Ki‑67 Expression in Oral Potential Malignant and Malignant Lesions and Correlation of Mitotic Index with MIB‑1 Labeling Index

Introduction: Oral cancers are the most serious health issues in underdeveloped countries such as India and considered as the main cause of death. Among them, oral squamous cell carcinoma is the most common type (90%) of all malignancies. Various oral potential malignant lesions (OPMLs) can transform into malignancies. This study was conducted to determine the significance of Ki‑67 expression in oral potential malignant and malignant lesions (MLs) as well as correlation of mitotic index (MI) with MIB‑1 labeling index (LI) in these lesions. MaterialsandMethods: The study was performed on 60 cases in a tertiary care center over a period of 2 years. Ki‑67 expression, MI and MIB‑1 LI were calculated and correlated. Results: In the studied population, there were 49 (81.7%) males and 11 (18.3%) females. The mean age was 46.60 ± 9.94 (23–68 years), with majority of patients in 41–60 years of age group (46/60 cases). Anterior 2/3rd tongue is the most affected site, presented ulcer as the most common lesion. Smoking, tobacco, and betel nutchewing addiction were presented in 72% of the patients. Among 60 cases, 45 (75%) were OPMLs, while 15 (25%) cases were MLs. MI increases in OPMLs and MLs and comparison was significant (P < 0.01). MIB‑1 LI was significant (P < 0.01) on comparison to dysplasia III and MLs. A positive correlation (0.01) was established between MI and MIB‑1 LI of OPMLs and MLs. Conclusion: Ki‑67 expression was found correlated with the progression of disease from OPMLs to MLs. Therefore, it is considered a proliferative marker that corresponds with disease progression. Both proliferative indices (MI and MIB‑1 LI) are positively correlated

Role of Hematological and Inflammatory Markers in Early Diagnosis and Severity of COVID‑19 Disease

Background: COVID‑19 virus, causing severe acute respiratory illness (SARS‑CoV‑2), was declared as a pandemic by the WHO in March 2020, after its first outbreak in China at the end of 2019. The major purpose is to establish the role of a hematological and inflammatory markers in early diagnosis of COVID‑19 illness and its relationship with the disease severity. Materials and Methods: The study was performed in a tertiary care center from April to September 2020. The study included 150 hospitalized COVID‑19 Reverse transcription‑polymerase chain reaction positive patients. According to ICMR standards, research patients were grouped into mild, moderate, and severe categories depending on clinical evaluation. Different laboratory parameters complete blood counts, prothrombin time (PT), activated partial thromboplastin time (APTT), d‑dimer, serum ferritin, C‑reactive protein (CRP), and mean results are compared among the patient in three disease severity groups. Results: In the studied population, there were 106 (70.7%) males and 44 (29.3%) females. The average age of the research participants was 48.40 ± 11.50 (21–75 years), with majority of patients being old (>60 years). Hematological markers such as total leukocyte count, Neutrophil‑to‑lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) and the levels of PT, APTT, and D‑dimer, as well as ferritin and CRP, all were considerably high with different groups of disease severity (P = 0.001). Conclusion: The study concluded that patients of severe disease category have significantly higher levels of leukocytosis, neutrophilia, elevated NLR, PLR, PT, APTT, D‑dimer, serum ferritin, and CRP. Hematological and coagulation symptoms are associated with COVID‑19 illness, and these indicators might be employed as a prognosticator for prediction of early disease severity.

Floating Drug Delivery System: A New Approach

Floating drug delivery system (FDDS) helps to improve the buoyancy property of the drug over the gastric fluids and hence maintain the longer duration of action. The aim of the present study is on floating drug delivery systems (FDDS) was to compile the recent literature with particular focus on the main floating mechanism to achieve gastric retention. Floating multi-particulate are gastro-retentive drug delivery systems which are based on non-effervescent and effervescent approach. This type of drug delivery method would have comparatively less side effect and would eliminate the need for repeated dosages.

CHALLENGES IN INITIATION OF TREATMENT OF MULTI DRUG RESISTANT-TB PATIENTS: A HOSPITAL BASED CROSS SECTIONAL STUDY IN JHARKHAND.

BACKGROUND: Multi-drug resistant tuberculosis has become major public health problem and obstacle to effective control of tuberculosis. Over a period of time, there are several landmark achievements including policy and system preparedness for universal access to TB care including mandatory noti?cation of TB cases, development of standard for TB care in India, comprehensive real time TB information management system-NIKSHAY, use of rapid molecular diagnostics, successful innovations in private sector engagement for TB care-Universal access to TB care. Objective was to ?nd out the challenges in initiation of treatment of Multi Drug Resistant-TB patients get admitted in ITKI Sanatorium Ranchi Jharkhand. METHODS: It was a hospital based cross sectional study carried out from August 2016 to Nov.2018 on Multi drug resistant tuberculosis patients admitted in MDR-TB centre Itki Sanatorium Ranchi after approved from institutional ethics committee. Total study subjects included in study was 64. RESULTS: Most of the study subjects 58 (90.6%) did not know about the MDR-TB. Most of the study subjects 40 (62.5%) had been given reports of CB-NAAT test on same day followed by study subjects 24 (37.5%) on alternate day. No one study subjects 64 (100%) had been given any type of incentive for travelling to pretreatment evaluation centre. In above table, most of the patients 51 (79.7%) had made payment for investigations at district hospital/ SDH level followed by 13 (20.3%) who were free of any expenditure for investigations. Most of the study subjects 60 (93.7%) were not visited by any health staff between ?nal diagnosis of MDR-TB and initiation of treatment for MDR-TB followed by subjects 4 (6.3%) who were being visited by health staff. Most of the study subjects 48 (75%) were unaware about the NIKSHAY POSHAN SCHEME for MDR-TB patients followed by subjects 16 (25%) who knew about the NIKSHAY POSHAN SCHEME for MDR-TB patients by means of various medium.

A Prospective Study to Improve the Yield of Esophagogastroduodenoscopy at a Tertiary Hospital in India

Background: Esophagogastroduodenoscopy (EGD)is an efficient tool for diagnosis, screening and therapy. However, it must be used efficiently, to maximize value for costs and reduce complications. Many centers have adopted an open-access referral policy, resulting in increased costs, waiting times and clinical workload. When EGD is used for screening of common symptoms like dyspepsia by medical and paramedical personnel, the yield is less than 50%.We planned a study to differentiate disease from non-diseased findings and improve the diagnostic yield of EGD. Methods: The clinical history and examination of 150 patients of a tertiary care hospital in north India over 2 years wasrecorded. EGD when indicated by any clinician or desired by a patient was performed by a consultant, using topical anaesthesia.The outcome of the endoscopy was categorized as positive, if there was significant finding. Less severe and equivocal findings such as gastritis, duodenitis were not considered positive for the purpose of this study. Logistic regression (forward LR score) was used; the coefficient of regressionwas used to assign a score for each symptom. Results: Pain was the most common symptom; in 110 patients (77.3%) the endoscopy showed no significant findings. Significant findings were seen in 34 patients giving a diagnostic yield of 22.7%. Clinical features like weight loss, hematemesis, melena, dysphagia, anemia, abdominal distention, ascites, and abdominal lump significantly discriminated and pointed towards a positive endoscopic finding. Pain was not a good discriminating factor; dysphagia, presence of ascites and the presence of abdominal lump independently predict significant endoscopic findings. At a total score of 4 or less endoscopy could be avoided in 75 (50%) of the patients. A score of 5 yielded a sensitivity of 82% and specificity of 71%. For picking up a positive finding. All 11 patients with malignancy had a score >5. Conclusions: Our findings suggest selection of patients for EGD can be improved based on a scoring system. It also provides a basis for prospective studies which can lead to better use of resources in future.

Outcomes of Surgical Management of Floating Knee Injuries

Introduction: Floating knee, referred to as ipsilateralfractures of the femur and tibia, is usually associated withseveral complications and mortality. This study was designedto present our experience with treatment of this injury.Demographic parameters like age, sex, mechanism of injury,associated injuries, method and results of treatment, andcomplications of floating knee are discussedMaterial and Methods: This Prospective study wasperformed between January 2014-July 2016. All patientswith floating knee injuries who were admitted to the PMCHfulfilling the inclusion and exclusion criteria were included.The information about the 20 cases of floating knee injurieswere gathered, particularly the demographic parameters, modeof injury, bones involved, condition of skin, other associatedinjuries and their neurovascular status. The patients werefollowed for a minimum of one year duration and functionaloutcome was assessed.Result: Most of the patients were between 21-30years of age(45%). The floating knee injuries were more common in males(85%). FraserType I fracture was observed in 70% of cases.Roadtraffic accidents(RTA) was the most common cause ofsuch injuries. 18 out of 20(90%) cases were having associatedinjuries while only 10%were cases of isolated floating knee.The most common early and late complications were infectionand knee stiffness respectively. The final outcome as perKarlstrom criteria was excellent and good in 11 out of 14 casesof Fraser type I fracture and in 3 out of 6 cases of Fraser type IIfracture, and this was statistically significant (P=0.05).Conclusion: This study revealed that the complication rateassociated with floating knee injuries remain high and theprognosis mostly depends on type of injury and associatedinjuries. This study also advocates early aggressive approachfor management of these injuries.

To Assess the Correlation between Bone Marrow Morphology and Immunophenotypic Findings in Patients of Chronic Lymphoproliferative Disorders (CLPD’s) and to Assess the Role of Flowcytometric Immunophenotyping in Diagnosis and Subclassification of CLPD’s

Introduction: Chronic lymphoproliferative disorderrepresent clonal proliferation of morphologically andimmunophenotypically mature B or T cells characterized by alow proliferation rate and prolonged cell survival. Study aimedto assess the correlation between bone marrow morphologyand immunophenotypic findings in patients of ChronicLymphoproliferative Disorders (CLPD’s) and to assess therole of flowcytometric immunophenotyping in diagnosis andsubclassification of CLPD’s.Material and Methods: 48 newly diagnosed cases ofCLPD were included. After complete clinical evaluation theyunderwent marrow aspiration, biopsy and immunophenotypingby flowcytometry with selected panel of monoclonalantibodies.Results: On morphology 47.9% cases were CLL. In 52.1%non CLL cases , 4.2% were PLL , 2% case as LPL and45.8% cases were CLPD-unclassifiable. Commonest patternof marrow infiltration noted on trephine biopsy was diffuse inCLL, HCL-V, B-PLL and T-CLPD. On immunophenotyping95.8% cases were B-CLPD and 4.25% T-CLPD. CD5, CD22,CD23, FMC7 and SmIg were used as first line markersfollowed by CD 10, CD 25, CD103, CD38, CD138 andCyclin D1 (on biopsy sections) as second line markers. Finalimmunophenotypic diagnosis was CLL (54.2%), B-CLPDunclassified (29.2%), 4.1% each of LPL, MCL, T-CLPD and2% each of B-PLLand HCL-V.Conclusion: Concordance rate between morphologicaldiagnosis and immunophenotypic diagnosis was 79.17%.Hence, Flowcytometry is necessary for confirmationof diagnosis and to classify the CLPD cases which areunclassifiable by morphology

Progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers

Background: The aims and objectives were to study the progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers.Methods: The study was carried out in TB Sanatorium ITKI, Sadar Hospital Ranchi and RIMS Ranchi. The interview of various health personnel including SAHIYAs was taken using a semi-structured questionnaire based on programmatic management of multi drug resistant tuberculosis guidelines -2016.Results: Among Doctors knowledge level was good compared to other health personnel which had mean value 7.33 (±2.79), laboratory technician 3.45 (±2.64), STS 4.67 (±1.59), Sahiya 2.1 (±0.73). Regarding capacity enhancement level all health personnel needed refresher trainings in which doctors got 4.67 (±1.58), laboratory technician 3.45±2.64, STS 1.72±0.34, and Sahiya 0.5±0.52. Specially sahiya needs training regarding MDR-TB because they are the connecting link between health system and community. Regarding execution level, Doctors got 1.86 (±0.74), laboratory technician 1.64 (±0.56), STS 1.64 (±0.56) and Sahiya (ASHA) 2.2 (±0.44). Sahiya were better than other health personnel at execution level.Conclusions: Advocacy, communication, and social mobilization are important aspects of TB control, Policy makers and administrators should be sensitized for need of adequate and sustained funding for TB control to ensure quality capacity building. They need to provide continuous and quality training of staff at different levels and retention of trained staff and periodic reviews to identify gaps and take corrective steps.

Cytological Study of Cervical Lymph Nodes with Clinico-Radiological Correlation in Adults

Objective: The spectrum of lesions diagnosed by fine needleaspiration cytology with routine & special stains and it’scorrelation with radiological findings.Materials & Methods: The study is performed on a total ofhundred (100) patients over duration from February 2017 toSeptember 2018. The data was collected in cytopathologysection of TMMC & RC from the patients referred from OPDsor was admitted through the period of study.Results: Among 100 FNAC cases, 36(36%) had NecrotizingGranulomatous Lymphadenitis, 23(23%) had GranulomatousLymphadenitis, 20(20%) had Reactive Lymphadenopathy, 6%had suppurative lymphadenitis & 2% had Necrotic Lymphnode, 10(10%) had Metastatic Squamous cell carcinoma,2(2%) had Hodgkin Lymphoma, 1(1%) had Non – HodgkinLymphoma.Conclusion: Our study concluded that FNAC is a minimallyinvasive, cost effective and rapid diagnostic tool. When used inconjunction with radiology for the diagnosis oflymphadenopathy FNAC can be a cost effective method

Necrotizing Soft Tissue Infections: Management and Outcomes in a Tertiary Care Hospital of North India

Introduction: Necrotizing soft tissue infections (NSTIs) are agroup of fulminant infections which can involve any part of thesoft tissue with high mortality rate. Hence, it requires promptrecognition and management consisting of critical care supportand widespread surgical debridement.Methods: The present study summarizes the epidemiology,clinical features, risk factors and treatment principles used tomanage cases of NSTIs in a Tertiary care hospital of Delhi.Results: NSTI was found to be more prevalent in males(72.06%), 66.17% of the cases were those who were alreadysuffering from comorbidities. A high mortality rate of 20.59%was observed in the study.Conclusion: Diagnosis is deciding factor for overall positiveoutcome in these cases, which is usually made on the basis ofclinical history, physical findings and high index of suspicion.Overall management needs a multidisciplinary approach.

Conservative Management of a Traumatic Tracheal Tear: A Case Report

We describe here a case of traumatic anterior tracheal walltear managed conservatively with a successful outcome.Conservative treatment has a high likelihood of success inpatients who meet strict selection criteria and are closelymonitored in ICUs or elsewhere. This case highlights the roleof conservative management in treating such crucial cases inthe presence of limited resources, especially in a governmentset up in India.

A comparative study of histopathological findings in psoriatic lesions with and without treatment

Background: Psoriasis is a multifactorial chronic relapsing inflammatory dermatological disorder associated with significant comorbidities. It is characterized by sharply demarcated, erythematous papules, and plaques with abundant silvery-white scales. Due to its variable clinical presentation, histopathology remains the mainstay of diagnosis. However, these histologic features changes with treatment and may also guide in therapeutic decision-making. Aim: The aim is to evaluate and compare the histopathological features of psoriatic lesions before treatment with those receiving treatment for psoriasis. Patients and Methods: A total of 101 biopsies from selected consecutive patients of histopathologically confirmed psoriasis vulgaris were included in the study. These cases were then divided into two groups, Group A includes cases who never received treatment and Group B, those receiving treatment for psoriasis. These biopsies were histopathologically analyzed and compared for various morphological features. Results: Of 101 cases of psoriasis, 72 cases were included in Group A and 29 were included in Group B. Biopsies of Group A showed parakeratosis and acanthosis as a common feature in all of them with dilated or abnormal capillary pattern in dermal papillae in 93.1%. In Group B, in spite of uniform parakeratosis as noticed in Group A biopsies, focal parakeratosis was seen in 83.3%, acanthosis in 87.5%, and dilated/abnormal capillary pattern in dermis was observed to be a universal feature in biopsies of Group B. All other microscopic features of psoriasis also decreased in frequency in Group B. However, statistically significant difference is seen only in changes in morphological features of superficial epidermis that is, parakeratosis, acanthosis, and absent or decreased granular layer in both the groups. Conclusion: Treatment may lead to improvement in the histologic features in epidermis with significant difference in few of them. However, abnormal vasculature in the dermal papillae persists and does not show any improvement with therapy.

Study of pandrug and heavy metal resistance among E. coli from anthropogenically influenced Delhi stretch of river Yamuna

Abstract Escalating burden of antibiotic resistance that has reached new heights present a grave concern to mankind. As the problem is no longer confined to clinics, we hereby report identification of a pandrug resistant Escherichia coli isolate from heavily polluted Delhi stretch of river Yamuna, India. E. coli MRC11 was found sensitive only to tobramycin against 21 antibiotics tested, with minimum inhibitory concentration values >256 µg/mL for amoxicillin, carbenicillin, aztreonam, ceftazidime and cefotaxime. Addition of certain heavy metals at higher concentrations were ineffective in increasing susceptibility of E. coli MRC11 to antibiotics. Withstanding sub-optimal concentration of cefotaxime (10 µg/mL) and mercuric chloride (2 µg/mL), and also resistance to their combinatorial use, indicates better adaptability in heavily polluted environment through clustering and expression of resistance genes. Interestingly, E. coli MRC11 harbours two different variants of blaTEM (blaTEM-116 and blaTEM-1 with and without extended-spectrum activity, respectively), in addition to mer operon (merB, merP and merT) genes. Studies employing conjugation, confirmed localization of blaTEM-116, merP and merT genes on the conjugative plasmid. Understanding potentialities of such isolates will help in determining risk factors attributing pandrug resistance and strengthening strategic development of new and effective antimicrobial agents.

Flagging Of Malaria Parasite In Hematology Analyzer With Its Correlation On Peripheral Smear And Rapid Diagnostic KIT

Background: Malaria has long been known to human populations from across the world. Malaria remains the most important parasitic disease worldwide. Malaria is a potential medical emergency and should be treated accordingly. Routinely malaria is diagnosed using a combination of clinical observations, case history, and diagnostic tests, principally microscopic examination of stained slides. The objective of this study is to detect the flagging of malaria parasite in sysmex with correlation in peripheral smear and kit so that early detection of Malaria can be done with the most accurate result in lesser duration and cost. Objectives:-To detect the flagging of malaria parasite in hematology analyser & to correlate the flagging findings on peripheral smear and rapid diagnostic kit. Methods: the study was conducted in Department of Pathology in collaboration, Teerthankar Mahaveer Medical College and Research Centre (TMMC&RC), Moradabad, Uttar Pradesh. TMMC&RC .A total of 11o cases were enrolled with Patients presenting with fever suggestive of clinical features of malaria (high grade fever with chills) and found serologically positive by blood smear, Sysmex flagging or RDT. Results: On the basis of observations made in the present study, Sysmex flagging was positive in 92 (83.6%) cases, 94 (85.5%) were positive by RDT& PBS positivity was seen in 99 (90%) cases. Among 99 positive cases, 85 were positive for P. vivax, 9 were positive for P. falciparum and 6 were positive for mixed infection. As compared to RDT, Sysmex flagging had 90.4% sensitivity; 56.3% specificity; 92.4% positive predictive value; 50.0% negative predictive value and 84.5% accuracy for detection of malarial parasite. Whereas when compared to PBS, Sysmex flagging had 90.9% sensitivity; 81.8% specificity; 97.8% positive predictive value; 50.0% negative predictive value and 90% accuracy for detection of malarial parasite. Sysmex flagging had moderate and significant agreement with both RDT and PBS assessments. Flagging had a detection rate of 66.7%, 94.1% and 80% respectively for P. falciparum, P. vivax and mixed infections. Conclusion: The findings of present study showed that Sysmex flagging is a cost-effective highly efficacious tool for screening of malaria parasite and it showed a high level of agreement with conventionally used laboratory tests as well as peripheral blood smear.

Comparative Study of DENTA Scan and Radiography for Pre-Operative Assessment of Dental Implants

Background: Dental implant placement has become a very common procedure in the modern era. Pre operative assessment is of immense value to ensure the long term stability of dental implants. Aim: The aim of our study was to compare the efficacy of Dental CT with radiography in planning implant surgery and pre-operative evaluation prior to implant placement. Methods: We conducted a hospital based prospective study in which patients for dental implant placement were evaluated with Dental CT and Radiography. Results: The radiographs overestimated the height of the alveolar ridge in majority of the pre implant cases as compared to Dental CT. For bucco-lingual analysis Dental CT provided an overwhelming advantage over Dental Radiography and clinical examination. The angle of alveolar ridge could not be assessed on radiographs whereas could be accurately estimated on Dental CT. Bone density of the implant site could be quantitatively determined on Dental CT whereas could not be determined on Radiographs. Conclusions: We concluded that Dental CT yields significantly better information than radiographs regarding pre-operative assessment of dental implants.

Significance of Silver Stained Nucleolar Organiser Region (AgNOR) in Fine Needle Aspiration Smears of Breast Lesions

Background: Breast cancer is the leading cause of cancer - related deaths in Asia. The number of intra-nuclear silver stained structures, termed AgNORs, is significantly higher in malignant cells than in normal, reactive or benign cells. The purpose of this study was to evaluate the AgNOR scores in FNA smears of breast lesions and their correlation with histopathology. Aims & Objective: To establish AgNOR staining as a diagnostic and prognostic tool in management of various breast lesions. Methods: This was a prospective study conducted over a period of 18 months may 2015 to November 2016. A total of 100 cases were included in the study. AgNOR stain was done in both cytology and scoring was done and analysed. Results: In FNAC aspirates, Mean AgNOR count ranged from 5 to 9.9 per high power field with a mean value of 2.888±2.553. The AgNOR dots morphology was homogenous, symmetric with regular contours in FNAC slides of benign breast lesion. In malignant breast lesions, the dots were asymmetric with irregular contours and were aggregated, smaller and more scattered. Conclusions: The present study showed that fine needle aspiration cytology is a useful modality for diagnosis of breast lesions. It has a high concordance with the histopathology . AgNOR count assessment provides a useful objective measure for segregation of different grades of tumor with 100% accuracy for detection of higher grade of lesions, as observed in present study. For differentiation of benign from malignant lesions too it has a high sensitivity as well as specificity. The usefulness of FNAC to evaluate nodal involvement also showed a 90% sensitivity and 95.6% specificity. On the basis of present study, it could be concluded that AgNOR count estimation using fine needle aspiration is a useful method to differentiate and diagnose breast lesions.

Cytomorphological Study of Palpable Breast Lumps: Spectrum of Lesions and Diagnostic Utility of FNAC.

Background: Palpable breast lumps are quite common which can be benign or malignant. Carcinoma breast is the second most common cancer after cervical cancer. Fine needle aspiration cytology (FNAC) is a minimally invasive, rapid, reliable and cost-effective outdoor procedure to provide effective diagnosis and way to further planning of treatment without need for biopsy. The objective of the study is to study the spectrum of various breast lesions on cytomorphology and its histopathological correlation. Methods: This was a two years retrospective study from June 2014 to May 2016 including 280 cases aspirated from palpable breast lumps. Physical examination of breast lumps by palpation was done. Cytological diagnosis was made and histopathological correlation was done, wherever available. Results: On cytomorphological study of 280 breast lump aspirates 32 (11.43%) were inflammatory lesions, 180 (64.29%) benign, 6 (2.14%) atypical/probably benign, 8 (2.86%) suspicious of malignancy, 46 (16.43%) malignant and 8 (2.86%) were unsatisfactory for evaluation, of these 280 cases, 70 (25%) were available for histopathological examination. The most common benign lesion in the present study was fibroadenoma 115 (41.07%) and the most common malignant lesion was ductal carcinoma 43 (15.36%). Conclusion: Fine needle aspiration cytology is a rapid and reliable tool to provide effective diagnosis in palpable breast lumps. It should be used as routine diagnostic procedure to provide the effective health care to the patients with breast lesions.