Histopathological analysis of hysterectomy specimens

Background: Uterus is prone for various non-neoplastic and neoplastic lesions and also hysterectomy is the most common gynecological surgery indicated as a definitive treatment. Grossly unremarkable many specimens may reveal pathologies on histological examination. Hence, all hysterectomy specimens must undergo proper histopathological examination. In our study, hysterectomy specimens were studied and results compared with their clinical diagnosis. Aim and Objective: The objectives of the present study were to know the frequency and incidence of various lesions of the female genital tract and to compare findings of the present study with other studies. Materials and Methods: The study was a retrospective analysis of 250 hysterectomy specimens. All types of hysterectomies such as vaginal, abdominal, laparoscopic, and total abdominal hysterectomy without or with unilateral/bilateral salpingectomy/salpingo-oophorectomy were included in the study. Histopathological examination was done minimum by two faculty members. The results were noted and statistical analysis was done. Results: Total 250 hysterectomy specimens were studied. Vaginal hysterectomy was the most commonly performed type of hysterectomy which includes 187 cases (74.8%) out of 250 cases. Among the uterine pathologies, the most common lesion was leiomyoma (34.4%) followed by adenomyosis (26%). In our study during histopathological examination of cervix, the most frequent cervical lesion was found chronic cervicitis in 50.4% of cases. Conclusion: The present study highlights the wide spectrum of lesions of female genital tract and conveys that histopathology remains the primary modality for confirmation of diagnosis of lesions. We can conclude from the present study that many lesions had been diagnosed on microscopic examination though normal gross examination. Hysterectomy specimen should undergo proper histopathological examination, because it is the gold standard tool for final diagnosis.

Prevalence of anemia and dyslipidemia in patients with Diabetes Mellitus Type 2

Introduction: Diabetes is the leading cause of dyslipidemia and is associated with excessive cardiovascular morbidity and mortality. Anemia is common among those with diabetes and greatly contributes to patient outcomes. Observational studies indicate that low hemoglobin levels in such patients may increase risk for progression of kidney disease and cardiovascular morbidity and mortality in diabetic patients. Aim: The aim of the study was to find prevalence of anaemia and dyslipidemia in our population of patients with diabetes. Materials and methods: This was a descriptive analytical cross-sectional study carried out in GMERS Medical College and Hospital, Valsad. Total 100 consecutive patients with diabetes were enrolled and serum lipid profile, blood sugar estimation and complete blood count of all patients were done. All the results were noted and analysed statistically. Results: Anemia was present in 44% diabetic patients and 53% of the patients were dyslipidemics out of 100 patients in our study. Anemia and dyslipidemia were significantly higher in patients with diabetes, chronic kidney disease and diabetes with chronic kidney disease. Conclusion: Anemia and dyslipidemia was more prevalent in patients with diabetes and diabetes associated with chronic kidney disease. Correction of anemia may have a significant role in prevention of other diabetic complications.

Study of students perceptions regarding knowledge and attitude towards torture

Background: Torture and violence are associated with humans since beginning. Torture is one of the most extreme forms of human violence, resulting in both physical and psychological consequences. Materials and methods: Present study was conducted among total 113 students of 2nd MBBS after obtaining their informed written consent. All student participants were subjected to pre-tested and prevalidated questionnaire regarding torture which contained total 13 multiple choice type questions, out of which 8 questions were related to knowledge while 5 questions were related to attitude. Results: Age of participants was varied from 19 to 22 years with a mean of 21.25 years with male: female ratio of participants was 5.5:1. Among knowledge questions, 88% had given correct answer of meaning of term torture, 56% had given correct objectives of torture, 66% had given correct types of torture, 73% had given correct answer of commonest form of physical torture, 61% had given correct answer of commonest form of sexual torture, 59% had given correct answer of commonest form of psychological torture, 52% had given correct answer regarding laws related to torture and 79% had given correct role of National Human Right Commission in torture. Among attitude questions, 43% had agreed that beating in police custody to elicit confession is proper while 42% were undetermined, 88% had agreed that awareness of torture medicine by general medical practitioner is required, 79% had agreed that inclusion of torture medicine in undergraduate medical curriculum is required, 61% had agreed that teaching is torture medicine to paramedical branches is required and 69% had agreed that punishment of torture should be increased. Conclusion: Knowledge and attitude regarding torture among medical students give an idea for future planning of curriculum for betterment of subject.

Wilms tumor in 3 years old female patient – A case report

Nephroblastoma or Wilms' tumor is an embryonic tumor derived from primitive renal epithelial and mesenchymal components. It is the most common abdominal malignant tumour of young children. Overall, Wilms' tumor incidence is 7.8 cases per million children. Peak age of incidence is 2 to 3 years of age, or 99% occurring less than six years of age. Here, we are presenting a case of 3 years old female patient with diagnosis of Nephroblastoma.

Primary plasma cell leukemia in 32 years old male A case report.

Plasma cell leukemia (PCL) is a rare disease and is the least common variant of multiple myeloma accounting for 2-3% of all plasma cell dyscrasias. Histogenetically, plasma cell leukemia is derived from terminally differentiated B cells. It is diagnosed by presence of absolute plasma cell count >2000 per cm or >20% circulating plasma cells. Here we report a case of plasma cell leukemia, who presented with easy fatigability, weakness and high grade fever since 1 month. Hematological investigation revealed leukocytosis with plasmacytosis (7420/ mm3). On bone marrow examination, >45% plasma blasts were seen. Biochemical analysis showed high LDH level (4236 U/L) and serum calcium level was also raised (12.3 mg/dl). Final diagnosis of plasma cell leukemia was made. As PCL is rare disease and it is even rarer to find them in a 32 years old. Here we are able to find and document the typical features of PCL.

Progressive multifocal leukoencephalopathy in non HIV, splenectomised, 66 years old male A rare case report.

Progressive multifocal leukoencephalopathy (PML) is a rapidly progressive AIDS-defining disease of the central nervous system. PML affects up to 8% of patients with AIDS and in most cases is fatal within 3–5 months. We presented here a case of 66 years old male who is non HIV with past history of splenectomy, and diagnosed as progressive multifocal leukoencephalopathy which is very rare. Here, we presented this rare entity which may be difficult to diagnose although, histopathological examination helps greatly in the diagnosis of this condition but the specificity and sensitivity of JC virus DNA PCR in CSF are quite acceptable.

Audit of repeat fine needle aspiration in cytopathology laboratory.

Background: FNAC is cost-effective, high diagnostic accuracy, reliable, rapid and inexpensive procedure in diagnosis of various clinically palpable as well as deep seated swellings. This study was intended to discover factors associated with repeat aspiration with the help of audit of cytology laboratory. Material and methods: Retrospective study of 248 cases which came to Cytology Laboratory of Dhiraj Hospital during the period of 1st January 2013 to 30th December 2013 had included. All patients who attended the Cytology laboratory for the FNAC procedure and USG guided FNAC were included in the study. Data for the audit was collected from the cytology records. The following information was documented for this audit: Age and sex, site of FNAC, documented reasons for repeat and patient IPD/OPD numbers. We had also noted the documented reasons for repeats and the duration between the repeats. Results: Out of 248 aspirations, 61 from breast swellings, 75 from the lymph nodes, 58 from the thyroid lesions, and 54 were from the miscellaneous lesions. 31 patients (12.5%) were advised repeat aspiration and 22 (8.87%) were actually repeated. In our study the most common cause for the repeat aspiration was inadequate cellularity (51.61%). Outcome of the repeat aspirations included 16 (72.73%) diagnostic and 6 (27.27%) non diagnostic aspirations. Conclusion: In our study, there were so many reasons for the repeat aspirates. In order of occurrence these are: Inadequate aspirates, non-diagnostic descriptive reports and hemorrhagic aspiration.

Non-neoplastic lesions of the ovary - A review.

Ovary is an important organ as it is concerned with the production of progeny. Ovary is the commonest site of neoplastic and non-neoplastic lesion, can present in childhood to postmenopausal age group and accounts for the most prevalent cause of hospital admissions. non-neoplastic ovarian lesions are classified as inflammatory (infectious and non infection ), non-inflammatory (cystic and non-cystic) and pregnancy related disorders.

Study of innovative teaching methods to enhance teaching and learning in Forensic Medicine.

Background: Didactic lecture is the current method of choice but it is not effective way of teaching. Interactive lecture with various innovative teaching methods is the best proven way for teaching and learning. Material and methods: Cross sectional study was conducted in Department of Forensic Medicine for period of 1 year by voluntary participation of 100 students 2nd MBBS. Three topics of Forensic Medicine were taught by jigsaw, think-pair-share and team project to three equal number groups of students and they were subjected to pre and post intervention questionnaire. Results: There was significance increase in mean post test score for all the innovative teaching methods for all topics. There was no significance difference in mean post test scores of all three innovative teaching methods which indicated that all three innovative teaching methods were effective and good to practice. Conclusion: Instead of didactic lecture, interactive lecture with innovative methods like think-pair-share, team project , and jigsaw is a very helpful and essential for effective teaching and learning.

Histopathological vs cytological findings in cervical lesions (bethesda system) A comparative study.

Background: Cervical cancer is the major health burden in India. For detection in early stage, the screening test is Pap smear. To check the sensitivity and specificity of Bethesda system, the cytological findings have to be correlated with histology considering histopathology as gold standard. Material and methods: The The study was retrospective review of Pap smears in Dhiraj General Hospital in the period from November 2013 to December 2014. They were correlated with corresponding follow-up biopsies using revised 2001 Bethesda System. Results: Most of patients were of group 41-50 years which were 106 (42.4%), followed by group 51-60 years which was 53 (21.2%). Majority of cases were of parity 3 which were 71 (28.4%) followed by of parity 4 which were 53 (21. 2%), Majority of cases were of parity 3 which were 71 (28.4%) followed by of parity 4 which were 53 (21.2%). with mean parity of patient was 3.30. Conclusion: The Pap smear has good sensitivity and specificity in detecting pre-neoplastic and neoplastic lesions of uterine cervix

Histopathological vs cytological findings in cervical lesions (bethesda system) A comparative study.

Background: Cervical cancer is the major health burden in India. For detection in early stage, the screening test is Pap smear. To check the sensitivity and specificity of Bethesda system, the cytological findings have to be correlated with histology considering histopathology as gold standard. Material and methods: The study was retrospective review of Pap smears in Dhiraj General Hospital in the period from November 2013 to December 2014. They were correlated with corresponding follow-up biopsies using revised 2001 Bethesda System. Results: Most of patients were of group 41-50 years which were 106 (42.4%), followed by group 51-60 years which was 53 (21.2%). Majority of cases were of parity 3 which were 71 (28.4%) followed by of parity 4 which were 53 (21.2%), with mean parity of patient was 3.30. Conclusion: The Pap smear has good sensitivity and specificity in detecting pre-neoplastic and neoplastic lesions of uterine cervix.

Role of FNAC in diagnosis of gouty tophi-A case report.

Periarticular nodules may not be recognized as tophi because the clinical diagnosis of gout in many instances is not straightforward. In such a setting, fine needle aspiration cytology (FNAC) of gouty tophi would facilitate the clinical diagnosis and treatment. FNAC is valuable in confirming the nature of periarticular nodules especially in case of gouty tophi as compared to the histopathology. Thus FNAC is the gold standard for the diagnosis of gouty tophi presenting as periarticular nodules.

Clinicopathologic assessment of Candida colonization of oral leukoplakia.

Background: Leukoplakia is the most common premalignant lesion of the oral mucosa. We studied the colonization of Candida in oral leukoplakia using direct microscopy, culture and histopathology to determine if there is a statistical correlation between Candida invasion and the clinical appearance and presence of epithelial dysplasia in leukoplakia. Methods: Samples were collected from 40 patients with oral leukoplakia and 21 controls. The swabs collected were used to inoculate Sabouraud's dextrose agar slant and for direct microscopy with Gram's stain. Culture growths were subjected to germ tube and corn meal agar tests to differentiate between Candida albicans and non-albicans groups. Biopsies were also done in all patients for histopathological confirmation; Gomori's methanamine silver stain was used to identify fungal invasion of lesional epithelium. Results and Conclusions: Nineteen cases of leukoplakia showed Candida on direct smears, compared to 3 controls. Eighteen cases and one control showed growth of Candida on culture. Non-homogenous leukoplakia showed a higher positivity rate on microscopy and culture than homogenous lesions. All these correlations were statistically significant. Forty percent of leukoplakia cases were simultaneously positive for Candida on direct microscopy, culture and histopathologic evaluation. No significant difference was found between non-dysplastic and distinctly dysplastic lesions with respect to Candida detection on microscopy or culture.