essential role in physiology to foster active learning by the students. Blunder lecture has been used to stimulate inquiry, reflection, and promote collaborative learning by cognitive conflict strategy. Aims and Objectives: The objectives of the study were as follows: (i) To compare the effectiveness of blunder lecture with tutorial for SGD and (ii) to assess the perception of students toward blunder lecture and tutorial. Material and Methods: An educational interventional study was conducted in the department of physiology among 116 Phase I MBBS students using tutorial and blunder lecture for SGD on two core topics of physiology which were already covered in didactic lectures. Blunder lecture included deliberate mistakes spread over the different levels of Bloom’s taxonomy. Blunders were identified and discussed during the group activity. The evaluation was done by validated pre-post tests and questionnaires. Results: There was a statistically significant gain in the mean score of the students who attended blunder lecture session in comparison to tutorial. Out of 116 students who participated in the study, 89% perceived blunder lecture as a challenging way to recollect prior knowledge. Conclusion: Blunder lecture is an effective reinforcement tool that can be used in SGD to facilitate the learning of the undergraduates.

Neuroblastoma: Application of International Neuroblastoma Pathology Classification on fine needle aspiration cytology smears

Background: Neuroblastoma (NB) is the fourth most common tumor of childhood. There is a paucity of literature on its subtyping of cytology and prognostic utility. Aims: We aimed to study the cytopathological features of NB on the aspirated material, subtype it, and assess the role of International Neuroblastoma Pathology Classification (INPC) classification on cytology smears in the preoperative prognosis of NB. Materials and Methods: Fifteen cases of NB reported on fine-needle aspiration cytology (FNAC) in the past 3 years were included. Detailed clinical, radiological, and cytological features were noted. Smears were assessed for characteristics such as cellularity, neuroblasts (cytoplasmic, nuclear details), rosettes, neuropil, Schwann cells, fibroblasts, calcification, and necrosis. Afterward, cases were categorized as undifferentiated (UD), poorly differentiated (PD), and differentiating (D) subtypes. Mitotic-karyorrhectic index (MKI) was calculated and correlated with histopathology. Follow-up was done to date. Results: The age ranged from 19 days to 10 years with an M: F ratio of 3:1. Twelve cases were retroperitoneal, two cervical, and one mediastinal. Metastatic disease was seen in six cases, one to the cervical, four to the bone marrow, and two to the scalp. The International Neuroblastoma Risk Group (INRG) staging system was available in all cases, out of which three were in stage L1, six in stage L2, four in stage M, and two in stage Ms. On cytology, four cases were differentiating NB, five PD NB, and six UD NB. The MKI was high (>4%) in 80% of UD, intermediate (2–4%) in 100% of PD, and low (<2%) in 75% of D cases. MKI corroborated in both histology and cytology, except in one case. Conclusion: NB can be subtyped on cytology on the basis of characteristics of neuroblasts, presence of neutrophils, rosettes, and necrosis. UD NB has a high MKI and is associated with a poor prognosis. A preoperative comprehensive reporting of NB on cytology can be very useful in guiding appropriate chemotherapy with some increment in survival. However, larger studies are needed to validate the calculation of MKI on FNA smears.

Anterior segment optical coherence tomography of intraocular lens opacification

Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.

Various Obturation methods used in deciduous teeth.

Pulpectomy is one of the treatment options used to maintain primary teeth with radicular pulpal tissue inflammation or that have become nonvital, until normal exfoliation. The primary goal of this procedure is to maintain arch length and function by preserving primary teeth that are essential to proper guidance of the permanent dentition. Other objectives of preserving primary teeth are to enhance esthetics and mastication, prevent aberrant tongue habits, aid in speech, and prevent the psychological effects associated with tooth loss. The treatment consists of removing the pulp tissue associated with micro-organisms and debris from the canal and obturating with resorbable filling material. Familiarity with the complexity of primary tooth canal systems, their formation and resorption pattern dictates the parameters that affect the probability of success of root canal therapy. Moreover, the obturating material as well as obturation technique used that is capable of densely filling the entire root canal system and providing a fluid tight seal from the apical segment of the canal to the cavosurface margin in order to prevent reinfection also significantly influences the success rate of the endodontic therapy. Several methods have been used to deliver obturating materials into the root canals. The purpose of this article is to throw light on various obturation techniques used in deciduous teeth with their comparison, pros and cons.

Emergence of decreased susceptibility to extended-spectrum cephalosporins in Neisseria gonorrhoeae in India.

Background. In the past, Neisseria gonorrhoeae has developed resistance to antimicrobial agents used for its treatment. Consequently, extended-spectrum cephalosporins form the mainstay of treatment for gonorrhoea. Methods. Samples from 88 patients attending the sexually transmitted diseases clinics from December 2009 to January 2011 in two referral hospitals in New Delhi were studied. Antimicrobial susceptibility testing was done using the disc diffusion method as per the calibrated dichotomous sensitivity technique against the following antibiotics: penicillin (0.5 i.u.), tetracycline (10 μg), nalidixic acid (30 μg), ciprofloxacin (1 μg), spectinomycin (100 μg), ceftriaxone (0.5 μg) and cefpodoxime (10 μg) (Oxoid UK). Azithromycin (15 μg) (Oxoid, UK) was tested as per the guidelines of the Clinical and Laboratory Standards Institute. Minimum inhibitory concentrations were determined using the Etest for penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin and azithromycin as per the manufacturer’s instruction (Biomerieux, France). Results. Eighteen isolates of Neisseria gonorrhoeae were obtained. Three of these had decreased susceptibility to ceftriaxone and cefpodoxime by the disc diffusion method. The minimum inhibitory concentrations of ceftriaxone for two isolates were 0.064 μg/ml and for one isolate it was 0.125 μg/ml. Conclusion. Higher minimum inhibitory concentrations to extended-spectrum cephalosporins is of concern as it has been shown to precede treatment failure. This may warrant its use in increased/multiple dosages alone or possibly in combination (dual therapy), thereby complicating effective disease control. Our report is in accordance with earlier reports from different parts of the world. Therefore, a continuous surveillance of antimicrobial resistance is crucial to tailor treatment schedules for Neisseria gonorrhoeae in a particular geographical region.

Unifocal bony lesion of langerhans cell histiocytosis of tibia in a child mimicking osteomyelitis : A diagnostic challenge.

Langerhans cell histiocytosis (LCH) is a rare proliferative histiocytic disorder of unknown etiopathogenesis. The clinical presentations range from unifocal or multifocal bony lesions to disseminated form of the disease with multiorgan involvement. The unifocal bony lesion (Solitary eosinophilic granuloma) carries a good prognosis. We report such a case of unifocal bony lesion of LCH involving tibia in a 8 years old female child. The clinical and radiological manifestations were non specific, enlightening the suspicion of osteomyelitis. A curettage excision biopsy was performed which on microscopy revealed sheets of eosinophils in milieu of Langerhans cells, giant cells, lymphocytes and plasma cells. Langerhans cells showed strong immunoreactivity for S-100 and CD1a antigen thus establishing the diagnosis of LCH. LCH of long bones may be a rare entity but it must be kept in mind as a differential diagnosis whenever a child presents with features of osteomyelitis.

Extrapulmonary Tuberculosis In M.M.I.M.S.R, Muallana Ambala: A Microbiological & Histopathological Study.

Clinical microbiological and histopathological confirmation plays a key role in the diagnosis of tuberculosis. The present study correlates Zeihl Nelson staining , Lowenstein Jensen culture media, Montoux test and histopathology in the diagnostic yield of extrapulmonary tuberculosis.Result of current study shows out of total 255 samples, 24 (9.4 %.) showed the presence of mycobacteria by either of the following methods: LJ culture media, ZN staining, histopathology and montoux test.

The role of a commercial enzyme immuno assay antigen detection system for diagnosis of C. trachomatis in genital swab samples.

In the present pilot study, endocervical and urethral swabs collected from 100 patients attending sexually transmitted disease (STD) clinics and regional centre for STD in two referral hospitals in New Delhi were analyzed by enzyme immune assay (EIA), polymerase chain reaction (PCR) and direct fluorescent antibody (DFA) for detection of C. trachomatis. It was found that EIA could detect a very low number of cases (3/100) as against DFA (11/100) and PCR (9/100). Thus, in spite of the widespread availability, lower cost and ease of performance of the enzyme-linked-immunosorbent serologic assay, the present study highlights the need to employ sophisticated diagnostic tools like DFA and PCR for detection of Chlamydia trachomatis in STD patients.

Fine needle aspiration cytology of thyroid swellings: How useful and accurate is it.

Background: Fine needle aspiration cytology (FNAC) is widely considered as the diagnostic technique of choice in the assessment of thyroid lesions. Aims: The aim of this study is to determine the utility and diagnostic accuracy of FNAC of thyroid lesions performed at our institution and to compare our experience with that of the experts from other regions of the world. Setting and Design: The present study is a five-year retrospective study of FNAC of thyroid lesions performed in the Pathology Department of our institute, during the period January 2004 to December 2008. The FNAC findings were correlated with the histopathological diagnosis, wherever available. Materials And Methods: 0 The records of 252 patients who had undergone FNAC during the study period were retrieved and information about age, sex, FNAC, and Histopathological diagnoses were extracted and the corresponding original slides were reviewed. The cytological results were classified as inadequate, benign, suspicious, and malignant. The histopathology diagnosis was classified as non-neoplastic (benign) and neoplastic (malignant). Results: A total of 252 FNACs of thyroid lesions were done during the study period. The results of the FNA cytological diagnosis showed that four (1.6%) of the patients had FNAs, which were inadequate for cytological assessment, 228 (90.5%) patients had benign lesions, 17 (6.7%) had lesions that were suspicious for malignancy, and three (1.2%) had malignant neoplasms. The correlation of the FNAC findings with the histopathological diagnosis, showed that our FNAC diagnostic accuracy rate was 96.2%, with a sensitivity of 66%, and specificity of 100%. Conclusions: The results of our study are comparable with the current published data and demonstrate that FNA cytology is a sensitive, specific and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings in our setting as well. The clinicians should be encouraged to embrace this procedure in the initial management of such patients.

Primary endometrial squamous cell carcinoma with extensive squamous metaplasia and dysplasia.

Primary squamous cell carcinoma of endometrium is a rare entity. Only 64 cases have been documented in the literature. We report a case of 60-year-old postmenopausal woman who presented with abdominal distention and blood-stained vaginal discharge for 6-7 months. Clinically, chronic pyometra was considered. Total abdominal hysterectomy was performed and histopathologically, it was diagnosed as a case of primary squamous cell carcinoma of endometrium with extensive squamous metaplasia and dysplasia.