A comparative study between conventional and the Bethesda System for Reporting Thyroid Cytology of 240 cases.

Introduction: Thyroid nodule is a common disorder of thyroid. Despite their benign nature, they can be associated with multiple pathologic conditions including thyroid cancer. Fine-needle aspiration plays an essential role in evaluating thyroid nodules. The Bethesda System for Reporting Thyroid Cytology (TBSRTC) has attempted to standardize reporting and cytological criteria in aspiration smears. Aim: The aim of this study is to compare the conventional and TBSRTC and to compare and correlate the cases with histological findings wherever available. Materials and Methods: The present study was a retrospective study undertaken in the department of pathology from January 2018 to December 2018 to access the validity of TBSRTC considering histopathology as the gold standard. May Grünwald Giemsa and Papanicolaou stained thyroid FNA smears of 240 patients were collected which were reported by the conventional system for reporting thyroid cytology and also categorized as per current Bethesda nomenclature for thyroid cytology. Diagnosis of both the reporting systems was then compared and correlated with the histological diagnosis wherever possible. Results: A total of 240 cases were examined on cytology, out of which histopathological correlation was possible in 110 cases. For benign thyroid lesions, sensitivity and specificity with conventional system were 69.91% and 40.25%, respectively, while with TBSRTC, sensitivity and specificity were 84.04% and 29.94%, respectively. Sensitivity and specificity of conventional system for malignant thyroid lesions were 58.56% and 69.91%, respectively, while with TBSRTC, sensitivity and specificity were 73.69% and 95.12%, respectively. The Bethesda system found to be highly sensitive for benign thyroid lesions and highly specific for malignant thyroid lesions as compared to the conventional method of reporting of thyroid cytology. Conclusion: Bethesda system was found to be superior for reporting thyroid cytology over the conventional system of reporting for thyroid cytology.

Assessment of immunohistochemical expression of p16 in head and neck squamous cell carcinoma and their correlation with clinicopathological parameters.

INTRODUCTION: Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with tobacco chewing, paan chewing and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in the etiology of head-and-neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma. MATERIALS AND METHODS: In this cross-sectional observational study, a total of 100 cases of HNSCC were taken. p16 expression was determined by immunohistochemical (IHC) staining and correlated with clinicopathological parameters. The obtained results were analyzed and evaluated using Chi-square test, value of P < 0.05 was taken significant. RESULTS: P16 was positive in 60% of cases. A statistically significant direct association was observed between p16 with age, site of the tumor, abnormal sexual habits and lymph node involvement. CONCLUSION: IHC expression of p16 can be used as a surrogate marker of HPV. Study of p16 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness, treatment modalities and can provide support for vaccination program in a high-risk group.

An Open-Label Prospective Study to Compare the Efficacy and Safety of Topical Fluticasone Versus Tacrolimus in the Proactive Treatment of Atopic Dermatitis.

BACKGROUND: Atopic dermatitis (AD), a chronic, recurrent inflammatory skin condition primarily affects children. Topical treatment, systemic treatment, and phototherapy are mainstays of treatment. Topical corticosteroids (TCS) are first-line therapy for AD but are associated with various adverse effects. Topical calcineurin inhibitors (TCI) can be used as an alternative to TCS. OBJECTIVE: The aim of the study is to compare the efficacy of topical preparations of fluticasone and tacrolimus in reducing the severity of disease and, to assess the quality of life (QoL), and to estimate if any association exists between severity of disease and QoL. METHODS: Thirty-seven children with AD randomly received one of the 2 topical treatments, with daily application for the first 4 weeks in the acute phase and twice weekly for next 4 weeks in the maintenance phase. The severity of disease was assessed using SCORing Atopic Dermatitis (SCORAD), and QoL was assessed using the Children's Dermatology Life Quality Index (CDLQI). RESULTS: At the end of the acute phase, there was a reduction in SCORAD score of 69.29% in the fluticasone group and 64.2% in the tacrolimus group (P < 0.001). In the maintenance phase, the score had risen in the fluticasone group by a mean difference of 0.81, while in the tacrolimus group it decreased by 0.99. Both fluticasone and tacrolimus groups improved in children's QoL (P < 0.001). Positive correlation (r = 0.4668) exists between SCORAD and QoL. The most common adverse skin reaction noted was skin burning with tacrolimus. CONCLUSIONS: Fluticasone and tacrolimus are equally efficacious in the treatment of AD and have similar benefits with children's QoL. Tacrolimus is better than fluticasone at reducing the extent of lesions.

In Vivo Effects of Nonselective, Partially Selective, and Selective Non Steroidal Anti-Inflammatory Drugs on Lipid Peroxidation and Antioxidant Enzymes in Patients with Rheumatoid Arthritis: A Clinical Study.

BACKGROUND: The relationship between oxidative stress, decreased antioxidant status, and rheumatoid arthritis (RA) has been widely investigated. To date, few clinical studies have assessed the role of conventional nonsteroidal anti-inflammatory drugs (NSAIDs) in the modulation of oxidative stress in patients with RA. AIM: The aim of this study was to compare the effects of nonselective, partially selective, and selective cyclooxygenase (COX) inhibitors on markers of oxidative stress in patients with RA. MATERIALS AND METHODS: Thirty RA patients were enrolled in this open label, prospective study for 12 weeks and randomly assigned to either group receiving diclofenac 100 mg, meloxicam 15 mg, or celecoxib 200 mg daily (n = 10 in each group). Patients were evaluated for superoxide dismutase (SOD) and serum malondialdehyde (MDA) as oxidative markers at the baseline and at the end of 12 weeks. Various parameters for efficacy were also assessed. RESULTS: The baseline values of the SOD enzyme were significantly lower and MDA values were significantly elevated in patients randomized to the three treatment groups as compared to the control group (P < 0.05). MDA level was significantly decreased in patients across all the treatment groups (P < 0.05) after 12 weeks. There was an improvement in mean SOD enzyme levels at the end of 12 weeks; the difference for SOD was significant as compared to the baseline in the meloxicam group only (P < 0.05) but not in diclofenac- and celecoxib-treated patients. Significant improvement was observed in all the treatment groups as regards patient assessment of pain visual analog scale, tender and swollen joint count, and patient global assessment. CONCLUSIONS: Diclofenac, meloxicam, and celecoxib carry antioxidant effects to a variable extent. NSAID possesses additional mechanism independent of COX inhibition which modulates oxidative stress.

Ivermectin: Potential Role as Repurposed Drug for COVID-19.

Severe acute respiratory illness caused by 2019 novel coronavirus (2019-nCoV), officially named severe acute respiratory syndrome coronavirus (SARS-CoV-2) in late December 2019 is an extremely communicable disease. World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) as a pandemic as it has spread to at least 200 countries in a short span of time. Being a new disease there is lack of information about pathogenesis and proliferation pathways of this new coronavirus. Currently there is no effective treatment for coronavirus infection; major effort is to develop vaccine against the virus and development of therapeutic drugs for the disease. The development of genome-based vaccine and therapeutic antibodies require thorough testing for safety and will be available after some time. In the meanwhile, the available practical approach is to repurpose existing therapeutic agents, with proven safety record as a rapid response measure for the current pandemic. Here we discuss the presently used repurposed drugs for COVID-19 and the potential for ivermectin (IVM) to be used as a therapeutic option in COVID-19.

A comparative study on efficacy of fixed combination timolol/brinzolamide versus travoprost monotherapy in drug-naïve open-angle glaucoma patients.

BACKGROUND: Glaucoma is most common irreversible cause of blindness in India. First line management of open-angle glaucoma is either beta blockers or prostaglandin analogs monotherapy. Monotherapy rarely achieves target intraocular pressure within 2 years and patients are shifted to combination medications, usually fixed-dose combination. OBJECTIVE: To compare travoprost monotherapy and timolol/brinzolamide fixed-dose combination for their intraocular pressure lowering efficacy, their effects on hemodynamic parameters and cup disc ratio reversibility in newly diagnosed drug-naïve open-angle glaucoma patients. MATERIAL AND METHODS: In a 12-week, prospective, randomised, single-blind study, patients were randomised to receive twice daily 0.5% timolol and 0.2% brinzolamide fixed-dose combination (n = 52) or once daily travoprost 0.004% (n = 52). Intraocular pressure, blood pressure, pulse rate and cup disc ratio were compared across treatment groups over 3 months. RESULTS: Significant reduction (p < 0.001) in intraocular pressure by 27.99% and 30.49% at 12th-week visit as compared with baseline was observed in monotherapy and fixed-dose combination group, respectively. Significant changes in pulse rate (9 beats/min) and systolic blood pressure (2.35 mmHg) was observed in fixed-dose combination group. No cup disc ratio reversibility was observed at the end of study. Conjunctival hyperaemia (n = 14) and transient blurring of vision (n = 16) were most commonly reported adverse drug reaction in monotherapy and fixed-dose combination, respectively. CONCLUSION: The 0.5% timolol and 0.2% brinzolamide fixed-dose combination produced greater reduction in intraocular pressure than those produced by 0.004% travoprost alone in drug-naïve open-angle glaucoma patients.

Oral Brush Liquid-Based Cytology: A Study of Concordance between a Cytotechnologist and a Cytopathologist.

OBJECTIVE: Oral cancer accounts for almost 40% of all cancers in the Indian subcontinent. Techniques like oral scrape cytology are helpful in early diagnosis of premalignant lesion and thus prevention of malignant transformation. The purpose of this study is to evaluate the performance of cytotechnologists in assessing the adequacy and preliminary diagnostic accuracy of oral brush liquid-based cytology. STUDY DESIGN: 110 oral brush liquid-based cytology smears were prospectively screened by a cytotechnologist for adequacy assessment, and a preliminary diagnosis was recorded. Smears were subsequently studied by the reporting cytopathologist for the final diagnosis. The performance of the cytotechnologist in the assessment of adequacy and the preliminary diagnosis were compared with the final interpretation rendered by the cytopathologist. RESULTS: There was no significant difference in adequacy assessment between both observers, and good concordance was observed in the identification of frankly malignant lesions; however, in premalignant cases, complete agreement in all the cases was not observed. Maximum numbers of discrepant cases were seen in high-grade squamous intraepithelial lesions, 4/17 were downgraded to low-grade squamous intraepithelial lesions and 2/17 to negative for intraepithelial lesion or malignancy, respectively. CONCLUSION: Trained cytotechnologists are capable of assessing the adequacy and identifying the malignancy in oral brush liquid-based cytology smears, and hence there is potential for them to perform initial screening of such cases.

Gastrointestinal helminthosis: prevalence and associated determinants in goats of Jabalpur, India.

A total of 632 faecal samples of goats of Jabalpur district of Madhya Pradesh state were examined during three years of the study period (November 2012-October 2015), out of which 82.75 % samples were positive for helminthic infections. Among various helminths, maximum prevalence was of strongyles (32.59 %) followed by amphistomes (14.40 %), Moniezia spp. (12.50 %), Strongyloides spp. (0.79 %), Trichuris spp. (0.47 %) and Fasciolagigantica (0.32 %). Year wise prevalence revealed a highly significant (p < 0.01) decrease in prevalence of helminths. Except Trichuris and Moniezia spp., the effect of year was significant for prevalence of all other gastro-intestinal helminths observed during the study. Significantly higher (p < 0.05) helminth infections were observed in monsoon (87.97 %) as compared to that of winter (81.48 %) or summer (79.03 %) season. The seasonal difference in prevalence was found significant for strongyles, Strongyloides spp., amphistomes and Moniezia spp. There was no significant variation in Trichuris spp. and Fasciola gigantica infections in relation to season. Age wise prevalence of helminths was non-significantly higher in kids (83.13 %) than in adults (82.62 %). Except Moniezia spp., age wise observations did not reveal any significant difference (p > 0.05) in prevalence of other gastrointestinal helminths.

Prevalence and burden of gastrointestinal parasites in cattle and buffaloes in Jabalpur, India.

AIM: The study was conducted to determine the prevalence and burden of gastrointestinal (GI) parasites in cattle and buffaloes of Jabalpur, Madhya Pradesh. MATERIALS AND METHODS: The presence of helminths eggs and coccidial oocysts in fecal samples were detected using standard qualitative and quantitative methods. Identification of eggs or oocysts was done on the basis of morphology and size of the eggs or oocysts. RESULTS: Out of 120 cattle and buffaloes examined, 73.33% were found positive for eggs of one or more species of GI parasite. The prevalence of parasitic infection was higher in cattle (75%) as compared to that of buffaloes (70.45%), but the difference was nonsignificant (p>0.05). Sex wise prevalence of GI parasites was higher in males as compared to that of females, but the difference was nonsignificant (p>0.05). The animals above 2 years of age were more affected by GI parasites as compared to animals of 6 months - 2 years of age, but the age wise differences were nonsignificant (p>0.05). Single parasitic infections were more common than mixed infections. The monthly prevalence of GI parasites in cattle and buffaloes were highest in the month of September (81.81%) and least in December (61.11%). The eggs/oocysts per gram in most of the animals, was in the range of 201-300. CONCLUSION: GI parasites are problem in cattle and buffaloes of Jabalpur, Madhya Pradesh. The prevalence rate of GI parasites varied with month. The burden of parasitic infection was moderate in most animals warranting treatment.

Cytological diagnosis of bancroftian filariasis presented as a subcutaneous swelling in the cubital fossa: an unusual presentation.

Filariasis is a disabling parasitic disease and the prevalence of lymphatic filariasis caused by Wuchereria bancrofti is quite high in India. However, W. bancrofti presenting as a subcutaneous swelling and a demonstration of microfilariae in cytological smears from upper extremity lesions is extremely rare. We report a case of 20-year-old male who presented with a small subcutaneous swelling near medial aspect of the left cubital fossa. The wet mount preparation showed many motile microfilariae. Cytology smears revealed a large number of sheathed microfilariae with the tail tip free of nucleus, identified as W. bancrofti without significant inflammatory cell infiltrate. Indirect ELISA was highly positive for specific recombinant W. bancrofti filarial antigen (WL-L2). The role of cytology cannot be underestimated in clinically unanticipated cases of bancroftian filariasis, especially with the amicrofilaremic state. Filariasis should always be considered in the differential diagnosis during cytological evaluation of any swelling, especially in endemic areas.