Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm.

Functional Outcome in Digital Replantations – A Study Over A Period of 5 Years

Introduction: Replantation should be the prime indicationsfor treatment of amputated fingers, due to functional andaesthetic advantages. Study aimed to evaluate not study thefunctional outcome of digital replantation over a period of 5years.Material and methods: Seventy four digital replantationswere carried out since June 2013 till May 2018. Mechanism ofinjury was sharp in 36 digits, crush in 18 digits, avulsion in 14digits and blast injury accounted for 6 digits. The distributionof replanted digits was 38 thumbs, 22 index fingers, 9 middlefingers and 5 ring fingers. In 18 patients multiple digits werereplanted. Eleven digits required reexploration and two digitswere reexplored thrice.Results: We had 62 successful replantations with 12 failures.18 digits had good functional recovery, 30 satisfactoryrecovery and 14 poor function. The subjective satisfactionscore was calculated by the DASH score.Conclusion: Replantation surgery have become the method ofchoice in treating the digit amputations with the developmentof microscope. The viability of the replanted part is guaranteedby a successful vessel anastomosis, while the quality ofthe bone, tendon, nerve, and skin repair will determine theoverall functional success of the replanted parts. Repair ofall structures at the time of the primary procedure should beattempted, as secondary surgery is technically difficult

Job Satisfaction Of Faculties Of Medical Teaching Institutions: A Multicentric Cross–Sectional Study

BACKGROUND– Work output of an employee is dependent on the job satisfaction level and is an important criterion as its effect has an indirect impact on the society. A study on job satisfaction level of faculties in Government Medical Colleges would help in the betterment of the Medical Education System in India as it would bring out factors that affect the performance of medical teachers. METHODS-- 100 structured questionnaires, based on 'The Minnesota Satisfaction Questionnaire', were distributed among faculties, which were duly filled up by the participants and the data from the questionnaires were statistically analyzed. RESULT--According to the grade of satisfaction level, it was found that 4.4% were extremely satisfied, 21.1% were very satisfied , 37.8% were satisfied, 30% were somewhat satisfied, , 5.5% were not satisfied, and 1.2% was indecisive. CONCLUSION—Transfer, low salary, disparity in infrastructure is instigating medical teachers to join different private medical colleges.

Nuclear morphometry and texture analysis on cytological smears of thyroid neoplasms: a study of 50 cases

Fine needle aspiration cytology (FNAC) is a reliable and reproducible diagnostic technique for thyroid lesions with certain limitations. Computed morphometric methods have been introduced with a view to improve the diagnostic yield of thyroid aspirates. However, a review of the existing literature revealed conflicting reports regarding morphometric parameters in thyroid neoplasms. Materials and Methods: This study included 50 cases of thyroid lesions (20 cases of colloid goitre, 15 of follicular adenoma, 5 of follicular carcinoma and 10 papillary carcinomas). Digital images of cytologic smears of these cases were captured using a dedicated photomicrography system and nuclear profiles traced manually. With self-designed image analysis software, nuclear morphometric measurements, including texture analysis, were performed. Discriminant analysis was performed including the morphometric parameters and percentage of correctly classified nuclei noted. Results: Nuclear morphometry parameters showed that papillary thyroid carcinoma had the highest perimeter, area, radius and elongation factor compared to other thyroid lesions. Discriminant analysis revealed that altogether 77.9% of cells could be correctly classified to their lesion category based on the nuclear morphometric and textural parameters. Of the neoplastic cases, 84.5% of cells of follicular neoplasms and 72.5% of papillary carcinoma were classified to the respective category. Conclusion: Nuclear morphometry, including texture analysis, can assist in the cytologic diagnosis of thyroid lesions, considering the high degree of accuracy of classification. Further studies and methodological refinements can achieve higher accuracy.

Study of drug use in outdoor pediatric patients of upper respiratory tract infections in a tertiary care hospital.

Background: Upper respiratory tract infections (URTI) are the most common and frequent occurring infections in the pediatric population. URTI is mostly viral in origin and requires mostly symptomatic treatment. The present study was undertaken to analyze the pattern of drug use in the management of URTI in the pediatric age group. Methods: It is a retrospective study to assess the pattern of drug use in URTI in pediatric outpatient department during the 5 months period from January 2015 to May 2015. Results: A total of 2256 prescriptions were analyzed. Most of the pediatric patients belonged to 1-5 years age group and 58.33% were males, and 41.66% were females. A total of 6332 drugs were prescribed out of which the antibiotics used was 1341. The average number of drugs per prescription used was 2.81. The percentage of prescriptions containing antibiotics was found to be 59.44%. Amoxicillin (70.91%) was the most frequent prescribed antibiotic followed by cotrimoxazole (10.21%). Antihistaminic and expectorant combinations were found to be the most common prescribed class of drugs (29.34%) followed by analgesic and antipyretics (26.45%) and antibiotics (21.17%). Conclusions: The study revealed that the majority of children were below 5 years of age. The most common class of drugs prescribed was antihistaminics and expectorant combinations followed by analgesics and antipyretics. Although the majority of the patients received antibiotics, 40.55% of patients received symptomatic treatment. This is a welcome step as inappropriate use of the antibiotics can potentiate to the increasing trend of antimicrobial resistance.

Forced egg retention and oviposition behavior of malaria, dengue and filariasis vectors to a topical repellent diethyl-phenylacetamide.

Egg retention and oviposition behavior of four species of mosquito vectors viz., Anopheles stephensi, Aedes aegypti, Aedes albopictus, and Culex quinquefasciatus to a topical insect repellent diethyl-phenylacetamide (DEPA) at 0.1-1000 mg/L was investigated under laboratory conditions. Based on oviposition activity indices, DEPA demonstrated concentration dependent oviposition deterrent effect to A. stephensi (-0.18 to -0.97), A. aegypti (-0.18 to -0.91) and A. albopictus (-0.50 to -0.98) females. In contrast, positive oviposition response by C. quinquefasciatus (+0.39 and +0.70) was observed respectively at 0.1 and 1 ppm, while 10 ppm of DEPA on water received 50% lesser egg rafts than control. Gravid Culex females laid no egg rafts at 100 and 1000 ppm DEPA treated bowls effecting 100% oviposition deterrence. Test mosquito females deposited most of their eggs (>90%) in the absence of repellent odour, while DEPA odour on water surface forced them to retain huge numbers of eggs. Females of A. aegypti, A. albopictus and A. stephensi retained 49, 67 and 50% of total eggs, respectively throughout the experiment. Egg retention by Culex females due to DEPA on the water surface was ca. 65%, equivalent to 4 egg rafts. Therefore, DEPA at lower concentrations could effectively disturb the oviposition by these vectors. Application of repellents in small water bodies would help in reducing the population build up of mosquitoes near human households and could be useful in the integrated management of mosquito vectors.

To evaluate and compare the hypoglycemic, antioxidant and hypolipidemic effect of lycopene with atorvastatin in hyperlipidemic New Zealand white rabbits.

Background: During recent years, the carotenoid lycopene has attracted much attention for its potentially beneficial cardiovascular effects, which is located mainly in tomato peels. The antioxidant properties of tomatoes has been extensively studied for the prevention of cardiovascular disease, but the beneficial effects of pure lycopene supplement is still debatable. Therefore, this study was planned to evaluate and compare the hypoglycemic, hypolipidemic and antioxidant effects of pure lycopene powder and to compare it with that of atorvastatin in hyperlipidemic New Zealand white rabbits. Methods: Adult male New Zealand white rabbits (1.5-2.5 kg) were divided into three groups of six animals each. Group I - High fat diet (HFD) (5 ml/kg). Group II - HFD (5 ml/kg) + lycopene (10 mg/kg) orally. Group III - HFD (5 ml/kg) + atorvastatin (5 mg/kg) orally. Blood samples were taken from all 18 rabbits for baseline estimation of blood sugar levels (BSL), lipid levels and blood superoxide dismutase levels. Same tests were performed in all groups after 6 weeks. Results: The lipid lowering activity of atorvastatin 5 mg/kg was better than that of lycopene while the antioxidant activity of lycopene was better than that of atorvastatin. Both the results were statistically significant. There was no significant difference in fasting BSLs in both the groups. Conclusion: Findings suggest that lycopene may have considerable therapeutic benefit as an antioxidant and hypolipidemic agent, but may not be effective as a hypoglycemic agent.

Evaluation of wound healing activity of topical phenytoin in an excision wound model in rats.

Background: Wound healing is a significant healthcare problem in today’s medical practice. Despite extensive treatment modalities that are supposed to hasten the wound healing process, the outcomes of existing methods are far from optimal. One such agent that has been tried previously and found controversial in wound healing is phenytoin. Therefore, this study was planned to evaluate and compare wound healing effect of topical phenytoin with povidone iodine ointment in rats. Methods: This study was conducted after approval from Institutional Animal Ethics Committee (IAEC). Wound healing activity of topical phenytoin (1 g% and 2 g%) was assessed in excision wound model in Sprague Dawley rats (n=8), which was compared with topical petroleum jelly and povidone iodine ointment. Parameters studied included wound area on day 0, 4, 8, 12, 16, 20, percentage wound contraction, percentage wound healing from day 0 to day 20 and period of re-epithelisation. Results: Wound surface area decreased in all treatment groups from day 0 through day 20 and the percentage wound closure was better in both the preparations (1% and 2%) of phenytoin when compared wih control and povidone iodine, but this was not statistically significant. Furthermore, the days required for complete re-epithelisation were less with phenytoin treated groups. There was no statistical difference between both the preparations of phenytoin. Conclusion: In this study, it was found that topical phenytoin accelerates wound healing process in an excision wound model.

Evaluation of anti-leishmanial activity of artemisinin combined with amphotericin B or miltefosine in Leishmania donovani promastigotes.

Background: The increasing incidence of drug resistance in Leishmaniasis necessitates evaluation of combination chemotherapy. Miltefosine and amphotericin B are established anti-leishmanial drugs, while artemisinin has shown significant leishmanicidal activity in experimental models. In this study, we have evaluated the additive/synergistic effect of artemisinin with amphotericin B or miltefosine. Methods: Leishmania parasites were isolated from the bone marrow aspirate of a patient with visceral leishmaniasis. Parasites were typed as Leishmania donovani by restriction fragment length polymorphism of internal transcribed spacer 1 region of Leishmania genome. Promastigotes were incubated in a fixed ratio combination of artemisinin (0-500 μM) and amphotericin B (0-100 nM) or miltefosine (0-100 μM) and cell viability was assessed. An isobologram was constructed to evaluate the additive/synergistic effect, wherein it was considered additive if the mean sum fractional inhibitory concentration (mean ΣFIC) at the IC50 level was <2, but ≥1 and synergism, if the mean ΣFIC was <1. Results: The isobologram showed an additive effect for three combinations of artemisinin-amphotericin B and artemisinin-miltefosine, the mean ΣFICs ranging from 1.02 to 1.44 and 1.08 to 1.33 along with a synergistic effect with one combination, the mean ΣFICs being 0.58 and 0.81 respectively. Conclusions: This study supports the combination use of artemisinin-amphotericin B and artemisinin-miltefosine, worthy of future pharmacological consideration.

Orientation of medical undergraduates to community nutrition.

The prevalence of non-communicable diseases is increasing and diet is an important risk factor for it. This is less recognized in the medical curriculum and even though it is there, it is presented unsystematically. Objective: We studied theresponse to an ‘innovative method of teaching nutrition’ to the undergraduates and assessed their perspective of the facilitating and hindering elements. Methodology: The nutrition model was applied to semester iv students at our institute. A session planning guide was drawn initially and short group interactive sessions were given including briefing, demonstrations and field visits followed by diet calculation and inference about the consumption of the concerned family. Feedback was taken from students and analysis was performed. Results: The majority of the responses were, learning the basics of Interviewing (72%), problem based assessment of Balanced diet (53%), social determinants of nutritional diseases (60%). The facilitating points stated were development of interviewing skills, community orientation, reasoning abilities, planning balanced diet for one-self etc. and still more of practical sessions were suggested to be included in the guide. Conclusion: Our method of teaching nutrition was well accepted by students. They understood the key concepts and could apply them to problems based on social scenarios.

Liver Function Tests in Type 2 Diabetes Mellitus Patients with and without Oral Hypoglycemic Agents and Statin Intake.

Background: Type 2 diabetes (T2DM) is often associated with liver function abnormalities, covering the entire spectrum from asymptomatic transamnitis to cirrhosis. The oral drugs used in diabetes are also associated with hepatic insult. Aims: Here we have tried to assess the prevalence the liver function test abnormality in type 2 diabetes mellitus patients with special reference to intake of oral hypoglycemic agents (OHA) and statins. Methods: We selected 101 patients of Type 2 Diabetes mellitus (T2DM). Among those diabetic patients 50 were on oral hypoglycemic drugs (OHA) and statins for at least last 6 months. Another 51 age and sex matched patients were diabetic but not on these drugs. The patients were screened for any existing liver disease by biochemical tests. Results and analysis: Our results showed that the prevalence of elevated liver enzymes and bilirubin is more in Diabetic patient than normal values but the oral hypoglycemic drugs and statins had no added effect. Altogether 70 patients (69.3%) had at least one liver function test abnormality. In our study, 4.95% of the patients had elevated bilirubin (>2.5 mg/dL). 24.75% of the study patients had ALT levels above normal (40 U/L) although high values (>100 U/L) were present only in 5 (4.95%). High AST levels (>40) was found in 34.65% cases. Mean alkaline phosphatase levels in 2 groups were similar (213.96 ± 46.2 vs. 222.75 ± 42.52 U/ L). Serum proteins, INR and alkaline phosphatase did not also show any association with drug intake in our study. Conclusion: Thus screening for liver function abnormalities can be a useful test in diabetic population to prevent future complications.

Two rare anatomical variations of external jugular vein: an embryological overview / Dos raras variaciones anatómicas de la vena yugular externa: una visión embriológica

Human anatomy is an ocean of unending variations and its mysteries are being unravelled since ages. Knowledge of variations in the superficial veins of head and neck is essential to carry out successful surgical procedures. During routine dissection of head and neck of two middle aged male cadavers, in the Department of Anatomy, Calcutta National Medical College, Kolkata, India, we came out with some interesting venous architecture. The retromandibular vein on the left side of both the cadavers was found to be undivided and joined with the facial vein in the neck at an acute angle to form a common venous trunk at variable distances from the angle of the mandible. That trunk ultimately drained into the left subclavian vein. This might be the result of disappearance of the cephalic part of the external jugular vein and formation of an additional communication between common facial vein and the external jugular vein in foetal life. In one case, we also came across an extra transverse communication between that common trunk and the internal jugular vein. A detail of those cases with embryological explanation is attempted...

La anatomía humana tiene un sin fin de variaciones y sus misterios se han develado desde el inicio de los tiempos. El conocimiento de las variaciones anatómicas de las venas superficiales de la cabeza y del cuello es fundamental para llevar a cabo con éxito los procedimientos quirúrgicos. Durante una disección de rutina de cabeza y cuello encontramos una arquitectura venosa interesante en dos cadáveres de hombres de mediana edad en el Departamento de Anatomía de la Facultad de Medicina Nacional Calcuta, Calcuta, India. En el lado izquierdo del cuello de ambos cadáveres, la vena retromandibular no se encontraba dividida, y se unía a la vena facial en un ángulo agudo, para formar un tronco venoso común a una distancia variable desde el ángulo de la mandíbula. Ese tronco finalmente drenaba en la vena subclavia izquierda. Esto podría ser el resultado de la desaparición de la parte cefálica de la vena yugular externa y la formación de una comunicación adicional entre la vena facial común y la vena yugular externa en la vida fetal. En un caso, también se encontró con una comunicación adicional transversal entre ese tronco común y la vena yugular interna. Se realiza una descripción en detalle de los casos junto a una explicación embriológica...

Molecular phenotypes of ductal carcinoma-in-situ and invasive ductal carcinoma: A comparative study.

Aims and Objectives: This study was aimed at analyzing the prevalence of molecular phenotypes in invasive ductal carcinoma (IDC) and coexisting ductal carcinoma-in-situ (DCIS) and to correlate with clinicopathological features. Materials and Methods: In this study, 75 cases of IDC with coexisting DCIS were included. Molecular phenotype was determined using expression of estrogen receptor, progesterone receptor, HER2/neu, and cytokeratin 5/6. Statistical analysis was performed for correlation between molecular phenotypes and clinicopathologic parameters. Results: Of the 75 cases, the invasive component in all cases was IDC-not otherwise specified. About one-third of our patients were post-menopausal. The most common molecular phenotype was luminal A (45.3%) followed by HER2-expressing type (24%). In all cases, the molecular phenotype was identical in DCIS and the invasive component. HER2-expressing tumors were found to be larger in size with frequent nodal involvement. On statistical analysis, tumor size and grade were found to correlate with the molecular phenotype. Conclusion: In conclusion, the molecular phenotype in DCIS correlates well with that of coexisting IDC, suggesting that DCIS is a precursor lesion in these tumors. This correlation of molecular phenotype can be utilized in prediction of phenotype of the invasive component in a case with in-situ carcinoma.

Supernumerary nostril - an unusual case report

Developmental anomalies of the nose encompass a diverse group of conditions. Embryologic development anomalies of the nose include nasal dermoids, gliomas, encephaloceles, nasal clefts, proboscis lateralis, arhinia, polyrrhinia, nasopharyngeal teratoma, and epignathus. Supernumerary nostril is a very rare congenital anomaly. We report such a case with review of literature. Embryology of nasal development and embryogenesis of duplication anomalies are discussed in this review

A study to find out the proportion of prediabetes in patients with acute coronary syndrome in a medical college of Kolkata.

Prediabetes is now considered as a definite entity for increased incidence of cardiovascular disease and a potent risk for progression to type 2 diabetes mellitus. As macrovascular disease is the commonest cause of increased mortality in dysglycaemic individuals (prediabetes and diabetes) by 2-4 times as opposed to normal individuals, clinicians do encounter patients with cardiovascular disease of varying severity regularly. There are increased constellation of other cardiovascular risk factors (hypertension, dyslipidaemia, etc), in prediabetes as compared to normal population. Here a study was carried out among 62 acute coronary syndrome patients who were admitted in a tertiary care hospital in Kolkata to find out the proportion of prediabetes in them. Majority of the patients (54.8%) were in the age group of 45-64 years and were males (77.4%). The study showed 48.4% of all acute coronary syndrome patients were prediabetic and 25% were diabetic. The proportion of impaired fasting glucose and impaired glucose tolerance were 19.4% and 22.6% respectively. So, altogether 72.4% patients were dysglycaemic. Out of all acute coronary syndrome patients, non-ST elevated myocardial infarction group had 50% prediabetic patients, ST elevated myocardial infarction group had 50% prediabetic patients and unstable angina group have 45.8% prediabetic patients. So, all patients of acute coronary syndrome should be screened to detect hyperglycaemia in early stage to prevent further development of diabetes mellitus and also further cardiovascular events.

A study on clinical and biochemical profile of low body weight type 2 diabetes mellitus.

Low body weight type2 diabetes mellitus (T2DM) is a distinct entity in T2DM having different clinical presentation, morbidity and mortality patterns as well as biochemical profile when compared with classical T2 DM. This study was aimed at comparing three subtypes of T2 DM-overweight (BMI>25), normal weight (BMI>18.5 but <25) and low body weight or lean type2 DM (BM1<18.5). Seventy-five cases of T2 DM (25-lean, 25-normal weight and 25-overweight) were selected. The present study revealed that normal C-peptide level with basal hyperglycaemia is an important characteristic of lean T2 DM. Lower prevalence of hypercholesterolaemia and higher level of triglycerides were found in low body weight T2 DM.Lower prevalence of macrovascular and higher prevalence of microvascular complications are also noted.

Transthoracic cutting needle biopsy: a valuable diagnostic procedure.

Intrathoracic mass lesions, especially peripherally situated masses, often present as a problem as tissue diagnosis is not always possible by cytopathological examination. Cutting needle biopsy may be the method of choice in selected cases for tissue diagnosis. Cutting needle biopsy is indicated for patients with peripherally situated mass lesions abutting chest wall, which are non-vascular and non-cystic in nature.