Role of Chromohysteroscopy in Evaluation of Endometrial Pathology Using Methylene Blue Dye.

BACKGROUND: Chromohysteroscopy is expected to help in diagnosing subtle endometrial pathologies which could be missed on conventional hysteroscopy and also help in targeting biopsy from endometrium. OBJECTIVE: To study staining pattern of endometrium in patients undergoing chromohysteroscopy and to evaluate and compare the histopathology of chromohysteroscopy-guided endometrial biopsy with conventional endometrial sampling. METHOD: This was a cross-sectional study conducted during the period of 18 months in Department of Obstetrics and Gynaecology, ESI PGIMSR, New Delhi, India, from September 2016 to February 2018. Totally, 60 women with complaints of infertility, failed intrauterine insemination (IUI), recurrent spontaneous abortions (RSA), heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB) and postmenopausal bleeding (PMB) meeting inclusion criteria were evaluated and enrolled in the study. In patients with normal looking endometrium on hysteroscopy, methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained areas followed by blind endometrial sampling immediately. The results of chromohysteroscopy-guided biopsy from light- and dark-blue-stained areas and blind biopsy were compared. RESULTS: Mean age of the study group was 37 years, with mean BMI of 24 kg/m2. There were 24 cases of HMB, 9 of IMB, 7 of PMB, 15 of infertility, 2 of failed IUI and 3 with RSA. On chromohysteroscopy, 39(65%) cases showed light-stained endometrium (group I) and 21(35%) showed dark-stained endometrium (group II). Comparison was done between histopathology obtained through chromohysteroscopy and blind endometrial sampling. The diagnostic accuracy of chromohysteroscopy-guided endometrial biopsy in evaluation of endometrial pathology was 86.67% with sensitivity of 91.67%, specificity of 85.41%, PPV of 61.12% and NPV of 97.61% (P <0.001). CONCLUSION: Chromohysteroscopy was able to detect endometrial pathology which was missed on conventional hysteroscopy and detected more cases of endometrial pathology than blind endometrial sampling.

Posterior encephalopathy syndrome in women with eclampsia: Predictors and outcome.

BACKGROUND: This study aims to study predictors of posterior encephalopathy syndrome in eclampsia and the impact of posterior encephalopathy syndrome on outcome. MATERIAL AND METHODS: This prospective study enrolled consecutive women with eclampsia. These women were subjected to magnetic resonance imaging of the brain. Predictors of posterior encephalopathy syndrome were determined using univariate, followed by multivariate, analysis. Women were followed for 30days. Maternal outcome was assessed using modified Rankin scale (mRS). RESULTS: One hundred and four consecutive women with eclampsia were included. Seventy-four women with eclampsia had posterior encephalopathy syndrome. Predictors of posterior encephalopathy syndrome were primigravida status, altered sensorium, impairment of vision, vomiting, status epilepticus, unregistered status in a regular ante-natal check-up programme, lactate dehydrogenase, uric acid, low platelet count and deranged kidney and liver functions on univariate analysis. On multivariate analysis, vision impairment, primigravida status, and unbooked pregnancy were independent factors. Posterior encephalopathy syndrome was associated with a poor maternal and fetal outcome. CONCLUSION: Vision impairment, primigravida status, and unbooked pregnancy are independent predictors of posterior encephalopathy syndrome, that in turn is associated with a poor maternal and fetal outcome.

Thyroid cytopathology reporting by the bethesda system: a two-year prospective study in an academic institution.

Background. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has attempted to standardize reporting and cytological criteria in aspiration smears. Aims. The objective of this study was to analyze the thyroid cytology smears by TBSRTC, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the cytopathology with histopathology, wherever surgery was done. Materials and Methods. This was a prospective study of 225 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnoses were classified according to the features given in the monograph of TBSRTC into nondiagnostic/unsatisfactory (ND/UNS), benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious of a follicular neoplasm (FN/SFN), suspicious for malignancy (SFM), and malignant. Cytohistological correlation was done, when surgical material was available. Results. The distribution of various categories from 225 evaluated thyroid nodules was as follows: 7.2% ND/UNS, 80.0% benign, 4.9% AUS/FLUS, 2.2% FN, 3.5% SFM, and 2.2% malignant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Conclusions. TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNA or surgery and also the extent of surgery.

A prospective study of soft tissue tumors histocytopathology correlation.

Background. Soft tissue tumors are defined as nonepithelial extraskeletal tissue of the body exclusive of the reticuloendothelial system, glia, and supporting tissue of various parenchymal organs. The absence of recognizable tissue architectural patterns in cytological preparation makes diagnosis by FNAC more difficult. Aims. To assess the utility of FNAC in diagnosing soft tissue tumors and to determine their patterns compared with with the respective histopathology results. Materials and Methods. 150 cases of soft tissue tumors were included in this study for cytologic and histologic correlation. FNAC air dried smears were stained with Giemsa stain and 95% ethanol fixed smears were stained with Papanicolaou stain. The smears were studied for cytological diagnosis and were categorized as benign, suspicious of malignancy, and malignant along with specific subtyping of the lesion. All diagnostic FNAC results were compared for diagnostic concordance using histology results as the "gold standard." Results. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were 70%, 100%, 97.90%, 100%, and 98%, respectively. P value was <0.0001 which shows statistically extreme significant correlation. Conclusion. FNAC is a very important preliminary diagnostic tool in palpable soft tissue lumps with high degree of correlation with the final histopathology report.

Association of metabolic syndrome with schizophrenia.

BACKGROUND: Metabolic syndrome (MetS) is associated with mental illnesses. It is a major predictor of mortality and morbidity in patients of such mental illnesses. This study was undertaken to study the association of MetS and schizophrenia. OBJECTIVES: To study the association of MetS in patients of schizophrenia. MATERIALS AND METHODS: Adult schizophrenic patients diagnosed as per Diagnostic and Statistical Manual -IV Third R evisioncriteria visiting the psychiatric Out Patient Day during the study period were evaluated for prevalence of MetS as per the criteria of the international diabetes federation. Fifty patients of schizophrenia with age-and sex-matched 50 controls were enrolled for the study. RESULTS: MetS was found to be 28% in patient group and 12% in control group (P < 0.05). Fourteen patients were found to have MetS out of 38 patients who were on antipsychotics for >6 months. All the 14 patients having MetS were taking second-generation antipsychotics (SGAs) (P < 0.05). CONCLUSION: The study showed a higher prevalence of MetS in schizophrenia than in general population. MetS was present only in patients taking SGAs and prevalence of MetS had a positive correlation with duration of treatment. The study points toward urgent need for consultation - liaisoning between Diabetologist and Psychiatrists.