Application of the Milan System for Reporting Salivary Gland Cytology and Risk Stratification by Cytohistological Correlation

Introduction:Salivary gland neoplasms are uncommon tumors comprising <3%–10% of all head‑and‑neck neoplasms. Recent WHO classification of salivary gland tumor added many newer entities; however, no definite risk‑stratification system is specified to predict the likelihood of malignancy for each diagnostic category. The present study is designed to evaluate the salivary gland aspirates using the Milan System for Reporting Salivary Gland Cytology for reporting correlating with histological diagnosis which will lead to determine the malignancy risk for each diagnostic category. Risk of malignancy is calculated by the ratio of cytopathology cases with a malignant histopathology to the total number of cytopathology cases with follow‑up histopathology for that particular category. MaterialsandMethods: The present study was a cross‑sectional study done prospectively over a period of 2 years, and a total of 72 participants were selected. This study characterized the cytological features of spectrum of salivary gland lesions varying from benign to malignant. The lesions were evaluated and classified cytologically according to “the Milan System for Reporting Salivary Gland Cytopathology” for reporting salivary gland neoplasms. Histopathological correlation was done with cytological diagnosis wherever possible. Results: In our study of 72 patients with salivary gland lesions with the mean age of the patient being 50.6 years and maximum number of lesions involved the parotid gland followed by the submandibular gland and sublingual gland. Majority of the lesions in the present study were nonneoplastic in nature followed by lesions benign in nature. Malignant lesions were least common in occurrence. Among 72 cases, majority of the cases were seen in Milan category II (nonneoplastic) consisting of 34 cases (47.2%), followed by 31 cases (43.1%) in Milan category IV (benign). Final diagnostic categorization of 72 cases of salivary gland lesions was done according to the Milan system and the histopathological correlation was available in 23 of these cases. Out of the 34 cases in Milan system category II (nonneoplastic), histopathological evaluation was done in 2 cases. Both the cases were benign in nature, 31 cases in Milan system category IV (benign) histopathological evaluation was done in 16 cases where 15 cases were benign in nature and 1 lesion was malignant. Four cases were put in category VI of the Milan system, histopathological evaluation was done in all the 4 cases which were all malignant in nature. Conclusion: The current study validates fine‑needle aspiration cytology as a cost‑effective and noninvasive procedure for differentiating between benign and malignant lesions of the salivary gland, information of critical importance when determining the patient’s next course of treatment.

Corneal endothelial changes following cataract surgery in hard nuclear cataract: Randomized trial comparing phacoemulsification to manual small-incision cataract surgery

Purpose: To evaluate and compare endothelial cell changes in phacoemulsification and manual small- incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts. Methods: This was a prospective, tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors. Results: Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05). Conclusion: Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification

Implementation Research: The Need of the Hour

Formative research creates evidence. Evidence-based interventions are implemented in community settings. In the past, evidence-based interventions have failed to get desired outcomes. The tuberculosis control program despite being evidence based did not succeed at the beginning. Similarly, evidence-based treatment of hypertension and diabetes has not yet controlled these diseases. This is where the role of implementation research (IR) starts. IR either as part of evidence-based research or independently should be a part of health programs so that the program shall be able to ensure feasibility, fidelity, penetration, acceptability, sustainability, efficiency, effectiveness, and equity

Burden of sickle cell disease in tribal students in Maa-Baadi institutions in southern Rajasthan - A pilot study

Background & objectives: Sickle cell disease (SCD), an inherited disorder of erythrocytes, is highly prevalent in the tribal population of India. The tribal population of India is approximately 100 million and it is necessary to identify the magnitude of this problem. Furthermore, the prevalence of the disease is unknown among the five million tribal people of southern provinces of Rajasthan. In this study, we intended to determine the prevalence and characteristics of sickle cell disorder among the tribal inhabitants of southern Rajasthan. Methods: This cross-sectional study was conducted among the tribal students of the Maa-Baadis and hostels situated in the five tribal sub-plan districts of Rajasthan. Maa-Baadi centres are located in every village, whereas for every four to five villages, one hostel is allocated to accommodate the tribal students. The screening for SCD was done by solubility test and electrophoresis was used for confirmation. Results: A total of 36,752 tribal students were screened from 1,006 Maa-Baadi centres and 243 hostels. The prevalence of SCD among the tribal students was 5.8 per cent. The prevalence of heterozygous and homozygous conditions was 5.61 and 0.17 per cent, respectively. Among the five sub-plan districts, the highest prevalence was observed in Sirohi district (10.5%) followed by Banswara (7.42%), Udaipur (6.53%), Pratapgarh (5.51%) and Dungarpur (1.89%). Among the four major tribes belonging to these districts, the highest prevalence was recorded in Garasia tribes (13.81%). The history of leg ulcers and the mean pulse rate were significantly high in SCD individuals. Interpretation & conclusions: SCD is a significant problem among the tribes of southern Rajasthan, with the highest prevalence among the Garasia tribe. The present study recommends that a structured screening programme targeting the entire tribal population with appropriate counselling as well as providing treatment through the existing health system is the need of the hour.

Spatial Epidemiology of COPD in Delhi, India

Introduction?Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common chronic respiratory illnesses. COPD is one of the three most common causes of death worldwide. The main burden of mortality from COPD is seen in Latin America, sub-Saharan Africa, India, China, and South-East Asia. Absence of true prevalence values and mortality burden hinder planning and operationalization of public health interventions for prevention, control, and treatment of the disease. Further, the aggregated value of prevalence estimates calculated for a whole city or a larger geographical area does not provide the location of patients and presence of locally prevalent risk factors. The objective of this study was to understand the spatial distribution of COPD in a large, highly polluted city of a developing country. Materials and Methods?A cross-sectional community-based study was conducted in the National Capital Territory of Delhi (NCTD). All surveyed households were geocoded. GOLD screening criteria and pulmonary function tests using portable digital spirometer were used for diagnosis of COPD. Results?Results are presented as a series of maps depicting spatial epidemiology. Overall prevalence rate was 9.8/1,000 population. Highest prevalence was seen in industrial area. Most of the spatial hotspots were seen in industrial and slum areas. Similarly, Kernel density was also highest in industrial area. Conclusion?In the city of NCTD, we found the COPD being distributed in all types of habitations but spatial distribution helped us understand clustering of cases and compare prevalence rates in subunits of residential clusters within a metropolitan city.

A procalcitonina sérica como marcador prognóstico na colite ulcerativa aguda / Serum procalcitonin as a prognostic marker in acute severe ulcerative colitis: a prospective study

ABSTRACT Background Procalcitonin may be increased in active ulcerative colitis (UC). We investigated the role of procalcitonin in predicting response in acute severe UC (ASUC). Methods Consecutive patients with ASUC diagnosed on basis of Truelove and Witts criteria were enrolled. Serum procalcitonin levels for consecutive patients were measured at admission and day 3. We assessed role of procalcitonin values at presentation and at day 3 in assessing response on day 3 (Oxford's criteria) and need for second line therapy (day 28). Results Of fifty patients (23 males, mean age: 35.98±13.8 years), 16 did not respond (day 3). Ten (20%) patients required second-line therapy. Baseline procalcitonin was significantly associated with response on day 3 (P=0.016). There was no association between day 1 or day 3 procalcitonin and need for second-line rescue therapy. Conclusion Serial procalcitonin is not an effective biomarker for predicting outcomes or need for second line therapy in ASUC.

RESUMO Contexto A procalcitonina pode estar aumentada em colite ulcerativa ativa. Investigamos o papel da procalcitonina na previsão de resposta na colite ulcerativa aguda grave. Métodos Foram inscritos pacientes consecutivos com colite ulcerativa aguda grave diagnosticados com base nos critérios de Truelove e Witts. Os níveis de procalcitonina sérica dos pacientes foram medidos consecutivamente na internação e no terceiro dia. Avaliamos o papel dos valores procalcitonina na apresentação e na avaliação da resposta no terceiro dia (critérios de Oxford) e necessidade de terapia de segunda linha (dia 28). Resultados Dos 50 pacientes (23 homens, idade média: 35,98±13,8 anos), 16 não responderam (terceiro dia). Dez pacientes (20%) necessitaram de terapia de segunda linha. A procalcitonina de linha de base foi significativamente associada à resposta no terceiro dia (P=0,016). Não houve associação entre o primeiro dia ou o terceiro dia de procalcitonina e necessidade de terapia de resgate de segunda linha. Conclusão A procalcitonina sérica não é um biomarcador eficaz para prever desfechos ou necessidade de terapia de segunda linha em colite ulcerativa aguda grave.

ROLE OF ADVERTISING IN CONSUMER'S BUYING DECISION : A REVIEW OF LITERATURE

Literature review is an account of what has been published in connection with this research. The main purpose is to gain knowledge and ideas based on the previous establishment and get to know what their strength and weakness are in order to further enhance and upgrade the integration. It identifies the work done by other authors. This paper describes explores various studies that are related with role of advertising in consumer's buying decision

Successful endovascular repair with coil embolization of ruptured right internal thoracic artery aneurysm / Reparo endovascular bem-sucedido de aneurisma da artéria torácica interna direita roto com embolização com molas

Abstract Internal thoracic artery aneurysms (ITAAs) are rare with wide variation in clinical presentation and a high risk of rupture. Endovascular techniques are increasingly being used for treatment of such aneurysms over surgical repair in recent times. A 34-year-old male presented with progressive swelling of the right anterior chest wall for 2 weeks and was diagnosed with right internal thoracic artery aneurysm with contained rupture. He underwent successful endovascular repair with coil embolization of ruptured right ITAA. Post intervention computed tomography (CT) angiography confirmed sealing of the ruptured aneurysm with no residual filling of the sac. At six months follow-up he is doing well with complete resolution of hematoma. This case demonstrates that an endovascular approach with coil embolization is a feasible and safe option for treating the rare ruptured ITAAs.

Resumo Os aneurismas da artéria torácica interna (ITAAs) são raros, com ampla variação na apresentação clínica e alto risco de ruptura. As técnicas endovasculares têm sido cada vez mais utilizadas para o tratamento desses aneurismas em relação ao reparo cirúrgico. Um homem de 34 anos de idade apresentou edema progressivo da parede torácica anterior direita por 2 semanas e foi diagnosticado com aneurisma da artéria mamária interna direita com ruptura contida. Ele foi submetido a reparo endovascular bem-sucedido, com embolização de ITAA direito roto. A angiotomografia computadorizada (angioTC) pós-intervenção confirmou o selamento do aneurisma rompido, sem enchimento residual do saco. No seguimento de 6 meses, ele estava bem, com resolução completa do hematoma. Este caso demonstra que a abordagem endovascular com embolização com molas é uma opção viável e segura no tratamento dos raros ITAAs rotos.

Adjunctive effects of acupressure therapy on pain and quality of life in patients with knee osteoarthritis: an interventional study / 针灸推拿医学（英文版）

Objective: To investigate the effect of acupressure therapy as an adjunctive therapy to pharmacological treatment on pain and health-related quality of life (QOL) among knee osteoarthritis (KOA) patients.Methods: One hundred KOA patients were recruited from the orthopedic out-patient clinic of the institute. The patients were allocated randomly (flipping-coin simple randomization method) into an intervention group (n=50) and a control group (n=50). Patients in the intervention group received acupressure therapy along with pharmacological treatment. Patients in the control group did not receive acupressure therapy but continued their pharmacological treatment. Changes in pain (visual analog scale, VAS) and QOL (short-form 36-item health survey, SF-36) scores at baseline (A0), during training session (A1), follow-up at the 3rd month after training (A2) and follow-up at the 6th month after training session (A3) were collected and examined. Multiple regression analysis was used to check the relationship between pain and SF-36 domains. Results: The VAS score of participants in the intervention group decreased at A3 (P=0.001). Scores of physical functioning (PF), role limitations due to emotional problems (RE) and mental health (MH) of SF-36 in the intervention group improved more as compared with the control group. Patients in the intervention group with improvement in VAS (pain) score showed greater changes in mean scores of all domains of SF-36 from baseline (all P?0.05). Except bodily pain (BP), the other domains of SF-36 were negatively correlated with pain score. Conclusion: Acupressure therapy with pharmacological treatment can improve health-related QOL and pain among KOA patients.

Sexual Dimorphism In Splenial Morphology: A Cadaveric Study

Introduction: There is no uniformity in published works regarding the presence of sexual dimorphism in themorphology of the Corpus Callosum (CC), specifically splenium.Objective: The present study was conducted on formalin fixed preserved brains to get comprehensive dataregarding gender related differences of CC.Materials and Methods: 50 formalin fixed human brains without apparent neuropathology were cut in themidsagittal plane. The various morphometric features of CC were measured and recorded on these midsagittalsections.The diameters measured were: (i) length of CC (AB), (ii) Width of body of CC at mid point (WBM), (iii) Maximumwidth of genu (AE), (iv) Maximum width of splenium (BD).Results: Mean values of two parameters (AB and AE) were greater in male than in female. However, 2 parameters(WMB and BD) had greater value in female than male. Only two parameters (AB and BD) showed statisticallysignificant (p value < 0.05) gender differences.Conclusion:significant sexual dimorphism was observed in the longitudinal length of the CC, including morphologyof the splenium. However, these gender related differences are more likely due to individual differences regardlessof sex

AtMBD4: A methylated DNA binding protein negatively regulates a subset of phosphate starvation genes

DNA methylation is an important epigenetic modification that governs transcriptional regulation. The methylation mark isread by a special class of proteins called methyl-CpG-binding domain proteins. The role of DNA methylation has beenfound in X-chromosome inactivation, genomic imprinting, transposon silencing, and self-incompatibility. Recently,remodeling of global DNA methylation was demonstrated in Arabidopsis during low phosphate availability. The presentstudy reports that AtMBD4 gene of Arabidopsis negatively regulates phosphate starvation. The T-DNA insertion mutation atthe AtMBD4 locus exhibited altered root architecture as compared to wild-type plants. Using microarray hybridization andanalysis, an increased transcript accumulation of 242 genes was observed in the mutant. Many of these genes were relatedto phosphate transporters and transcription factors, involved in phosphate starvation response. Comparison of data ofatmbd4 mutant with publicly available microarray data of phosphate starvation response indicated the role of AtMBD4protein in phosphate starvation response. Further, promoter analysis of up-regulated genes suggested that cis-regulatoryelements like MBS, W-box, and B1BS are more prominent in the promoters of up-regulated genes. Upon performing amethylation-specific PCR, a decreased DNA methylation in the promoter regions of up-regulated genes was observed. Theaccumulation of anthocyanin and inorganic phosphate in the atmbd4 mutant was found to be higher than the wild-typeplant. Altered root morphology, up-regulation of phosphate starvation-induced genes in atmbd4 mutant suggests thatAtMBD4 negatively regulates the phosphate starvation response.

Assessment of timely immunization in an urbanized agglomeration of East Delhi, India

Background: The under-5 mortality rate in India has shown a decline in the last few decades. However, there is still a lot of work to be done for our country to achieve sustainable developmental goals. One of the factors contributing to child survival is immunization coverage, but high coverage does not mean timely vaccination. ‘On time’ immunization is an important yet little researched factor shielding a child from susceptibility to vaccine preventable diseases. This study aims at assessing the extent of timely immunization and predictors of intentional delay in vaccination of children.Methods: A cross-sectional study was conducted in East Delhi among caregivers having a child in the age group of 13-24 months. Sample size was calculated at 95% confidence limit and 3.5% absolute precision. The final sample size obtained was 350.Results: The percentage of fully and timely vaccinated children is 67.1%, whereas children fully vaccinated but with a delay of 4 weeks from the recommended age of administration is 19.7%. Partial vaccination was found in 11.2% of children and 2% of children were found to be not vaccinated. The most common reason for delay in immunization was pain at the time of administration leading baby cries and fear of needles (26.1%), followed by bad experience with previous vaccination (11.6%). Fear of side effects (14.5%) and being denied vaccination without card (11.6%) were other reasons.Conclusions: The immunization program should include timely completion of vaccination as a quality indicator. Delayed immunization can lead to epidemics in the community and threaten the goal of elimination of vaccine preventable diseases. Improving timeliness can be successfully achieved if the reasons for delay are taken into account.

Pericardiocentesis can be nasty. Accidents do occur while “Rail-roading” Sheaths and pigtails!

Pericardiocentesis is a challenging procedure and complications may vary depending on the patient-specific risk factors and procedural indications. Cardiac chamber perforation and the subsequent insertion of pigtail catheter into the main pulmonary artery are an unreported mishap during attempted pericardiocentesis. This potentially life-threatening complication is completely preventable by identification of high-risk patients and appropriate use of available technologies. Adjunctive imaging decreases procedural risk for difficult-to-access pericardial fluid collections and must be used to prevent inadvertent morbidities.

Morphological Variations In The Arterial & Nerve Supply Of Thyroid Gland – A Cadaveric Study

Introduction: The arteries and nerves related to the thyroid gland are very important as they are the potentialsource of bleeding and palsy during thyroidectomies and other head and neck surgeries. Thus a thoroughknowledge of relation between them is a prerequisite for the surgeons and other interventionists.Materials and Methods: The study was done in the Department of Anatomy, Government Medical College, Patiala,Punjab among 30 adult human cadavers from May 2015 to Nov 2015. The origin, course, terminal branches andthe relation of superior and inferior thyroid arteries to external and recurrent laryngeal nerves respectively werenoted and the results were evaluated. The complete pattern of morphology of the thyroid gland in relation to thearterial and nerve supply was labelled as standard or variant. Bilateral symmetry of pattern was noted anddetails of the variations were enumerated. A detailed inference was obtained in the light of present observationsand the findings of earlier workers.Results: In 29 cases we found the superior and inferior thyroid arteries were originating from the externalcarotid artery and thyrocervical trunk respectively while in 1 case there was thyroidea ima artery originatingfrom right common carotid artery with absent right inferior thyroid artery. The external and recurrent laryngealnerves were related to superior and inferior thyroid arteries as described by most of the standard textbooks butthe detail percentages of the relationship is given below.Conclusion: The study is an attempt to establish a relation between the variations that we generally encounter inthyroid glands related to its arteries and nerves. Proper identification of thyroid gland vessels is very importantin order to avoid major complications during and after neck surgeries. Thyroid anatomy and its associatedanatomical variations are very essential to know for Endocrinologist and Surgeons, so that these anomalies arenot overlooked while arriving at a diagnosis

Application of GIS in public health in India: A literature-based review, analysis, and recommendations.

The implementation of geospatial technologies and methods for improving health has become widespread in many nations, but India's adoption of these approaches has been fairly slow. With a large population, ongoing public health challenges, and a growing economy with an emphasis on innovative technologies, the adoption of spatial approaches to disease surveillance, spatial epidemiology, and implementation of health policies in India has great potential for both success and efficacy. Through our evaluation of scientific papers selected through a structured key phrase review of the National Center for Biotechnology Information on the database PubMed, we found that current spatial approaches to health research in India are fairly descriptive in nature, but the use of more complex models and statistics is increasing. The institutional home of the authors is skewed regionally, with Delhi and South India more likely to show evidence of use. The need for scientists engaged in spatial health analysis to first digitize basic data, such as maps of road networks, hydrological features, and land use, is a strong impediment to efficiency, and their work would certainly advance more quickly without this requirement.

Hepatitis C virus (HCV) infection & risk factors for HCV positivity in injecting & non-injecting drug users attending a de-addiction centre in northern India.

Background & objectives: Injecting drug use is a major route of hepatitis C virus (HCV) infection in India, but there may be other risk factors also. this study was carried out to determine the seroprevalence of anti-HCV antibody in injecting drug users (IDUs) vs. non-IDUs (NIDUs), and to study the risk estimates for HCV seropositivity in the total sample of substance users with regard to various demographic, clinical, behavioural and personality factors. Methods: the IDUs (n = 201) and NIDUs (n = 219) were assessed for demographic, clinical and behavioural information, and were rated on instruments for severity of dependence, risk behaviour and personality profiles. Anti-HCV antibody was tested by ELISA and confirmed by recombinant immunoblot assay (RIBA) test. Results: Almost one-third of the IDUs (64 of 201; 31.8%) were positive for anti-HCV antibody, as opposed to only seven (3.2%) of the NIDUs. The four risk factors strongly associated with HCV positivity in multivariate analysis were sharing syringe [Exp(B) 75.04; 95%CI 18.28-307.96; P<0.001], reuse of injection accessories (16.39; 3.51-76.92; P<0.001), blood transfusion (5.88; 1.63-21.23; P=0.007) and IDU status (3.60; 1.26-10.31; P=0.017). Other variables less strongly but significantly associated with HCV positivity were multiple sex partners, opioid dependence, risk behaviour scores, impulsivity, and lower age of onset of drug use. Interpretation & conclusions: Our study showed a high seroprevalence of anti-HCV antibody in IDUs. In the substance users, HCV positivity was significantly and independently associated with several clinical, behavioural, and personality risk factors.

Controlled trial comparing the efficacy of 88% phenol versus 10% sodium hydroxide for chemical matricectomy in the management of ingrown toenail.

Background: Partial nail avulsion with lateral chemical matricectomy is the treatment of choice for ingrown toenails. Phenol (88%) is the most widely used chemical agent but prolonged postoperative drainage and collateral damage are common. Sodiumhydroxide (NaOH) 10% has fewer side‑effects. Methods: Adult, consenting patients with ingrown toenails were alternately allocated into two treatment groups in the order of their joining the study, to receive either 88% phenol (Group 1, n = 26) or 10% NaOH (Group 0, n = 23) chemical matricectomy. The patients as well as the statistician were blinded to the agent being used. Post‑procedure follow‑up evaluated median duration of pain, discharge, and healing along with recurrence, if any, in both the groups. The group wise data was statistically analyzed. Results: Both the groups responded well to treatment with the median duration of postoperative pain being 7.92 days in Group 0 and 16.25 days in Group 1 (P < 0.202). Postoperative discharge continued for a median period of 15.42 days (Group 0) and 18.13 days (Group 1) (P < 0.203). The tissue condition normalized in 7.50 days (Group 0) and 15.63 days (Group 1) (P < 0.007). Limitations: Limited postsurgical follow up of 6 months is a limitation of the study. Conclusion: Chemical matricectomy using NaOH is as efficacious as phenolisation, with the advantage of faster tissue normalization.