Role of pipelle versus dilatation and curettage in tissue diagnosis abnormal uterine bleeding

Background: Menstrual irregularities and abnormal heavy menstruation account for up to 26-35% of women attending Gynecological outpatient Department. Abnormal Uterine Bleeding (AUB), it is more common at extremes of age endometrial hyperplasia occurs in 5-10% of patients with post-menopausal bleeding out of which atypical hyperplasia has 26-32 % risk of having malignancy in future. Therefore, endometrial sampling for histopathology is important in the assessment of abnormal uterine bleeding is mandatory. Our study was conductive to know the effectiveness of pipelle type devices, versus Dilatation and curettage in obtaining quality endometrial tissue for histopathological examination.Methods: The study was undertaken in Department of obstetrics and gynaecology along with department of Pathology at Rajarshi Chhatrapati Shahu Maharaj, government medical college, Kolhapur after getting approval from the Hospital Committee on Clinical Research and Ethical Committee of the institution, during the period from October 2016 to March 2017 (six months). Total number of subjects included in study is Hundred after taking into consideration of inclusion and exclusion criteria.Results: The ease of doing procedure was much easier as compared to D&C and the Tissue sample obtained for histopathological examination were as par D&C. It was concluded that histopathology report was available in 92 of the 100 pipelle samples and 93 of 100 D&C samples. It was also, observed that increased endometrial thickness was not always associated with adequate tissue diagnosis.Conclusions: Pipelle is simple, affordable, patient friendly can be easily performed with minimal training, which can be performed in Outpatient Gynaecological Department. The diagnostic value and positive predictive value of Pipelle is at par with conventional D&C. So, pipelle can be recommended for all perimenopausal patients with AUB to rule out various, premalignant and malignant conditions of the endometrium.

Prognostic and predictive significance of microsatellite instability in stage II colorectal carcinoma: An 8-year study from a tertiary center in South India

BACKGROUND: Microsatellite instability (MSI) accounts for 15–20% of colorectal cancer (CRC) and is considered to have favorable stage-adjusted prognosis compared to Microsatellite stable (MSS) CRCs. Determination of MSI in stage II CRC is important for management decisions regarding adjuvant chemotherapy administration. The aim of this study was to determine the prognostic and predictive significance of MSI in stage 2 CRC in the Indian scenario. MATERIALS AND METHODS: A total of 195 patients who underwent curative surgery for stage II CRC from 2010 to 2017 were included. MSI testing by immunohistochemistry (DNA MisMatch Repair proteins) was performed in all. Various clinicopathological factors and disease-free survival and overall survival were assessed between MSI and MSS groups. The effect of treatment in terms of survival benefits with adjuvant therapy in the MSI group was also assessed. RESULTS: 27.1% of the CRCs' showed MSI. Younger age (<50 years), family history of cancer, synchronous/metachronous malignancies, proximal (right sided) location, poor morphological tumour differentiation, mucin production, and presence of peritumoral (Crohn's-like) lymphocytic response showed statistically significant association with MSI. Majority (56%) of our patients showed combined loss of MLH1 and PMS2. Overall, survival among the MSI patients was significantly higher (76.6 ± 4.149 months) than the MSS patients (65.05 ± 3.555)P= 0.04. MSI patients did not show any differences in survival with or without treatment. CONCLUSION: This study highlights the distinct clinicopathological features of MSI-related CRC and the relevance of MSI testing of stage II CRC for management decisions and prognostication.

Evaluation of a modified team based learning method for teaching general embryology to 1st year medical graduate students.

BACKGROUND AND AIMS: To encourage student participation in the learning process, the authors introduced a modified team based learning (TBL) method to cover two general embryology topics in the 1st year MBBS curriculum. The aim of this study was to evaluate students' perception of this method vis-à-vis the lecture method of teaching. SETTINGS AND DESIGN: A questionnaire was used to survey and evaluate the perceptions of 1st year MBBS students at the Department of Anatomy at our medical college in India. MATERIALS AND METHODS: A total of eight classes were allotted to cover General Embryology. Six of these classes were conducted using the traditional didactic lecture method. Two topics were covered using the modified TBL method. Five teams of students were constituted, and each team was given handouts which contained basic factual material, four clinical case histories, and previous university exam questions from the topic. On the day of the session, these were discussed in the presence of the faculty facilitator. Students evaluated these sessions through a questionnaire. RESULTS: A majority of students felt that the modified TBL sessions were better at fulfilling learning objectives (46 students, 85%), enabled better understanding (43 students, 79%), were more interesting (43 students, 81%), ensured greater student participation (51 students, 94%) and involved greater effort on the part of students (53 students, 98%), as compared to traditional teaching methods. Most of the students (43 students, 79%) opined that more such sessions should be organized in the future. CONCLUSIONS: Responses from students show that the modified TBL classes could be utilized judiciously along with the traditional didactic lectures for teaching embryology.

The direction and location of mental foramen and incidence of accessory mental foramen in south Indian mandibles.

One hundred and forty two south Indian mandibles of unknown sex were examined for the variations of the location and direction of the mental foramen. Accessory mental foramen were also looked for. The findings have been compared with those of other studies in the literature. Topography of the mental foramen is of practical importance to the dental and maxillo-facial surgeon for purpose of anesthesia and surgical procedures.