A comparative study of conventional cytology and cell block in the diagnosis of pleural effusion with special reference to immunohistochemistry

Background: Body cavity fluids are evaluated by cell block (CB) technique. In conventional cytological smears (CS), appropriate identification of the cells as either reactive mesothelial cells or malignant cells is a diagnostic problem. In CB method, there is increase in cellularity, so it gives more morphological details of cells and improving the sensitivity of diagnosis. Sections obtained by CB method are also can be stored for future study like immunohistochemistry (IHC). Aims and Objectives: The aim of the study was to determine the diagnostic efficacy of CB technique over conventional CS and to study of IHC in CB of malignant pleural effusion. Materials and Methods: This will be institution-based, cross-sectional, and observational study. The pleural fluid (except blood and pus) obtained by thoracocentesis from both male and female patient (>18 years of age) 100 cases was included in the study. Pleural fluid mixed with blood/pus, fluid from cystic lesion, and inadequate sample (<15 ml vol.) were excluded in the study. Results: Association between architectural pattern in CB versus architectural pattern in cytology smear showed statistically significant value Chi-square: 201.7417, P < 0.0001. Conclusion: We may conclude that CB technique is better than conventional cytology smear technique especially in case of malignant pleural effusion. It increases true positive cases and decreases false negative cases. It also increases cellularity, maintain architectural pattern, and cellular morphology.

Clinicopathological spectrum of anterior mediastinal lesions with special reference to the role of cytology in diagnosis: A cross-sectional study

Background: Anterior mediastinal tumors comprise only 3% of all chest tumours. They are often of diagnostic challenge to both clinicians and histopathologists owing to their wide variety of clinical presentations and diversity in histomorphological appearance respectively. Hence, there is a need for elaborated studies to make the pathologists and clinicians aware of their diversity. Aim and Objectives: The present study was aimed to evaluate the diverse spectrum of clinical presentations and histomorphological appearances of anterior mediastinal lesions. In addition, cytological and radiological interpretations were correlated with histological diagnosis to assess their comparative role in diagnosis. Materials and Methods: It was a descriptive observational cross-sectional study. Patients diagnosed with anterior mediastinal mass on chest computed tomography (CT) scan were included in this study. Demographic details including clinical presentations and radiological interpretations were recorded. Patients underwent both CT guided Fine needle aspiration cytology (FNAC) and needle core/excisional biopsy. Histological diagnosis was correlated with radiological and cytological interpretations. Results: Of 659 patients presented with chest tumours, 19 were detected as having anterior mediastinal mass on chest CT scan indicating the prevalence of 2.88%. The most common presenting symptom was respiratory distress (73.68%), followed by chest pain (36.84%), superior vena cava syndrome (26.32%) and Myasthenic features (5.26%). About 50% of malignant tumours occurred at the 2nd decade of life. Thymic epithelial neoplasms comprise the major tumour type in this study (52.63%) followed by germ cell tumors (15.79%) and lymphomas (10.53%). Cytology was found to be more effective compared to radiology in diagnosis. Conclusion: Anterior mediastinal tumors are extremely heterogeneous in clinical presentation and histomorphological appearance. CT-guided FNAC can play an important role in their diagnosis along with radiology and histology.

Association of fibrinogen, fibrin degradation product, and D-dimer level with disease severity in hospitalized COVID-19 patients – A cross-sectional study in Eastern India

Background: Although most of the COVID-19 patients presented with mild symptoms and recovered, a considerable number of cases became serious with poor prognosis in an unpredictable manner. They mostly presented with respiratory symptoms and coagulation abnormalities with thrombosis and multi-organ failure. Hence, timely prediction of these cases with the early intervention might decrease mortality. Aims and Objectives: The objectives of this were to determine whether values of fibrinogen, fibrin degradation products (FDP), and D-dimer level correlates with disease severity in COVID-19 patients. Materials and Methods: This observational cross-sectional study was done on total 400 hospitalized COVID-19 adult patients where patients were categorized into moderate and severe cases as per guideline of Government of India. Patients with pre-existing coagulation disorder or receiving anticoagulant drugs were excluded from the study. FDP, fibrinogen, and D-dimer values of these two groups were evaluated and compared statistically to determine their significance. Results: Overall mean and standard deviation of fibrinogen, FDP, and D-dimer were 607.48 ± 177.73, 34.93 ± 29.2, and 6.23 ± 6.48 for severe category, while for moderate category disease, they were 389.77 ± 110.16, 10.79 ± 10.47, and 1.96 ± 3.3, respectively. Unpaired t-test showed that the study parameters are significantly higher in severe COVID-19 patients compared to moderate ones. Conclusion: It was concluded that elevated level of D-dimer, fibrinogen, and FDP is indicator of disease progression in COVID-19. Thus, regular estimation of these simple coagulation parameters may predict disease severity and help in adequate management.

Are household food security, nutrient adequacy, and childhood nutrition clustered together? A cross-sectional study in Bankura, West Bengal

Background: Research on different measures of food security and their interrelation in order to identify vulnerable households are scarce in India. Objectives: The objective was to assess household food security (HHFS), nutrient adequacy, dietary diversity, and nutritional status of under-five children along with their interrelation in the slums of Bankura Municipality, West Bengal. Methods: A cross-sectional study was conducted during 2016–2017 among 240 households using two-stage 30-cluster random sampling. Information regarding socioeconomic characteristics, availability, and utilization of different poverty alleviation schemes was collected. HHFS was assessed by a validated HHFS scale-short form in Bengali and nutrient adequacy with 24-h recall method. The eldest under-five child in the family was measured for anthropometry using standard procedure and for dietary diversity with the Individual Dietary Diversity Score. Results: Overall, 74 (29.1%) households had “food security,” whereas 102 (44.3%) and 64 (26.6%) had, respectively, low and very low food security. Among 190 under-five children, 63 (35.3%) had single and 50 (25.5%) had multiple anthropometric failures. Overall, 89 (36.1%) households were deficient for both energy and protein and 111 (47.6%) had deficiency of either of these two. Indicators on the utilization of different poverty alleviation schemes were associated with low/very low food security. A “Composite Index of Food Scarcity” comprising of HHFS, nutrient adequacy, and dietary diversity was proposed which was found to have dose–response relationship with grades of anthropometric failure of under-five children. Conclusions: An index comprising of three indicators might help identify the vulnerable households in relation to food security more effectively than a single indicator.

Bimanual 25-gauge chandelier technique for direct perfluorocarbon liquid-silicone oil exchange in retinal detachments associated with giant retinal tear

Direct perfluorocarbon liquid (PFCL)-silicone oil exchange presents its own set of challenges in the micro incision vitreous surgery era. We propose a simple bimanual technique to circumvent this problem. Thirteen eyes of patients with retinal detachment associated with giant retinal tears underwent vitrectomy followed by self-retaining endo illuminator (Chandelier) assisted direct PFCL-silicone exchange. No intra or postoperative complications related to the surgical technique were noted. All patients had attached retinas and satisfactory visual recovery at 6 months. Direct bimanual PFCL silicone oil exchange using a Chandelier seems to be a safe and effective technique.

War against tobacco: Where do we stand?

India has launched war against tobacco epidemic for the past few decades but with partial success; hence, challenges are still there which need to be identified and addressed for winning the battle. Targeted approach directed at motivating smoking cessation of female smokers, frequent changing of pictorial warnings depicting variety of health consequences in cigarette packets and devoid of logos and colors in conjunction with plain packaging, and display of toll-free number for quitting are expected to dissuade tobacco consumers to quit and save themselves from the devastating health, social, environmental, and economic consequences of tobacco consumption. Online reporting system for violating legal enforcements can also be implemented easily. Moreover, guidance from success stories of countries/states who have achieved smoke-free status along with concerted efforts such as innovative anti-tobacco campaigns, involvement of religious leaders in anti-tobacco propaganda, strict legislations, and overall strong political commitment would further aid in winning the war.

A study on catch up growth among low birth weight infants in an urban slum of Kolkata.

OBJECTIVES: To study the catch up growth among low birth weight infants in relation to the normal birth weight counterparts in first six months of age. METHODS: A longitudinal community based study was done in 2004 -05 in an urban slum of Chetla, Kolkata among 126 singleton live born babies. Growth pattern of these babies was followed up at 15+/-5 days interval by house visit till six months of age. RESULTS: The incidence of low birth weight babies was 28.6%. 86.1% LBW infants caught up in length at 3rd month, 63.9% in chest circumference at 4th month, 66.7% in head circumference at 5th month, while 72.2% in weight at 6th month. Regular growth monitoring is essential for LBW babies to detect signs of growth faltering at the earliest.

Declining trend in routine UIP coverage.

Routine UIP coverage status in the state of West Bengal and three selected Municipal Corporation areas (Calcutta, Howrah and Siliguri) were studied during 1997-98 and 1998-99. Also, UIP coverage status in the 'high risk' areas of the State (areas which reported Polio cases during 1998) was studied during 1998-99. UIP coverage in the state of West Bengal was only 54.3% in 1997-98, which further declined to 48.1% in 1998-99. In the three urban areas, UIP coverage ranged between 57.3%-70.9% in 1997-98, which further declined to 29.6%-47.1% in 1998-99. Antigenwise coverage revealed very poor performance with DPT3, OPV3, and Measles in 1997-98 and further decline in 1998-99. Dropout rate was also very high. In 1998-99 drop-out rate ranged between 30.1% to 54.2% in different studied areas. Some other studies suggested that PPI activities, which are very visible and targetted programme, may adversely affect routine UIP services. There is urgent need for further probing to identify the reasons for such poor state of affairs, keeping PPI angle in mind and to initiate remedial measure urgently.

Pulse polio immunisation, 1995-96: an evaluation in West Bengal.

An evaluation of the Pulse Polio Immunisation Programme (PPI), 1995-96 in West Bengal was undertaken. It was observed that the PPI coverage (with two rounds) was 84.1%. Variations in the PPI coverage level were documented in relation to age, sex, residential status and parental literacy status of the beneficiaries. However, significantly lower PPI coverage was observed among Muslims (p < 0.001) and Scheduled Tribes (p < 0.01). The principal agency responsible for disseminating information about PPI was identified to be the multipurpose health workers. Some of the major reasons for non-acceptance of PPI were lack of information, illness of the child, absence of the child on the "PPI day", lack of faith in immunisation and fear of adverse reaction.

Sentinel surveillance on poliomyelitis and neonatal tetanus: a report.

A 5 year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus was undertaken at a rural Medical College Hospital at Burdwan, West Bengal. Poliomyelitis incidence showed an overall declining trend, which corroborated with the increased OPV coverage over the years. Incidence was more in males than females. Male:female ratio varied between 2.31:1 to 1.2:1. From 1989 to 1992, age-shift in poliomyelitis was observed when more cases were occurring above 1 year subjects. Cases were reported to be high during the months June to September every year. Incidence of neonatal tetanus (NNT) also showed a declining trend during the 5 year study period. A male preponderance was observed. NNT cases were more prevalent during the months between August and November. In an attempt for eradication of paralytic poliomyelitis and elimination of NNT, containment and other public health measures were undertaken a part of surveillance activities. The obstacles encountered in the surveillance system, as well as lacunae identified in undertaking appropriate health measures was discussed.

A report of diphtheria surveillance from a rural medical college hospital.

A 5-year sentinel surveillance of diphtheria from 1989 to 1993 was undertaken at a rural medical college hospital. No significant change in the number of diphtheria cases was observed in spite of sustained high level of diphtheria, pertussis, tetanus vaccine-3 doses (DPT3) coverage. Most of the diphtheria cases occurred during July to November. Age distribution of diphtheria cases showed that more than 75% occurred above 2 years age (except in 1989) and around 65% cases above 3 years age. The age shift in diphtheria signified success of primary diphtheria immunisation, as well as indicated the lack of coverage with booster doses at appropriate ages. Because of high coverage with primary diphtheria immunisation there was decrease in circulating toxigenic C diphtheriae resulting in less natural boosting of antibody titre. Thus, in absence of booster immunisation, the older children and adults were more vulnerable to diphtheria. The findings of the study justified the need of emphasising importance of booster diphtheria immunisation at appropriate ages for effective control of diphtheria.

Experience in running a Diarrhoeal Training cum Treatment Unit (DTTU) in a state teaching hospital in Calcutta.

The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.

A study on profile of stillbirths.

The incidence of stillbirths in "one year period" was studied by record analysis in a teaching hospital. A stillbirth rate of 38.4 per 1000 live births was observed. On admission 96.3% cases had some adverse foetal conditions detected readily. Leading factor detected was intra-uterine growth retardation (45.4%). Other major conditions observed were intra-uterine hypoxia (18.4%), malpresentation (11.9%), multiple pregnancy (8.3%). Birth weight was below 2000 g in 53.1% cases. Records showed 78.5% mothers had not received antenatal care.

A study of perinatal mortality and associated maternal profile in a medical college hospital.

Study of perinatal mortality in a Medical College Hospital revealed stillbirth rate as 38.4, early neonatal death rate as 29.3 and overall perinatal morality rate as 67.7 per 1000 live births. More than half (53.6%) of the perinatal deaths were in primipara and another 22.8% in mothers of parity more than 3. Most mothers (85.9%) did not receive adequate antenatal care services. On admission 35.1% mothers presented with some risk factors. The major risk factors identified were toxaemia of pregnancy (14.8%), severe anaemia (13%) and antepartum haemorrhage (2.6%).

An assessment of AIDS awareness program--for I.C.D.S. functionaries.

An assessment of the "One Day AIDS Awareness Program" for I.C.D.S. functionaries was done. The pre-training knowledge level scores were 55.3%, 39.3% and 60.4% of the total score, in 24-Parganas (S), Burdwan and Calcutta districts respectively. However, the post-training assessment scores were observed to be 91.9%, 84.9% and 94.8% in 24-Parganas (S), Burdwan and Calcutta districts respectively. The percentage increase in mean scores was found to be 66.5%, 115.8% and 57.1% in 24-Parganas (S), Burdwan and Calcutta districts respectively.

Utilisation of ORT during diarrhoea in three districts of West Bengal.

Use of ORT is saving 1 million diarrhoeal deaths each year among children. C.S.S.M. programme aims at preventing 70% diarrhoeal deaths, through widespread use of ORT. The present study was carried out to find out the extent of the problem of diarrhoea and utilisation of ORT in three districts of West Bengal. The results showed that the utilisation of ORT was 80.8%, 70.7% and 65% in Howrah, Hooghly and 24-Parganas (South) respectively, during attacks of diarrhoea. The continuing feeding rates were 60.1%, 62.7% and 55.5% in Howrah, Hooghly and 24-Parganas (South) respectively.