Histopathological Approach To The Diagnosis Of Benign Peripheral Nerve Sheath Tumors At Uncommon Location

PARIPEX - INDIAN JOURNAL F RESEARCH |O December - 202Volume - 11 | Issue - 12 | 2 | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex ABSTRACT Peripheral nerve sheath tumors are relatively common lesions that exhibit a wide morphological and biological spectrum. In the presence of classical morphological and immunohistochemical features, the histological diagnosis is usually straightforward, but they may represent diagnostic challenges. Schwannoma is a slow growing encapsulated tumor of neuroectodermal derivation that originates from the Schwann cells of the neural sheath. Most commonly presents as cerebellopontine angle mass but extracranial sites are known and needs to be considered in the differential diagnosis. Intraparotid and penile schwannomas are extremely rare. Their diagnosis could be missed on cytology due to cystic changes. Isolated plexiform neurofibroma of the tongue is again a rare tumor. Plexiform pattern recognition is important for the pathologist as these varients might show malignant transformation. Overall Fine needle aspiration cytology though inconclusive at times, help a lot initially to delineate between benign Vs malignant lesions. Moreover its minimally invasive so can be performed easily at the uncommon locations. Histopathology remains the gold standard. Clinicopathological and imaging correlation is must for definite diagnosis and treatment.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience

Abstract Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n = 6), middle turbinate (n = 3), posterior septum (n = 3), sphenoid sinus ostium (n = 1), and inferior meatus (n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n = 12), actinomycosis (n = 1), and rhinosporidiosis (n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

Long-term Persistence of Immunogenicity After Primary Vaccination and Response to Booster Vaccination With Typhoid Conjugate Vaccine: Results of a Phase IV Extension Study

Objective: To evaluate the persistence of antibodies three years after primary vaccination with typhoid conjugate vaccine (TCV) of either Cadila Healthcare Ltd. (Cadila-TCV) or Bharat Biotech International Ltd. (Bharat-TCV) administered in a previous phase II/III study, and to study the booster dose response to Cadila-TCV. Methods: This was an open-label, phase IV extension study conducted in tertiary care and multispecialty hospitals in India. 112 subjects (Cadila-TCV-57, Bharat-TCV-55) who had participated in previous study were enrolled. Of these, eligible subjects received a single-dose of Cadila-TCV and were followed-up for 28 days post-booster. Primary outcome was persistence of antibodies 3 years after primary vaccination and seroconversion (?4-fold rise in antibody titre from baseline) 28 days postbooster. Safety was based on reported adverse events (AEs) post-booster. Results: The baseline GMT reported in the current study was significantly higher than pre-vaccination GMT reported in the previous study. 89/112 (79.5%) subjects had antibody titer ?10 IU/mL at baseline; eligible subjects (n=17) who had baseline antibody titre <10 IU/mL were administered booster dose. All the vaccinated subjects showed seroconversion post-booster. The GMTs reported at 10 days and 28 days post-booster were significantly higher as compared to GMTs reported after primary vaccination in previous study. 4 (23.5%) vaccinated subjects reported 9 AEs; all were solicited and of mild/moderate intensity. Conclusion: There was a significant persistence of immunogenicity after primary vaccination with both the TCVs, and robust immune response after booster vaccination with Cadila-TCV.

An Objective Overview of Covid19 Vaccine Situation in India

Entire world was eagerly waiting for the vaccine against SARS-CoV2 ever since Covid19 pandemic started. India is the second largest populous nation and is among the very few nations who has developed a vaccine against SARS-CoV2. India is also a major vaccine producing hub supplying large quantum of vaccines to the rest of the world. Efficacy, advantages and comparison between various covid vaccine has been largely discussed by the scientific community. However, there are various other factors affecting the vaccine situation in a nation, may it be the plan, strategy, it抯 implementation, local context, health infrastructure etc. While there are many news and views related to covid-19 vaccine, one need to look beyond & into so many other aspects related to the factors affecting this situation. Through discussion of some of these key factors, we tried to draw an overall picture of the Covid19 vaccine situation in India. Keeping in line with our objective, we keep the focus of our discussion on vaccine development & manufacturing issues, diplomatic decisions on vaccine & the reasons behind the same, international factors etc. We have purposefully restricted our discussion to these factors and did not go in details of the national level policy and its implementation details in this article.

Internet addiction as a comorbid condition among users with mild intellectual disability

Background: Internet use provides the user with intellectual disability an opportunity for socialisation, entertainment, and knowledge. User with mild intellectual disability use internet more frequently during free time as well as for entertainment. The present case study is on the use of internet among users with mild intellectual disability. The users approached for management of addictive behaviour. Material and methods: Clinical interview, the Internet Addiction Test, the Problematic Online Gaming Questionnaire, and the Pornography Addiction Screening Tool were administered in individual setting. Results: The users found to have addictive use of internet, pornography, and game. It was associated with disturbance in their life style. Conclusions: It has implications for screening the addictive use of technology and their management among users with mild intellectual disability.

A pattern of serious adverse drug reactions reported in a tertiary care hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh

Background: Serious adverse drug reactions (ADRs) constitute a major limitation in clinical development of a drug thus necessitating close monitoring. Studies regarding the pattern of serious ADRs are limited in southern India. The present study was conducted in tertiary care hospital in Andhra Pradesh with an objective to evaluate the pattern of severe cutaneous and non-cutaneous ADRs in our hospital and to assess the causality, severity, and preventability of these reactions.Methods: A retrospective observational study was conducted over two years, from January 2016 till January 2018 in our ADR monitoring center. The pattern of serious adverse drug reactions, the nature of ADR, suspected drug, the outcome and preventability were analyzed using Modified Hartwig and Siegel scale, and modified Schumock and Thorton scale.Results: Out of 734 ADRs reported, 42 were serious, while 692 were non-serious. Out of 42, 22 were dermatological in origin while the others were acute kidney injury, acute psychosis, febrile neutropenia, gynecomastia, and lipodystrophy. According to WHO causality assessment scale, 27 were probable while 15 were possible. The majority were reported in the age group of 16 to 65 years with female (34) preponderance. The most common drug category responsible was antimicrobials, followed by antiretrovirals, anti-epileptics, and analgesics.Conclusions: Antimicrobial, anti-epileptics, and analgesics contributed to serious ADRs. Although non-cutaneous ADRs did not result in hospitalization, they caused social inhibition and mental stress in the patient.

Assessment of patient satisfaction in a tertiary and secondary hospitals of east Godavari district: a comparative study

Background: Satisfaction is an important element in the evaluation of services rendered by a hospital. Patient satisfaction is as important as other clinical health measures and is a primary means of measuring the effectiveness of health care delivery. It refers to the patient's state of being adequately rewarded. Patient satisfaction is a measure of success of the services being provided by the hospitals. Objective of the study was to assess the satisfaction levels of the people utilizing various services provided in secondary and tertiary health care delivery settings.Methods: Observational hospital based comparative study conducted among Inpatients aged 18 yrs and above from different wards who are discharged during the study period and are willing to participate in the study at Secondary and tertiary health care centres of East Godavari District during May 2015 to April 2016. Sample size was calculated using n-master version 2.0. Sample size calculation was based on assumption that the prevalence of patient satisfaction as 50% with mean difference of satisfaction of 15%, confidence interval of 95%, α - error of 5%, power 90%, with effect size 0.3, sample size estimated was 234 in each setting resulting in a cumulative sample size of 702.Results: It was found that 64.52% of inpatients of District Hospital, Rajahmundry, have expressed neutrality or dissatisfaction regarding overall admission services as compared to 49.14% in Government General Hospital, Kakinada and 14.52% in Area Hospital, Rampachodavaram.Conclusions: The overall patient satisfaction was observed to be around 80% for all the three hospitals.

Prevalence of non-cancer chronic morbidity in tobacco users among adults in Kolar district: community-based study

Background: Tobacco contains many chemicals which causes cancer and chronic morbidities as evidenced from number of studies. Information regarding the chronic morbidities resulting from tobacco use was lacking in Indian setting. This study was conducted with the objective to find the prevalence of chronic morbidities other than cancer and oral conditions in tobacco users among adults in Kolar district.Methods: This is a community based, cross sectional study conducted in Kolar district among selected sample size of 1534 from six taluks during December 2018 to March 2019. The structured questionnaire was used to collect information at different geographical and social meeting places to represent the sample. The questionnaire contained information about sociodemographic, tobacco use and self-declared morbidity conditions.Results: Study subjects were aged between 18 to 80 years and the mean age was 53.7±18.2 years. The prevalence of chronic morbidity was 14.4% in 1534 subjects and 24.2% in 521 tobacco users. Diabetes mellitus and cardiovascular diseases accounted for 80 percent of morbidities followed by respiratory and other systems. The odd ratio (OR) was 3.4 for tobacco users and chronic morbidities, OR for diabetes mellitus and cardiovascular diseases was 5-19 and 5-22 respectively.Conclusions: The prevalence of diabetes mellitus, cardiovascular diseases and other conditions are high among any form of tobacco use or consumption, illiterates, aged above 51 years and agriculture related workers compared to no tobacco users. There is a need of awareness about early detection of chronic morbidities to reduce the premature deaths and economic loss to the community.

Evaluation of safety and efficacy of intravenous iron sucrose therapy for moderate anaemia in antenatal women

Background: Prevalence of iron deficiency anaemia is high in developing countries like India. Treatment of iron deficiency anaemia in pregnancy is very important to bring down maternal mortality rate as blood loss during delivery can lead to death of the patient. The aim and objective of our study is to evaluate the efficacy and safety of intravenous iron sucrose infusions in antenatal women admitted in hospital suffering from moderate iron deficiency anaemia. Special emphasis was given to observe adverse drug effects.Methods: This was a prospective observational study conducted in Obstetrics and Gynaecology department, Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh. Study period was two months and study population included antenatal women with gestational age less than 37 weeks with moderate iron deficiency anaemia. Peripheral smear was examined for microcytic hypochromic anaemia and they were treated with intravenous infusion of iron sucrose. Haemoglobin levels were checked before and 5 weeks after iron infusions. Monitoring was done for adverse reactions.Results: Out of 322 admissions, 95% were found to be anaemic. 72 patients were suffering from moderate anaemia from which 25 have been included and treated with intravenous iron sucrose infusions. They were observed for efficacy and safety parameters. Two minor adverse events were reported (fever with chills and angioedema of lips) and they were excluded from study. Mean haemoglobin concentration was found to be raised from 7.08±0.73 (SD) to 11.33±0.48 (SD) within 5 weeks for 23 patients.Conclusions: Iron sucrose infusion is safe and effective for anaemia in pregnancy.

Clinical spectrum of dengue at a tertiary care hospital in Eastern India

Background: Dengue is a vector borne disease by four different serotypes of dengue virus transmitted by bite of female Aedes mosquito. It is an acute febrile illness characterised by myalgia, joint pain, gastrointestinal manifestations. Complications like dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) , Extended Dengue Syndrome(EDS) may be fatal for patients. Authors analyse different clinical spectrum of of manifestations, complications and correlation bleeding to platelet level.Methods: This study conducted from July 2017 to December 2018 comprising of 100 dengue patients of age more than 15 years in IMS & SUM Hospital.Result: Out of 100 dengue patients’ males 73% and females 27%. From the patients 57% were NS1 Antigen positive, 29% IgM positive, 9% NS1 and IgM positive, 4% IgM and IgG positive and 2 % with all NS1, IgM, IgG positive. In our series in clinical manifestations, all cases (100%) presented with fever, myalgia (78%), headache (53%), rashes (14%), nausea, pain abdomen (21%) loose motion (17%), and Retro-orbital pain (6%). Bleeding manifestations in any form was seen in 39% cases like Purpura or Petechie (23%), malena (18%), hematemesis ( 2% ), epixtasis (6%), Gum bleeding (2%), Hematuria (1%), and Ophthalmic bleeding like sub conjunctival hemorrhage, intra-vitreal hemorrhage in 8% cases. Complications detected e.g. hepatopathy in 53%, nephropathy. 4%, ascites 8%, pneumonia 7%, DSS (4%), Multi Organ Dysfunction (MODS) (4%), DHF (8%) and EDS in 2% cases. It was observed that 95.8% of patients with platelet counts between 20,000-50,000/cu.mm and 61% of patients less than 25000 had bleeding manifestations.Conclusion: Wide clinical spectrum of manifestations and complications makes it common differential diagnosis of acute febrile illnesses and bleeding manifestation does not always corelate with lower platelet count.

Studies on features, physical, mechanical, tribological properties and applications of Ti-6Al-4V in aerospace industry

This research article gives an overview of the extensive research of Ti-6Al-4V from past few decades helped in studying about the features, properties, characteristics and application of aerospace industries. The final objective of study is to obtain the inherent advantages of Ti-6Al-4V like low elasticity modulus, high strength, low density and more resistant to fatigue and corrosion that leads to rely on the required knowledge for the employment of application which improves all physical and mechanical properties.

Experience of Indian association of medical microbiology external quality assurance scheme centre, New Delhi: Challenges and quality assessment of clinical microbiology laboratories

Introduction: EQAS program at New Delhi under IAMM was started in January 2014 across North and North east regions of India with 217 participants, which grew up to 540 by 2018. Materials and Methods: In 2014, 4 analytes per year were sent for 3 exercises, i.e. smear culture and serology. 2018 onwards PT analytes were increased from 4 to 12 and comparative performance of techniques analysed. Results: Out of the 22 smears sent for gram staining, ZN staining, Kinyoun staining and Albert staining, completely correct results ranged between 29.55% - 79.9%, 94.3% - 99.2%, 35.5% & 93.8%, respectively. Correct results for culture isolate identification & susceptibility testing and serology exercises varied between 70 & 92.4% and 73.1 & 98.59%, respectively. In the year 2018, 470 responses were received for bacterial culture identification & antibiotic susceptibility testing out of which manual and automated systems were used by 54% & 46% and 52.5% & 47.5% participants, respectively. Techniques used in BBV assays for HBsAg, HCV & HIV found all methods like ELISA, ELFA, CLIA and Card Test performing similarly. The major challenges in running the EQA program included requirement of large amount of specimens for PT item preparation, stability in hot and humid conditions and timely delivery of PT challenges in remote parts of the country. Conclusion: A large number of the participating laboratories (77%) had an overall score of >80% for all exercises, demonstrating acceptable baseline performance of EQAS registered laboratories. However, continued EQAS participation could further improve the quality of results.

A Study of Propeller Flaps for the Reconstruction of Soft Tissue Defects of Lower Limbs

Introduction: Reconstruction of simple or complex woundsof the lower one third limb is a challenge for reconstructivesurgeons. Various local Fasciocutaneous, Musculocutaneousand free flaps have been described for reconstruction withtheir own merits and demerits. The perforator-based propellerflaps, harvested around a perforator pedicle by means of therotation of skin paddle, up to 1800 are now currently usedtechnique to cover the tissue loss in the lower extremities.There is no sacrifice of major blood vessel. The aim of thisstudy was to assess the versatility and reliability of the use ofpropeller flaps for leg defectsMaterial and Methods: 20 Patients with traumatic lower limbdefects of various sites and sizes treated in the Department ofPlastic Surgery, Gandhi Hospital, Secunderabad, during theperiod 2010 – 2013 were included in the study. A suitablesized perforator close to the defect was identified by hand heldHunt Leigh Doppler in all the patients.Results: Of the 20 patients 90% were males and commonestaetiology was trauma, 65% of the defects were in lower thirdlimb and our success rate is 70%.Conclusions: The perforator-based propeller flap adds newarmamentarium of reconstructive surgeons. This is a simpleversatile technique and is less time consuming with no donorsite morbidity. It is ideal for reconstruction of small-to mediumsize defects of distal leg and ankle region with good cosmetic,excellent colour, match

Awareness about harmful effects of cigarette smoking among adolescents in Shamirpet mandal, Hyderabad

Background: Tobacco smoking is habit which usually begins in the adolescent age. It is a risk factor for many non-communicable diseases and mortality can be prevented if smoking is quit.Methods: It is a cross sectional study.2 schools were randomly selected from urban and rural areas in field practice area of Mediciti Institute of Medical Sciences. A GYTS questionnaire is modified to local setting and administered to the students.Results: A total of 367 students were enrolled. The level of awareness regarding harmful effects of tobacco consumption was good. It was 98.85% in urban areas and 94.84% in rural areas.Conclusions: As adolescent is the age of habit forming identification of the problem and correcting it at early stage itself will be beneficial for individuals, family and society.

Assessment of Extra Dural Hematoma – Factors affecting morbidity, mortality and outcome

Background: Extradural hematomas occur in approximately 2% of all patients of head injuries and 5- 15% of fatal head injuries. EDH is considered to be one of the most serious conditions of head injury requiring immediate diagnosis and surgical intervention. Aim and Objectives: The purpose of this study was to evaluate the clinical presentation of patients with extradural hematoma and to decide upon the mode of management and to study the results of the management and the outcome and the factors affecting morbidity and mortality. Materials and Methods: Patients with EDH admitted in Neurosurgery Department, King George Hospital Andhra Medical College, Visakhapatnam were studied. Study period was one year July 2018 to June 2019. The sample size of the study was 106 patients who fulfill the inclusion and exclusion criteria. All the patients with head injury, diagnosed to have EDH on CT scan were included in the study. The management includes conservative measures and/or surgical intervention. The patients’ outcome was assessed during the hospital stay, at discharge and followed up to 6 months after discharge. The various factors were analyzed which are likely to affect the outcome. Results: Temporo-parietal and temporal region was the most common location of EDH. The most significant factors which influences outcome are - time of surgical intervention, older age group, low GCS and associated injuries on CT scans like contusions and other injuries. The patients were followed after 1, 3 and 6 months. P Prahaladu, M V Vijaya Sekhar, K Satyavara Prasad, Hemal Chheda. Assessment of Extra Dural Hematoma - Factors affecting morbidity, mortality and outcome. IAIM, 2019; 6(9): 102-107. Page 103 Conclusion: From this study, it was observed that neurological status of patient at the time of presentation, time of surgical intervention, associated injuries on CT scan and the volumetric details of EDH are the most important factors in management and outcome of EDH.

Study of Mast Cells in Non Neoplastic Skin Conditions

Introduction: Mast cells are always been a fascinating field of research workers working with inflammatory processes, Hypersensitive disorders, and hosts defence mechanisms. Wide variation in mast cell counts and blood density is noticed in different sections of the skin in same biopsy sample. Aim and objectives: To assess the pattern of mast cell arrangement in various non- neoplastic skin lesions and compared with normal skin biopsies, to analyze the pattern of mast cell distribution in various non-neoplastic lesions of the skin, to compare with quantum of mast cells in various nonneoplastic lesions. Materials and methods: A study was conducted for 10 years from March 2006 to February 2016, which included all non-neoplastic skin conditions were subjected for mast cell count and distribution in the Department of Pathology at Gandhi Medical College/ Hospital with collaboration with Dermatology Department. The biopsy specimens were processed and stained with routine H&E and special stain for mast cells Toluidine Blue. The mast cells counted with the help of ocular micrometer under the microscope. Results: About 1000 non-neoplastic lesions grouped into 11 categories and mast cell count was done. Irrespective of the category, Urticaria pigmentosa showed highest mast cell count (144/sqmm). Nevus comedonicus showed lowest count (13/sqmm). Conclusion: The role of mast cells in health and disease is significant and distinct alterations of mast cell are present in various non-neoplastic conditions.

A Study of Immunohistochemical Expression of Epidermal Growth Factor Receptor in Prostatic Lesions

Epidermal growth factor receptor (EGFR) is a 170-kDa tyrosine kinase transmembrane glycoprotein expressed in normal tissues in many organs and different types of tumours. In prostate, EGFR is expressed mainly in epithelial cells, phosphorylation of EGFR (pEGFR) which is assessed by immunohistochemical methods could be useful prognostic marker for prostate cancer cases. Tumours may affect the surrounding non-malignant tissue and pEGFR immunoreactivity in the morphologically normal prostate tissue can be used to retrieve prognostic information. In this study the membranous and cytoplasmic expression of EGFR is checked in both the basal and luminal cells. Intensity of the staining and the pattern of the staining were noted in benign, in-situ and malignant lesions and it was found that the staining intensity of the luminal cells increase with a subsequent decreased staining in the basal layer as the lesion progress towards malignancy. Subsequently the staining intensity and patterns were correlated with the Gleason grade for triaging of the cases into different prognostic groups.

A 3 years study of vaginal hormonal cytology at tertiary hospital

Background: Vaginal cytology is an efficient inexpensive and a rapid method for identifying diseases including establishing the hormonal condition of the patient. The Evaluation of the endocrinologic status of the female patient by means of the study of vaginal cells is actually one of the earliest diagnostic applications of clinical cytology. Though the vaginal cytologic characteristics of gynecologic patients have been studied throughout the world this subjected has received little attention. Vaginal cytology is useful for assessing ovarian function from puberty throughout the reproductive years, menopause and senium. Also it is used to estimate time of ovulation, to determine ovarian dysfunction, to assess placental function or dysfunction in obstetrics, to assist in selecting hormonal therapy and to follow hormonal treatment results. Aim and objectives: To ascertain the effective utilization of cost effective test of vaginal hormonal cytology as a supplement for costly biochemical hormonal estimation. A prospective study was undertaken with the following objectives: To study the normal hormonal patterns in females of different age groups and to study abnormal hormonal patterns in high risk pregnancies and in different clinical situations. Materials and methods: A prospective, hospital based study was done on vaginal smears obtained from One hundred and Sixty (160) patients, attending Gynecology and Obstetrics Out-patient department and few In-patients at Gandhi hospital, Secunderabad during the period of August 2004 to October 2006. The study group included randomly selected female patients of reproductive age groups (18 years to 35 years.);.with normal menstrual cycles; normal perimenopausal (36 years to 45 years.) and postmenopausal (above 45 years.) women, pregnant patients in the 1st, 2nd, 3rd trimesters T. Sundari Devi, Rajyalakshmi, S. Srujana, K.R.K. Prasad, O. Shravan Kumar. A 3 years study of vaginal hormonal cytology at tertiary hospital. IAIM, 2017; 4(8): 20-32. Page 21 and 1st stage of labour as well as post partum patients. The study group also included patients with primary infertility, menorrhagia, secondary oligomenorrhoea (scanty menstruation), threatened abortions, inevitable abortions, pre mature rupture of membranes, post maturity and patients with neoplastic lesion i.e. ovarian tumor. The material collected for the vaginal smear dried very rapidly during collection. Hence fixation was done within 30 sec. of spreading. The fixatives used were – 95% Ethanol or 80% Isopropyl Alcohol. Other fixatives used were ether / 95% alcohols; 100% methanol; Rapid fixative as cytospray; 2 to 10% carbowax in 95% ethanol (for mailing unstained smears). The stains used were Papanicolaou’s stain and Giemsa stain. Results: Vaginal hormonal cytology is a useful diagnostic aid in the female reproductive process. It may also provide a key to more effective conception control, as well as improvement in the treatment of menstrual disorders, anovulation, and other underlying disorders. In the present Indian scenario with lack of adequate clinical history available to the pathologist, in a rural setup as well the urban conditions; vaginal hormonal study is still a low cost diagnostic and prognostic test procedure. Hence the present study emphasizes the utility of vaginal smear study even today compared to the costly biochemical parameters available in the market which is a financial burden to poor patients. Conclusion: Vaginal smear collected between 4-11 days and 12-16 days of the normal menstrual cycle showed scattered intermediate and superficial cells. Vaginal smears collected between 17-28 days of normal menstrual cycle showed, predominately intermediate cells with folding and crowding. The KPI peak is between 12-16 days. This is extreme midzone shift, with clusters of navicular cells in all the three trimesters, of pregnancy. First stage of labour could be suspected with identification of increase in the number of superficial cells, with marked decrease in the intermediate cell values.

Management Of Rare Lateral Periodontal Cyst

Lateral periodontal cyst (LPC) is an uncommon type of odontogenic cyst of developmental origin that typically occurs laterally on the root surface of a tooth. They are frequently located in the mandibular premolar area followed by the anterior region of the maxilla. It is usually asymptomatic and is discovered on a routine radiograph. The involved teeth are usually vital. Although the occurrence of lateral periodontal cyst is rare, the precision of its diagnosis is necessary so that the correct treatment can be established. The features of a LPC can be easily confused with a odontogenic keratocyst and radicular cyst