Clinicopathological correlation of tumor-stroma ratio and inflammatory cell infiltrate with tumor grade and lymph node metastasis in squamous cell carcinoma of buccal mucosa and tongue in 41 cases with review of literature

Introduction: Several studies regarding tumor-stroma ratio (TSR) in colorectal, esophageal, breast, endometrial, and cervical carcinomas have been done in the past with significant results. Objectives: The objectives of this study were to (1) study and grade TSR in buccal mucosa and tongue squamous cell carcinoma (SCC), (2) grade inflammatory cell infiltrate surrounding the tumor, and (3) correlate the above two parameters with tumor grade, lymph node metastasis, lymphovascular invasion (LVI), and perineural invasion (PNI). Materials and Methods: Totally, 25 patients of buccal SCC and 16 cases of tongue SCC were included in the study. TSR was assessed visually on the hematoxylin and eosin-stained tissue sections by two independent observers. Cases were categorized into two groups: One with high TSR >50% (stroma poor) and the other with low TSR <50% as the stroma-rich group. TSR was correlated with tumor size, lymph node metastasis, inflammatory cell infiltrate, LVI, and PNI. Data were analyzed by the Statistical Package for the Social Sciences version 16.0 (Chicago, IL, USA) for Windows. The Chi-square and Fischer's exact tests were applied in the analysis of categorical variable. Results and Conclusion: SCC of buccal mucosa showed a significant correlation between TSR and size of the tumor (P = 0.001). We found that smaller the tumor size ≤2 cm (Stage T1), lesser the TSR, and size >2 cm was found to be associated with higher TSR. Hence, higher TSR (stroma poor) was associated with an adverse pathological characteristic, i.e., advanced T significantly. There was no significant correlation between TSR and inflammatory infiltrate with grade of the tumor, lymph node metastasis, LVI, and PNI. In 16 cases of SCC of the tongue; no correlation was observed between TSR and inflammatory infiltrate with tumor size, grade of the tumor, lymph node metastasis, LVI, and PNI. TSR has been studied in various malignancies (mostly adenocarcinomas) including laryngeal SCCs; however, it has never been studied on oral SCCs

Comparison Of Umbilical Cord Milking And Delayed Cord Clamping On Haemoglobin And Haematocrit Levels In Term Neonates. A Randomized Controlled Trial.

Background: Delayed umbilical cord clamping is an effective strategy and particularly relevant for infants living in low-resource settings with less access to iron-rich foods and thus are at greater risk of anaemia. Objective: To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on haematological parameters (serum ferritin & hemoglobin) at birth and at 72 hours in term neonates. Methods: This was an Open Label Randomized Controlled Trial conducted at Suvidha Mother and Child Nursing Home Talab Tillo Jammu over a period of 6 months. A total of 68 babies born at > 37 weeks of gestation were randomized in three groups, group I UCM alone (n=28) , Group II DCC alone (n=23) and Group III both UCC and DCC (n=17) using simple randomization technique . In milking group, Umbilical cord was milked 4 times towards the baby at a speed of 10 cm / sec . In Delayed Cord Clamping group cord was clamped and cut 2-3 cm distance from the umbilical stump after 3 minutes of birth. In Group III both procedures were done simultaneously. Statistical analysis: ANOVAwas used to compare mean difference of outcome between three intervention arms. Two tailed Pvalue of <0.05 was taken as significant. SPSS version 20.0 was used for data analysis Results: The baseline characteristics were mostly comparable in the all the groups. Maximum increase in Haemoglobin and PCV was seen in group II i.e delayed cord clamping . Mean haemoglobin and heamatocrit (PCV) levels at 72 hours of life neonates in group II (17.7g% and 55.4 ) and group III (17.3g% and 54) were comparable . Conclusion: Both the interventions i.e Delayed cord clamping performed alone or in combination with umbilical cord milking had comparable effect on hematological status in term neonates

Impact of Sex of The Previous Child on the Out Come of Subsequent Pregnancy.

Survival of the semi allogeneic fetus in uterus without rejection is an immunological paradox . The antigenic dissimilarity is pronounced when XX mother Carries an XY fetus Pervious birth of a boy negatively affects the obstetrical future in female where these has been a supposed failure of immunological tolerance of pregnancy. Out of all the obstetrical complication assessed, IUGR turned out to be the most strongly associated with pervious Male Baby. PIH turned out to be the most common complication associated with pregnancy. Rate of LBW was also significantly more in women with previous male child. Oligo - hydromnios was also found to be significantly associated with history of having previous male child. PROM was also seen more frequently in cases that had a preceding male child. Pre -Eclampsia was also significantly associated with history of having a previous male child. A total of 1350 cases were studied. As expected, 64.89% of the cases included in the study went uneventful. There were 22.52 % vs. 12.59% eventful pregnancies in women with previous male and previousfemale child respectively (p = 0.0001).27.04% pregnancies went uneventful in women with previous male compared to 37.85% in women with previous female child (p = 0.0001).The study clearly shows that there is a lesser predilection of obstetrical mishaps happening to women whose first child is a female compared to those who have a previous male child.

Study of Lipid Derangement in Pyschiatric Disorder.

Background: Several studies have investigated the relationships of lipid levels with psychiatric patients and their results revealed an association between lipid derangement and psychiatric disorders. The aim of our study is to evaluate the lipid profile alteration in psychiatric disorder and compare with normal control. Materials and Methods: This study was conducted at People’s College of Medical Sciences and Research Centre, Bhopal. Sixty newly diagnosed psychiatric patients were included in this study and compare with 40 normal subjects. In both the groups we have measured lipid profile which includes serum total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL), and cardiovascular risk factors (R-1and R2). Results: The levels of serum TC, TG, LDL-C and VLDL-C and risk factors in psychiatric patients was significantly increased as compared to control group (p<0.05). While serum HDL-C level was significantly decreased in test group (p > 0.05). Conclusion: In our study it is clearly evident that psychiatric disorders are associated with significantly higher levels of lipids (constituents of lipid profile) and risk factors for coronary heart disease.

Determination of a reference interval in a population.

The reference interval is the most widely used medical decisionmaking tool that separates healthy from diseased individuals. We briefly discuss the methods used to determine reference interval and its limitations.

Pregnancy Outcome In Women with the Polycystic Ovarian Syndrome.

The aim of the study is to compare the pregnancy outcome, especially the prevalence of gestational diabetes mellitus in a group of patients with PCOS, with a group of healthy weight matched women. Retrospectively we evaluated the pregnancies of 56 women with PCOS some of who had been treated for infertility. These were compared with a group of 56 age and weight matched controls. Incidence of Pregnancy induced hypertension in cases of PCOS was 14.2 % (8/56) , gestational diabetes was 14.2 % (8/56) IHCP 10.7% (6/56) as compared of age and weight matched controls is with the incidence of PIH was 7.10% (4/56), GDM 3.5% (2/56) IHCP 7% (4/56).The differences in the incidence of GDM & PIH in two groups was not significant. The outcome of pregnancy in controls & the test groups were not significant, though numerically found to be heigher.Thereby, suggesting PCOS must be screened for comorbid conditions like PIH, GDM &IHCP.

Mortality & clinical characteristics of hospitalized adult patients with HIV in Pune, India.

BACKGROUND & OBJECTIVE: In India, data regarding mortality and clinical characteristics of hospitalized HIV-infected patients are sparse, which may limit the effectiveness of new hospital-based HIV programmes providing antiretroviral therapy (ART). The objective of our study was to determine mortality and clinical characteristics of hospitalized HIV-infected individuals in a high HIV prevalence region of India. METHODS: A retrospective chart review was done of known HIV-infected adults admitted to the Medical Service of a large, public hospital in Pune, India, from January 2002 to November 2003. RESULTS: A total of 655 HIV-infected patients were identified; 489 (74.7%) were male and 4 (0.6%) were on ART. The most common illnesses reported were tuberculosis (55.8%), diarrhoea (4.2%), and alcoholic liver disease (3.7%) . The inpatient mortality was 172 (26.3%). The most common causes of death of the 172 people were tuberculosis (52.9%) and cryptococcal meningitis (7.6%). In multivariate analysis, factors associated with increased mortality were male sex (adjusted odds ratio (AOR) 1.92, 95% CI: 1.08-3.41), haemoglobin level < 7 g/dl (AOR 2.75, 95% CI:1.23-6.14), length of stay < 2 days (OR 5.78, 95%, CI: 1.82-18.4), and cryptococcal meningitis (OR 4.44, 95% CI:1.19-16.6). INTERPRETATION & CONCLUSION: In the era prior to widespread ART, a high inpatient mortality of 26 per cent was found among hospitalized HIV-infected individuals. Thus, while hospitalization is an important access and referral point for HIV care and treatment, earlier identification of HIV-infected persons must occur to ensure they will optimally benefit from the government's ART programme.

Mother-to-child transmission of HIV among women who chose not to exclusively breastfeed their infants in Pune, India.

BACKGROUND & OBJECTIVE: The percentage of HIV cases attributed to mother-to-child transmission (MTCT) has increased several fold in recent years. No reports are available on HIV MTCT rates among HIV-infected choosing not be exclusively breastfeed their infants in India. We examined HIV MTCT rates among 41 Indian women in a prospective cohort who chose predominantly not to exclusively breastfeed. METHODS: Of the 41 women, 27 (66%) received MTCT prophylaxis: 3 received short course zidovudine (AZT), 19 single-dose nevirapine (NVP), and 5 both AZT and NVP. Maternal HIV-I RNA levels (viral load) were measured at the time of delivery. Infants were tested for HIV-1 infection by PCR up to 11 times is first year of life and viral load was measured in PCR positive infants. RESULTS: All infants received single dose NVP. Thirty two (76%) infants were exclusively formula-fed, 10 (24%) were mixed fed. Four infants were diagnosed with HIV infection for an overall 12- month transmission probability of 8 per cent [95% confidence interval (CI) of 3.2 to 22.1%]. Restricting analysis to 31 women who exclusively formula-fed, only one (3.1%) transmission event occurred. The 41 HIV-infected women gave birth to 42 live-born infants. INTERPRETATION & CONCLUSION: Our data from a small cohort of HIV-infected women suggest that short-course AZT or single dose NVP are effective in reducing MTCT in an Indian setting. Larger studies are needed to assess HIV MTCT rates in India, but in this small study rates were comparable to that observed among women who chose not to exclusively breastfeed in other resource-limited settings.

Screening of Gestational Diabetes Mellitus with Glucose Challenge Test in High Risk Group

The present study of screening for gestational diabetes mellitus was carried out in 480 high risk women attending Suvidha Mother & Child Nursing Home. The patients underwent glucose challenge test with 50 gm glucose (GCT ) using glucometer, between 18-20 weeks and if negative the test was again done after 28 weeks. All the 120 patients with abnormal GCT were subjected to 3 hours 100gm oral glucose tolerance test (OGTT ) and 49 patients were found to have abnormal GTT. 3.05% of women were found to have gestational diabetes . Sensitivity of glucose challenge test in detection of gestational diabetes in high risk group was 40.5% The incidence of PIH in patients with abnormal GCT was 22.5%.Since screnning of high risk group was done with the help of glucometer it required no extra laboratory facilities, long waiting period or trained manpower. It has no side effects and guarantees good compliance of patient. GCT hence is a reliable method to detect gestational diabetes mellitus in high risk group.

Term Pregnancy with Partial Molar Changes of Placenta

A rare case report of successful term pregnancy with partial molar changes of placenta is being reported. The patient was 2nd gravida with twin pregnancy with pregnancy induced hypertension (Pili). Patient under went LSCS and gave birth to two healthy looking babies. She was followed up and serum HCG (Human Chorinic Gouadotrophin) level returned to normal within 4 weeks after delivery.