Retrospective histopathologic findings of routine cholecystectomy specimens in a teaching hospital in North East India.

Background: Cholecystectomy is one of the most common general surgical operations performed worldwide. Limited data is available about the histopathological diagnoses of various gallbladder diseases in North Eastern part of India even though a higher incidence of gallbladder cancer has been reported from this part of the Country. Hence, a retrospective review of the histopathological findings of routine cholecystectomy specimens was done to assess the incidence of gallbladder cancer and other gallbladder pathologies. Aims and Objective: To study the incidence of gallbladder cancer and other pathologic findings in routine cholecystectomy specimens. Methodology: A retrospective study of the histopathological findings of cholecystectomy specimens with presumed benign gallbladder diseases who had undergone cholecystectomy from June 2013 till October 2021. Results: A total of 1683 patients had undergone cholecystectomy during the study period. In total, 1354 patients underwent laparoscopic cholecystectomy and 339 patients underwent open cholecystectomy. Gallstones were present in 1631 patients. Chronic cholecystitis and cholesterosis were the most common histopathologic findings, followed by pyloric metaplasia. Unsuspected gallbladder cancer was detected in eight patients (0.48%). Conclusion: Chronic cholecystitis was the most common histopathologic finding followed by pyloric metaplasia. Gallstones were found in most patients. Incidental gallbladder cancer was detected in 0.48% of patients.

Plasma neutrophil gelatinase-associated lipocalin (NGAL): A candidate biomarker to detect early acute kidney injury (AKI) for at-risk intensive care admissions.

Introduction: Acute kidney injury (AKI) is a presentation of an underlying heterogeneous group of conditions that leads to impairment of filtration and excretion of nitrogenous waste products from the body. A prompt early diagnosis to detect AKI is a mandate due to the associated risk of high mortality and morbidity. We tested the sensitivity and specificity of plasma neutrophil gelatinase-associated lipocalin (NGAL), a potential biomarker of AKI, versus serum creatinine, the gold standard laboratory test. Materials and Methods: A cross-sectional diagnostic type study was conducted from February 2015 to January 2017 after obtaining the institutional ethics clearance certificate. Individuals admitted to the intensive care unit (ICU) of a tertiary care hospital of northeast India who were diagnosed with septicemia, heart failure, and ketoacidosis and individuals on nephrotoxic drugs such as aminoglycosides were included in the study. Serum creatinine and plasma NGAL of all individuals were estimated using suitable methods within 24 h of admissions. Results: Considering all inclusion and exclusion criteria, 138 individuals were included in the study. The area under the curve (AUC) for plasma NGAL on day 1 of admission was 0.800 (95% confidence interval [CI]: 0.712-0.882). In the study, we estimated a plasma NGAL cut-off value of 391 ng/mL (with an odds ratio of 9.89) within the day of admission. Conclusion: Plasma NGAL is a candidate biomarker of AKI with acceptable sensitivity and specificity (AUC of 0.80) that can predict AKI in our setup before serum creatinine is raised, thereby asking for a prompt intervention to reduce the mortality and morbidity associated with AKI.

Biosensors for detection of prostate cancer: a review.

Diagnosis of prostate cancer (PC) has posed a challenge worldwide due to the sophisticated and costly diagnostics tools, which include DRE, TRUS, GSU, PET/CT scan, MRI, and biopsy. These diagnostic techniques are very helpful in the detection of PCs; however, all the techniques have their serious limitations. Biosensors are easier to fabricate and do not require any cutting-edge technology as required for other imaging techniques. In this regard, point-of-care (POC) biosensors are important due to their portability, convenience, low cost, and fast procedure. This review explains the various existing diagnostic tools for the detection of PCs and the limitation of these methods. It also focuses on the recent studies on biosensors technologies as an alternative to the conventional diagnostic techniques for the detection of PCs.

An Anatomical Study on the Measurement of Stature From Ulnar Length in the Adult Ethnic Khasi Tribal Population of the North Eastern Region of India.

Introduction The stature of an individual is an important parameter for establishing identification. The height of an individual can be indirectly estimated from different parts of the skeleton and such measurements are of great use in forensic science, anatomy, and anthropometry. This study was an attempt to formulate a linear regression equation for estimation of stature by measuring the ulnar length in the living adult Khasi population. Methods The study population consists of 164 subjects (Male: 118; Female: 46) between 25 and 45 years of age. The left and right ulnar lengths were measured from the tip of the olecranon process to the tip of the styloid process with the elbow flexed and palm spread over the opposite shoulder by a spreading caliper. The measurements of the stature of the volunteers were done in the standard anatomical standing position with a bared foot with the head in the Frankfort plane. The documented data were calculated by the standard statistical software. Results The height and ulnar length in males (160.85 ± 6.34 cm and 24.41 ± 1.10 cm, respectively) were found to be significantly (p < 0.001) higher than females (149.56 ± 2.95 cm and 22.58 ± 0.47 cm, respectively). Significant positive correlation coefficient (r) between height (cm) and ulnar length (cm) were observed in both males (r = 0.955, P < 0.001) and females (r = 0.915, P < 0.001), respectively. Conclusion The length of the ulna provides an accurate and reliable means in estimating the height of an individual; being almost a percutaneous bone, its length can be measured easily. The regression formulae that were derived in this study will be useful for clinicians, human anatomists, archeologists, anthropologists, and forensic experts.

A Study to Evaluate the Association Between Thyroid Function and Serum Potassium Level in Diagnosed Cases of Diabetic Nephropathy.

Introduction Coexistence of diabetes mellitus and thyroid diseases is common. One of the main microvascular complications of diabetes is diabetic nephropathy (DN) and it is found to be the leading cause of chronic kidney disease. The aim of the present study was to assess the association between hypothyroidism and serum potassium levels in diabetic nephropathy patients. Materials and methods A cross-sectional study was conducted from March 2020 to January 2021. We enrolled 100 patients with DN along with 50 healthy controls belonging to the same localities. Serum potassium, creatinine, thyroid-stimulating hormone (TSH) and total triiodothyronine (T3) levels of all the cases were measured to establish the correlation of serum potassium along with each parameter separately. Results Serum potassium, creatinine, TSH levels were increased in all the cases of diabetic nephropathy showing positive correlations of serum potassium with serum TSH and serum creatinine levels with correlation coefficient values 0.71 and 0.7 respectively and serum T3 levels were decreased in all the cases significantly showing negative correlation with serum potassium levels with correlation coefficient value -0.34. Conclusion Estimation of serum TSH and T3 levels along with serum potassium levels is important and helpful in patients with diabetic renal disease. Changes in thyroid parameters like decreased TSH or increased T3 are significantly associated with deterioration in the severity of renal function in diabetic patients.

Dermatological manifestation can be an early sign in Covid-19: Report of three cases with a novel manifestation masquerading Steven Johnson syndrome.

Various dermatological manifestations have been observed in patients with Coronavirus disease (COVID-19) infection ranging from maculopapular rashes, urticaria, chickenpox-type lesions, chilblain-like, distal-limb ischemia, and livedo racemosa. While most of these cutaneous findings are self-resolving, they may aid in the timely diagnosis of this infection. We are reporting three patients presenting with dermatological features resembling (i) varicella zoster, (ii) herpes labialis, and (iii) Steven Johnson Syndrome (SJS) who were subsequently diagnosed with Covid-19 infection. The skin lesions disappeared after successful treatment of Covid-19.

Clinical and Laboratory Presentation of Hydatid Disease: A Study From Northeast India.

Introduction Hydatid disease is an immense health problem in developing countries. The diagnosis of hydatid cyst is often difficult because of its protean manifestations. Our objective was to evaluate the various clinical and laboratory presentations of hydatid disease and various modalities of treatment from a tertiary care center. Materials and methods We reviewed the clinical and laboratory features of patients presenting with hydatid cyst through retrospective analysis from January 2018 to December 2019 from a tertiary care hospital in northeast India. Results Of the 26 adult patients with hydatid cysts who were part of the study, 14 (53.8%) were males and 12 (46.2%) were females. The mean age was 34.6 years. The most common site of involvement was the liver (69%) followed by lung (19.2%) and brain (7.7%). Palpable mass in the right upper quadrant of the abdomen was the most common symptom (88.3%) for liver hydatid cyst followed by pain abdomen (66.6%). Systemic symptoms like fever and weakness were present in most of the patients. The majority of patients (80%) were from rural areas. Conclusion Hydatid cysts present with varied symptomatology. History of exposure to infected animals may not be present. A high degree of clinical suspicion combined with meticulous history and clinical examination supported by laboratory investigations are required for its diagnosis.

Prolactin and thyroid stimulating hormone affecting the pattern of LH/FSH secretion in patients with polycystic ovary syndrome: A hospital-based study from North East India.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most important endocrinal diseases in reproductive age group, clinically manifested by hyperandrogenism and anovulation and different other metabolic disturbances that may have important implications for long-term health. AIM AND OBJECTIVE: The aim of this study was to determine the incidence of abnormal luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio in women with polycystic ovary and to assess the influence of prolactin and thyroid-stimulating hormone (TSH) in the elevated LH/FSH ratio. STUDY DESIGN: Retrospective observational study. MATERIALS AND METHODS: Eighty-five women in reproductive age diagnosed with PCOS between June 2012 to June 2014 at the Department of Obstetrics and Gynecology in a tertiary care hospital were selected for the study. Serum LH and FSH levels were determined and LH/FHS ratio (normal range ≤2) calculated in the study subjects. They underwent a detailed clinical, hormonal, and metabolic evaluation, which was performed between the second and third days of a natural or induced menstrual period. RESULTS: Elevated LH/FSH ratio was found in 60 women (70.58%). Normal gonadotropin ratio was detected in 25 women (29.41%). Statistically significant differences in serum TSH levels were noted between groups with normal and elevated LH/FSH ratio. However, no statistically significant difference was noted in other endocrine parameters. Further analysis revealed a slight negative correlation of TSH with prolactin in the study subjects of PCOS with an 'r' value of - 0.3. CONCLUSIONS: LH/FSH ratio is one of the characteristic attribute of PCOS women. In the present study, this abnormality was detected in 70% of patients. Hypothyroidism was a common endocrinal abnormality and prolactin was inversely correlated to TSH levels in PCOS patients.

Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences.

BACKGROUND: Although burns are a major problem in health care, a lot of the variation in risk factors exists from region to region which if uncovered correctly could help take effective prevention measures. AIMS AND OBJECTIVES: To assess the 3-year (January 2012 to January 2015) epidemiology of burn injuries admitted to our hospital (primary objective) and to find areas of improvement in burn care (secondary objective). MATERIALS AND METHODS: After obtaining ethical approval data were obtained from the medical record section regarding age, sex, residence, occupation, marital status, socioeconomic status, dates of admission and discharge, circumstances regarding the place, intent, cause, and source of heat. Clinical assessment was done using Wallace's "Rule of Nine" in adult and "Lund and Browder" chart in the pediatric age groups. The interrelationships between clinical and epidemiological variables with burn injury were studied. RESULTS: An increasing trend in the admission rates of burn victims noted in last 3 years males (55.47%) outnumbered females (44.52%). The most common age group affected is older children, adolescents, and young adults (between 11 and 30 years). Flame (38.3%) and scald (25.3%) burns contributed to most of the injuries. Females (52.30%) are the major victim of flame burns. Electrical and chemical burns affected only the males suggesting work-related injuries. Trunk (30.8%) is the most severely affected site in all cases. Depression (6.8%) and power line workers (4.7%) seem to be important risk factors in our study. Inability to complete treatment (26.7%) was a major concern in our study. CONCLUSIONS: This study highlights the need for proper burn care that could be provided at the primary health-care level. The majority of burns were accidental in nature in school going children, young adults, and females. Flame and scald burns were the most common cause. Preventive measures directed toward burn safety and first aid measures may improve the outcome in burn injuries.

A Study to Assess the Validity of Estimation of Serum Ostase Level in Hyperthyroid and Hypothyroid Cases.

INTRODUCTION: One of the more specific assessments of the metabolic status of bone in normal and in disease conditions is the measurement of bone specific alkaline phosphatase or ostase. The measurement of serum ostase has several advantages over the measurements of other bone parameter. Because of its relatively long half-life, in-vivo (1 to 3days), it is relatively unaffected by diurnal variation. AIM: To find the correlation of serum ostase level in hyper and hypothyroid cases and also to study the validity of routine estimation of serum ostase in hyper and hypothyroid cases so as to monitor the base level bone health on presentation. MATERIALS AND METHODS: Serum ostase level was studied in 74 patients with disorder of thyroid function. Serum ostase level, Thyroid Stimulating Hormone (TSH), FT3, FT4 levels were estimated by chemiluminescent technique. The instrument used was Beckman- coulter Access 2. A total of 39 patients were hypothyroid, 31 were hyperthyroid and 4 patients had subclinical hyperthyroidism. RESULTS: The serum ostase level was found to be elevated above 40 µg/L in 26 of the cases and above 16 µg/L but below 40µg/L in 5 cases of hyperthyroidism along with decrease in Bone Mineral Density (BMD). Serum ostase level was found to be directly proportional to the serum FT3 level (Normal range of serum ostase is 8-16 µg/L). CONCLUSION: From this study, an inference can be drawn that a routine estimation of serum ostase level in hyperthyroid cases will help in proper monitoring of decrease bone turnover as indicated by increase serum ostase level. Besides, the estimation of serum ostase level in hyperthyroid cases it is found to be valid in this study, which can turn to be an important guiding parameter to the treating physician to formulate necessary protocols and guidelines for prophylaxis, treatment and to monitor the response to therapy in cases of reduced bone turnover related to hyperthyroid state.

A Rare Case Report of Hepatic Subcapsular Pseudocyst of Pancreas.

A pancreatic pseudocyst arises as a result of acute or chronic pancreatitis, pancreatic trauma, or obstruction of the pancreatic duct by a neoplasm. Most of the pseudocysts are located within the head and the body of the pancreas but 20% are extra-pancreatic. We report a case of a 33-year-old gentleman presenting with acute on chronic alcoholic pancreatitis with hepatic sub-capsular pseudocyst involving left lobe of liver, with intra-cystic bleed was successfully treated with Ultrasonography (USG) guided drainage. Computed tomography (CT) and high level of amylase in the collection plays an important role in diagnosing this condition. Large hepatic sub-capsular pseudocyst presenting with severe pain due to intra-cystic bleed can be treated with percutaneous drainage to pre-empt rupture.

Laparoscopic cholecystectomy under epidural anesthesia: a feasibility study.

BACKGROUND: Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia. AIMS: The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated. MATERIALS AND METHODS: In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study. RESULTS: The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia. CONCLUSIONS: The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

Tubercular esophagocutaneous fistula.

Tubercular esophagocutaneous fistula is a rare entity with only about four cases reported so far. We report here a case in a young female who has a very long tract but responded well to antitubercular treatment.