Evaluation of Efficacy of IAC Yokahama Reporting System For Breast Cytology – A Single Institutional Experience.

Purpose: Breast fine needle aspiration cytology (FNAC) has a long history of providing accurate, rapid and cost-effective diagnosis of palpable breast lesions. Recently, International Academy of Cytology (IAC) at Yokohama proposed a new reporting system for breast cytology, in order to bring uniformity across the globe. Any new classification system needs to be validated for its practical applicability. Objectives: This study was conducted to categorize the breast lesions as per this classification and further determine the diagnostic efficacy and risk of malignancy in each category. Material and methods: This was a cross sectional observational analytical study. All the cases presenting to cytology OPD from Janurary 2020 upto December 2022, (N=296) with breast lesions for FNAC were included in the study. All the cases were divided into five categories as per the newly proposed IAC Yokohama reporting system. The risk of malignancy for each category was determined and diagnostic efficacy was evaluated.Results:The sample were distributed as follows: insufficient material 4.39%, benign 66.21%, atypical 10.47%, suspicious for malignancy 1.35% and malignancy 17.56%. Histopathology was obtained in 88 cases, out of which 82 (93.18%) showed concordant diagnosis. The sensitivity and specificity were 85.71% and 98.11% respectively. Risk of malignancy (ROM) in each category was as follows-benign (0.01%), atypia (71.4%), suspicious (100%) and malignancy (96.66%) respectively.Conclusion:The high efficacy of FNAC obtained in the present study, when IAC Yokohama reporting system was applied, confirms the usefulness of this scheme in reporting breast lesions. A risk-based stratification is essential in the present era to guide and alert the clinician about the subsequent management plan and the ROM.

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India

Background and objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions.Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes

Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India

Background & objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India. Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated. Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills. Interpretation & conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Prevalence of Extended Spectrum Beta Lactamase Genotypes in Klebsiella pneumonia from Respiratory Tract Infections at Tertiary Care Hospital.

Background: Extended Spectrum Beta Lactamases(ESBLs) are rapidly evolving group of β-lactamaseenzymes that are of particular concern to clinicians andepidemiologists. Most ESBLs have been evolved bygenetic mutation from blaTEM and blaSHV genes, andare well described in Klebsiella pneumoniae. Aim andObjective: To investigate the ESBL genotypes in K.pneumoniae isolates from Respiratory Tract Infections(RTIs). Material and Methods: Clinical isolates of K.pneumoniae were obtained from RTI -sputum samples.Antimicrobial susceptibility was determined by KirbyBauer disc diffusion method. ESBL was detectedphenotypically and multiplex Polymerase ChainReaction (PCR) specific for blaTEM, blaSHV andblaCTX-M genes was performed to identify genotypes.Results: During the 19 months period, a total of 212 ofK. pneumoniae were found from RTIs. Of these 212isolates, 60 isolates (28.3%) were ESBL producers byphenotypic method. Of these 212 isolates, 96 wererandomly selected for multiplex PCR for blaTEM,blaSHV and blaCTX-M genes. The findings ofmultiplex PCR showed that 24 isolates (25%)possessed blaTEM gene and only 4 isolates (4.1%)possessed each blaSHV and blaCTX-M gene alone.Isolates having both blaTEM+blaSHV genes were 20(20.8%), and both blaTEM+blaCTX-M genes were 12(12.5%); and isolate possessing all threeblaTEM+blaSHV+blaCTX-M genes were 20 (20.8%).The overall prevalence of blaTEM, blaSHV andblaCTX-M genes in this study was 79.1%, 45.8% and37.5% respectively. Imipenem was most effectiveantibiotic. Conclusion: Spread of ESBL producing K.pneumoniae is a major concern, as it causes limitationsto optimal treatment. Multiplex PCR can be used as arapid method to identify ESBL genotypes in K.pneumoniae. It will prove valuable for surveillance andestablishing the treatment line against drug resistantorganisms, thus saving precious time and resources. Inour study blaTEM genotype was most prevalent.

Recommendations of Test of Prostate-specific Antigen along with Histopathological Examination for the Prostate Lesions

Introduction: Prostate disease is an important growing health problem, presenting a challenge to urologists, radiologists, and pathologists. Objectives: The aim of the study is to correlate prostatic-specific antigen test with histopathological examination in prostatic lesions and to recommend combine approach for management of the patients of prostatic lesions. Materials and Methods:This was a prospective study conducted at the department of pathology in a tertiary care center over 6 months. Data were collected from histopathology record department. The 2002 WHO classification was used to diagnose and classify prostate tumors. Gleason’s grading system was used for the cases of adenocarcinoma. Results: In our study, a total of 119 cases of prostatic lesions were noticed. The lesions diagnosed were benign prostatic hyperplasia (79% of cases), adenocarcinoma (6% of cases), prostatic intraepithelial neoplasia (4% of cases), stromal nodules of hyperplasia (4% of cases), and atypical adenomatous hyperplasia (4% of cases). A total of 3% of cases were inadequate. Majority of prostatic lesions were belonging to the 6th decade followed by the 7th decade. All cases of adenocarcinoma were belonging to the 6th decade. The test of prostatic-specific antigen was higher (more than 10 ng) in cases of adenocarcinoma. Conclusions: The study is conducted to see that combine approach of prostate-specific antigen and histopathological examination is useful for its recommendation, for better management of prostatic lesions in tertiary care center.

Spirometric evaluation in patients with allergic rhinitis- emphasising need of early diagnosis: a tertiary care experience from Central India

Background: Allergic rhinitis is predecessor of Bronchial asthma in most of the cases. Present study was aimed to understand the prevalence of the impaired spirometric changes in patients with allergic rhinitis and to find association with various demographic factors, sputum eosinophilia and eosinophil count in the blood with the impaired Spirometry of these patients.Methods: Authors conducted a cross sectional study among the patients of allergic rhinitis presented to us in our outpatient department from January 2016 to July 2017. The patient’s with allergic rhinitis either newly diagnosed or already on treatment were included in the study. Standard guidelines as given by ARIA were followed in defining a case of allergic rhinitis. The detailed clinical history was taken, and examination was performed of all the patients and documented. Spirometric evaluation was done using the standard guidelines by a desktop based Spirometry.Results: The mean age of the study subjects was 30.22±13.13 years with male: female ratio of 0.96. The mean duration of the allergic rhinitis in our study was 3.86±3.34years. The most common complaint was itching sensation of nose followed by paroxysmal sneezing and watering of eyes. About 22.15% of the study subjects have impaired Spirometry. Upon bronchodilator therapy 30% of the study subjects had significant reversibility in FEV1.Conclusions: About ¼ of present study subjects had impaired Spirometry and about 30% of them had reversibility after bronchodilator therapy. Authors also found that the higher age study subjects had significantly higher impaired Spirometry; persistent allergic rhinitis patients had higher impairment of Spirometry and the patients with higher the sputum eosinophilia had higher impairment in Spirometry.

Primary follicular lymphoma of disguised as multiple miliary like lesions: A case report and review of literature

Primary follicular lymphoma (PFL) of gastrointestinal tract (GIT) is rare and account for 1%–3% of non-Hodgkin lymphoma. Within the small intestine, the PFL is more common in jejunum than in the ileum. Due to low prevalence of the disease, the clinical manifestations are not well known, and diagnosis is usually delayed leading to complications. We herein report a case of PFL of GIT who presented with intestinal obstruction and unique gross morphology. Diagnosis was made by morphology and supported by immunohistochemistry.

Perceptions of State Government stakeholders & researchers regarding public health research priorities in India: An exploratory survey.

Public health research has several stakeholders that should be involved in identifying public health research agenda. A survey was conducted prior to a national consultation organized by the Department of Health Research with the objective to identify the key public health research priorities as perceived by the State health officials and public health researchers. A cross-sectional survey was done for the State health officials involved in public health programmes and public health researchers in various States of India. A self-administered semi-structured questionnaire was used for data collection. Overall, 35 State officials from 15 States and 17 public health researchers participated in the study. Five leading public health research priorities identified in the open ended query were maternal and child health (24%), non-communicable diseases (22%), vector borne diseases (6%), tuberculosis (6%) and HIV/AIDS/STI (5%). Maternal and child health research was the leading priority; however, researchers also gave emphasis on the need for research in the emerging public health challenges such as non-communicable diseases. Structured initiatives are needed to promote interactions between policymakers and researchers at all stages of research starting from defining problems to the use of research to achieve the health goals as envisaged in the 12th Plan over next five years.

Assessment of CT numbers in limited and medium field-of-view scans taken using Accuitomo 170 and Veraviewepocs 3De cone-beam computed tomography scanners

PURPOSE: To assess the influence of anatomic location on the relationship between computed tomography (CT) number and X-ray attenuation in limited and medium field-of-view (FOV) scans. MATERIALS AND METHODS: Tubes containing solutions with different concentrations of K2HPO4 were placed in the tooth sockets of a human head phantom. Cone-beam computed tomography (CBCT) scans were acquired, and CT numbers of the K2HPO4 solutions were measured. The relationship between CT number and K2HPO4 concentration was examined by linear regression analyses. Then, the variation in CT number according to anatomic location was examined. RESULTS: The relationship between K2HPO4 concentration and CT number was strongly linear. The slopes of the linear regressions for the limited FOVs were almost 2-fold lower than those for the medium FOVs. The absolute CT number differed between imaging protocols and anatomic locations. CONCLUSION: There is a strong linear relationship between X-ray attenuation and CT number. The specific imaging protocol and anatomic location of the object strongly influence this relationship.

Degradation of h-acid by free and immobilized cells of Alcaligenes latus

Alcaligenes latus, isolated from industrial effluent, was able to grow in mineral salts medium with 50 ppm (0.15 mM) of H-acid as a sole source of carbon. Immobilization of Alcaligenes latus in Ca-alginate and polyurethane foam resulted in cells embedded in the matrices. When free cells and immobilized cells were used for biodegradation studies at concentration ranging from 100 ppm (0.3 mM) to 500 ppm (1.15 mM) degradation rate was enhanced with immobilized cells. Cells immobilized in polyurethane foam showed 100 percent degradation up to 350 ppm (1.05 mM) and 57 percent degradation at 500 ppm (1.5 mM). Degradation rate of Ca-alginate immobilized cells was less as compared to that of polyurethane foam immobilized cells. With Ca-alginate immobilized cells 100 percent degradation was recorded up to 200 ppm (0.6 mM) of H-acid and only 33 percent degradation was recorded at 500 ppm (1.5 mM) of H-acid. Spectral analysis of the products after H-acid utilization showed that the spent medium did not contain any aromatic compounds indicating H-acid degradation by A. latus.

Detection, amplification & sequence homology of sodC in clinical isolates of Salmonella sp.

Background & objectives: Periplasmic copper and zinc superoxide dismutase (Cu,Zn-SOD or SodC) is an important component of the antioxidant shield which protects bacteria from the phagocytic oxidative burst. Cu,Zn-SODs protect Gram-negative bacteria against oxygen damage which have also been shown to contribute to the pathogenicity of these bacterial species. We report the presence of SodC in drug resistant Salmonella sp. isolated from patients suffering from enteric fever. Further sodC was amplified, cloned into Escherichia coli and the nucleotide sequence and amino acid sequence homology were compared with the standard strain sSalmonella Typhimurium 14028. Methods: Salmonella enterica serovar Typhi (S. Typhi) and Salmonella enterica serovar Paratyphi (S. Paratyphi) were isolated and identified from blood samples of the patients. The isolates were screened for the presence of Cu, Zn-SOD by PAGE using KCN as inhibitor of Cu,Zn-SOD. The gene (sodC) was amplified by PCR, cloned and sequenced. The nucleotide and amino acid sequences of sodC were compared using CLUSTAL X. Results: SodC was detected in 35 per cent of the Salmonella isolates. Amplification of the genomic DNA of S. Typhi and S. Paratyphi with sodC specific primers resulted in 519 and 515 bp amplicons respectively. Single mutational difference at position 489 was observed between the sodC of S. Typhi and S. Paratyphi while they differed at 6 positions with the sodC of S. Typhimurium 14028. The SodC amino acid sequences of the two isolates were homologous but 3 amino acid difference was observed with that of standard strain S. Typhimurium 14028. Interpretation & conclusions: The presence of SodC in pathogenic bacteria could be a novel candidate as phylogenetic marker.

Incident HIV infection among men attending STD clinics in Pune, India: pathways to disparity and interventions to enhance equity.

Systematic disparities in rates of HIV incidence by socioeconomic status were assessed among men attending three sexually transmitted disease (STD) clinics in Pune, India, to identify key policy-intervention points to increase health equity. Measures of socioeconomic status included level of education, family income, and occupation. From 1993 to 2000, 2,260 HIV-uninfected men who consented to participate in the study were followed on a quarterly basis. Proportional hazards regression analysis of incident HIV infection identified a statistically significant interaction between level of education and genital ulcer disease. Compared to the lowest-risk men without genital ulcer disease who completed high school, the relative risk (RR) for acquisition of HIV was 7.02 (p < 0.001) for illiterate men with genital ulcer disease, 3.62 (p < 0.001) for men with some education and genital ulcer disease, and 3.02 (p < 0.001) for men who completed high school and had genital ulcer disease. For men with no genital ulcer disease and those with no education RR was 1.09 (p = 0.84), and for men with primary/middle school it was 1.70 (p = 0.03). The study provides evidence that by enhancing access to treatment and interventions that include counselling, education, and provision of condoms for prevention of STDs, especially genital ulcer disease, among disadvantaged men, the disparity in rates of HIV incidence could be lessened considerably. Nevertheless, given the same level of knowledge on AIDS, the same level of risk behaviour, and the same level of biological co-factors, the most disadvantaged men still have higher rates of HIV incidence.