Diagnostic utility of special stains in defining the spectrum of maxillofacial pathologies

Background: The Fine needle aspiration cytology (FNAC) is considered as a valuable and distinguished diagnostic test in the initial assessment of the patients presenting with a mass in the head and neck region or when a recurrence is suspected after previous treatment. Aims: This study was therefore designed to elucidate the efficacy of FNAC as an alternate diagnostic tool to histopathology in head and neck swellings and evaluation of staining efficacy of PAP and MGG stain over Haematoxylin and eosin (H and E) in routine cytopathological smears. Settings and Design: The study was conducted in the Department of Oral and Maxillofacial Pathology, where FNAC samples were collected from 150 patients with head and neck swellings. Materials and Methods: All the slides were stained with H and E, Papanicolaou (PAP), and May Grunewald Giemsa (MGG) stains. The cytopathological diagnosis was compared with histopathological diagnosis based on H and E stained sections obtained from paraffin-embedded formalin-fixed biopsy specimen of benign and malignant neoplasms. Statistical Analysis Used: The resulting data were analyzed using SPSS software version 19. Differences between the variables were analyzed using Pearson Chi-square test and Kruskal–Wallis test wherever applicable. Results: The FNAC as a diagnostic tool has sensitivity of 84.8%, 72.72%, and 78.78%, specificity of 62.5%, 75%, and 75%, and accuracy of 80.48%, 73.14%, and 78.04% in H and E, MGG, and PAP stain, respectively. PAP stain was the most efficient stain when all qualitative parameters are taken into consideration with maximum sensitivity and specificity for achieving definitive cytodiagnosis. Conclusions: The FNAC is an inexpensive and minimally invasive technique to diagnose different types of head and neck swellings and complement histopathological diagnosis.

Phaeohyphomycosis: A study from tertiary health care center in North India

Objectives: Phaeohyphomycosis refers to infections caused by phaeoid/dematiaceous or darkly pigmented fungi. This study was undertaken to further increase our knowledge about the incidence of phaeohyphomycosis and its causative agents. Materials and Methods: The present study was conducted over a period of one and a half years (January 2018–June 2019) on specimens received from patients with varied clinical manifestations ranging from superficial infections, subcutaneous cysts, pneumonia, brain abscess to a disseminated infection. These specimens were processed in the Department of Microbiology for potassium hydroxide (KOH) examination and culture and in Pathology for cytology/histopathological examination (HPE). All specimens positive on direct examination for dark grey, brown or black fungi were included in the study. Results: A total of 20 specimens were confirmed as phaeohyphomycosis. Most of the patients belonged to the age group of 41 to 50 years. Male: Female ratio was 2.3:1. Trauma was the most common risk factor. Spectra of the isolated fungal pathogens comprised of Bipolaris species, Exophiala species, Curvularia geniculata, Phialemonium species, Daldinia eschscholtzii, Hypoxylon anthochroum, Phaeoacremonium species, Leptosphaerulina australis, Medicopsis romeroi, Lasiodiplodia theobromae, Eutypella species, Chaetomium globosum, Alternaria species, Cladophialophora bantiana and 2 unidentified dematiaceous fungi. Recovery from phaeohyphomycosis was seen in 12 patients, 7 were lost to follow up and one patient succumbed to the illness. Conclusion: Infections caused by phaeoid fungi can no longer be viewed as rare. In fact, phaeohyphomycosis can have myriad of presentations spanning from mild cutaneous infections to fatal brain disease. Therefore, a high index of clinical suspicion is needed to diagnose such infections. The primary treatment modality remains surgical removal of the lesion in cutaneous or subcutaneous infections however disseminated disease with a guarded prognosis requires aggressive management.

CD44 related stemness maneuvers oral squamous cell carcinoma biology

Introduction: Despite the commendable advancements in oral squamous cell carcinoma (OSCC) diagnostics and therapeutics, it remains a considerable medical challenge. Recent evidence suggests that small populations of stem-like cancer cells are responsible for tumor initiation, progression and metastasis. These cancer stem cells (CSCs) have been identified and characterized in various types of cancers, including OSCCs. CSC hypothesis has been supported by the expression of CD44, CD133, ALDH1 and ABCG2. Amongst them, CD44 (a transmembrane glycoprotein), is the most reported CSC marker in OSCCs. The increasing incidence of OSCC combined with its poor survival rates motivates a need for research into the expression of adhesion molecules and may play a pivotal role in studying tumor biology related to invasion and distant metastasis. Objective: To quantify the expression of CD44 in the different grades of OSCC and to correlate the expression of CD44 with clinicopathological parameters. Method: A total of 20 formalin-fixed paraffin-embedded tissues of OSCC were retrieved from department archives. Immunohistochemical staining was performed using anti-CD44 antibody (Biogenex). The expression was assessed semi-quantitatively in varying histopathological grades of OSCC and were correlated with tumor, node, metastasis (TNM) staging which were obtained from the department records. The results were statistically evaluated. Result: Overexpression of CD44 was detected in 48% of well-differentiated OSCCs followed by a linear decrease in moderately differentiated and poorly differentiated OSCCs and the expression correlated with the tumor size (T) in 23% cases and with lymph node metastases (N) in 42% of cases (P ?0.05). Conclusion: The results of the present study suggested an altered expression of CD44 in OSCC. This depicts an association of CD44 with tumor aggressiveness and Epithelial Mesenchymal Transition (EMT) related to loss of cell adhesion in a subset of OSCC—clearly stating tumor cell stemness as a key factor in malignant potential of OSCC.

Urodynamic profile after Wertheim's hysterectomy.

Wertheim 's hysterectomy is likely to cause damage to innervation and anatomical support of the lower urinary tract. Urodynamic assessment was done in twenty patients of histopathologically proven cancer cervix who were about to undergo Wertheim's hysterectomy. The study was performed preoperatively, in the immediate postoperative period and six weeks after surgery. Urodynamic study included uroflowmetry, cystometry and urethral pressure profile. Urinary symptoms were also corelated with the urodynamic profile. It was concluded that the bladder was hypertonic in the immediate postoperative period and urethral closure pressures were low. Some regeneration of damaged nerve fibres was found to occur during the 6-8 weeks after surgery resulting in some improvement in sensory and motor functions of the bladder Post operatively continuous catheter drainage appeared to be the most important part of management of hypertonic bladder and the duration was individualised on the basis of urodynamic investigations.

AIDS-related apprehensions among nursing students of Delhi.

Students from a nursing school of Delhi were surveyed anonymously using a self-administered questionnaire to explore various AIDS-related apprehensions and their possible reasons. The observations revealed that, majority of the students and their families/friends feared that these students were at risk of contracting HIV infection while providing routine patient care. A large number of students also opined that they would feel uncomfortable while talking, hugging, shaking hands, and sharing a room with an HIV positive person. The main reasons for their apprehensions were unsatisfactory anti-AIDS campaigning by the government, non-availability of sufficient protective measures in the health care settings, inadequate professional education related to prevention of HIV infection, and increase in HIV transmission following false sense of security due to excessive condom promotion. Findings of the study imply imparting factual knowledge addressing the concerns and removing misconceptions which influence attitudes and willingness of the nursing students to provide care to the HIV positives/AIDS patients, facts regarding efficacy of various preventive measures, and provision of counselling services in the event of exposure.

Expression and stable germline transmission of neomycin-resistance gene in transgenic mice.

Transgenic mice were produced to study the expression of amino-3' glycosyl phosphotransferase gene (neomycin resistance gene) in the embryonic fibroblast cells. A 1.9 Kb linear fragment of neomycin resistance gene under the control of pPGK promoter was microinjected into the pronucleus of mouse embryos. Out of 64 potential founders born, 5 were identified to be transgenic by the polymerase chain reaction (PCR) and southern hybridization. Multiple mice from first and second generation from two transgenic founders (N-10 and N-32) were analysed to determine the germline transmission. It was found to be 24.6 and 71.4% in first and second generation respectively. Results were also further confirmed by RT-PCR, sequencing and in vitro bioassays.

Some AIDS-related policy issues and nursing students' willingness to provide AIDS care.

Two thirty three diploma students from a Nursing School, in Delhi were surveyed anonymously to seek their opinion on some AIDS-related policy issues and willingness to provide AIDS care. More than one fourth of students opinionated that health personnel should be given a choice to refuse care to the AIDS patients and an equal proportion felt that authorities should be empowered to terminate the services of such personnel. Majority were in favour of making HIV testing compulsory for various high risk groups, indoor patients and health workers. Perceiving the risk of HIV infection, 41.2% students felt that girls might not opt for nursing career, whereas few (10.7%) were considering even to leave the profession. However, majority (58-72%) were willing to nurse the high risk individuals, if adequate training and preventive measures were provided in the health care settings. The study implies framing of an AIDS policy taking in to consideration the views of health professionals and imparting comprehensive training to the nursing students in order to promote a humane approach towards AIDS care.

Role of low dose aspirin in prevention of pregnancy induced hypertension.

In a prospective randomised clinical study 50 primi or multigravidae with history of essential hypertension or pregnancy induced hypertension (PIH) in previous pregnancy were selected from antenatal clinics, on the basis of positive roll over test (ROT) carried out between 28 to 30 weeks of pregnancy. The study group comprised 25 women who received 50 mg aspirin daily from day of positive ROT till 37 weeks of pregnancy. Other 25 women served as control. The incidence of PIH in study and control group was 4% versus 28% and that of pre-term birth was 4% versus 24%. The mean birth weight of newborns in the two groups was 3.04 +/- 0.38 kg and 2.71 +/- 0.48 kg respectively. All these differences were statistically significant. No adverse maternal or neonatal complication due to aspirin was observed.

AIDS awareness among nursing students of Delhi.

A total of 233 students of nursing school affiliated to a major hospital of Delhi were surveyed anonymously employing a predesigned, pretested and self-administered questionnaire. Although, 78.6 per cent students knew that AIDS stands for "Acquired Immuno-deficiency Syndrome," 15.5 per cent students were unaware of the fact that AIDS had reached India. Majority of them were aware of various aspects of HIV/AIDS. However, they also had few misconceptions particularly regarding HIV transmission. Contrary to our belief, only one-fourth students acquired AIDS information from scientific journals. One training session on AIDS conducted for a small group of students could not bring any significant change in their knowledge. Findings suggest organization of AIDS-training sessions at regular intervals from the very inception of nursing programme to impart complete and correct knowledge of these future Florence Nightingales regarding various aspects of HIV/AIDS and for removal of misconceptions.

Preventing gastro-enteritis deaths: recommendations based on a 3 years study.

Based on epidemiological investigation of 75 gstro-enteritis deaths that occurred in 22 major hospitals of Delhi during 1990-92, this paper deals with the observations pertaining to the role of physicians and health infrastructure in the management of gastro-enteritis patients. Majority of the patients visited private practitioners/clinics in the first instance. Hospital stay in 44% of cases was 6 hours or more, by which time dehydration and/or electrolyte imbalance should have been corrected. Still, in 54.5 percent out of these, dehydration was the cause of death, while in 18.2 percent electrolyte imbalance co-existed. Record maintenance at various hospitals was far from satisfactory. The study, highlighting the need for proper rehydration and timely referral enlists recommendations that might help in preventing gastro-enteritis deaths.

Phase contrast microscopic evaluation of placental pathology in premature gestation.

Numerous representative samples taken from forty placentas immediately after delivery from mothers associated with prematurity (i.e. less than 38 weeks), were semiquantitatively studied by phase contrast microscopy. Twenty placentas delivered from mothers without any antenatal complication served as control. Hypoplasia of the syncytium, stromal edema, ischaemia were prominent findings on phase contrast microscopy in the study group. Increased basement membrane thickening and high villous edema scores observed on light microscopy were statistically significant in prematurity as compared to controls. Observations by phase contrast and light microscopy were found complementary to each other. Phase contrast microscopy provided quicker results without disadvantage of fixation artefact and was found distinctly superior over the conventional histological methods.

Teachers' awareness and opinion about AIDS: implications for school based AIDS education.

Two hundred thirteen teachers of one secondary and four primary schools of East Delhi were interviewed to assess their knowledge and attitudes about AIDS and their opinions regarding school based AIDS education. Observations revealed that majority of the teachers were aware of various aspects of HIV/AIDS. However, they also had some misconceptions regarding transmission of the disease. Though, most of the teachers opined that they could play an important role in educating the students as well as the community regarding AIDS/STDs, three fourths of them had never discussed AIDS/STDs with their students. Majority of teachers were in favour of starting class room based education on AIDS/STDs, beginning from secondary classes onwards, and more than half opined that class teacher could educate the students better than the doctors or parents. The results suggest that after being properly trained, teachers can be effectively utilized for educating the students.

Knowledge and attitudes of university students regarding HIV/AIDS: an urban--rural difference.

A total of 322 students from two colleges of Delhi University, one located in urban and the other in the rural area were surveyed to assess and compare their knowledge, attitudes and beliefs regarding HIV/AIDS. A pretested and self-administered questionnaire containing mostly close ended questions was used. Observations revealed that majority of the students were aware of various aspects of HIV/AIDS. However, they also had some misconceptions particularly regarding transmission of the disease. The science and urban students had significantly more knowledge as compared to their counter parts, there by leading to more positive attitudes among them. Findings suggest intensification of AIDS education campaign focussed on removal of misconceptions and changing negative attitudes, more so amongst rural students. Science students can prove as a potential source of peer communication to the non-science students both in urban as well as rural areas.

An epidemiological profile of gastro-enteritis deaths in Delhi state.

This paper describes epidemiological features of 75 gastro-enteritis deaths that occured in 22 major hospitals of Delhi during 1990-92. Three fourth's of deaths were in under five years of age group and more than half were infants. In 84 per cent, diarrhoea was of an acute watery type. Dehydration was the commonest immediate cause of death, while malnutrition was the commonest associated cause. No ORS/SSS/HAF was given to one fourth of the patients. Close relatives of two third's of deceased were either not aware at all about ORS/SSS or had incorrect information. In 87 per cent, food intake was either stopped or had been restricted. The study emphasizes the need for an intensive IEC campaign for prevention, and for better case management in the hospitals coupled with appropriate reorientation training of private practitioners.