Microbial Profile of Tourniquets Used in Phlebotomy at a Rural Tertiary Care Teaching Hospital.

Background Reusable phlebotomy tourniquets may become contaminated through repeated use on the skin surfaces of multiple patients, the hands of healthcare workers, or various surfaces. Noncompliance with the protocol guidelines for managing tourniquets can contribute to the cross-transmission of microorganisms among patients. This study was conducted to determine the microbial flora and antimicrobial sensitivity pattern of reusable phlebotomy tourniquets. Methodology Tourniquets were randomly sampled across the different areas of the hospital and were transported to the microbiology laboratory for isolation, identification, and antibiotic susceptibility testing of microorganisms using standard microbiological techniques. Results The overall bacterial colonization rate of the 50 tourniquets was 80%. The most prevalent isolate on tourniquets was Coagulase-negative Staphylococcus (9, 22.54%), followed by Micrococcus (6, 15%), Staphylococcus aureus (5, 12.5%), diphtheroid (5, 12.5%), Acinetobacter (4, 10%) Enterococcus (3, 7.5%), Pseudomonas (3, 7.5%), Bacillus (3, 7.5%), and Escherichia coli (2, 5%). Conclusions Regular surveillance and disinfection of reusable tourniquets in resource-poor settings are recommended to decrease healthcare infections and the transmission of multidrug-resistant (MDR) strains.

Outcome-Based Medical Education Implication and Opportunities for Competency-Based Medical Education in Undergraduate Pathology.

Introduction Outcome-Based Education (OBE) is an education model for students that assist the teachers to outline the cause and evaluation with goals in mind to achieve results such as Program Outcome (PO) and Course Outcome (CO) which forms the basis for evaluating student performance. Materials and methods This study was conducted with the participants to discuss the hardships faced while implementing Competency-Based Medical Education (CBME). Need-gap analysis based on CBME guidelines was performed. Detailed discussion was done with department faculty to plan. Results Internal and final evaluations were done for all the students. When compared with conventional didactic lectures remarkable improvement in academic results of the students were noted which were statistically significant with p value less than 0.001. Conclusion CBME is not just adding capabilities but also achieving and strengthening these capabilities with a proper educational approach and efficacious evaluation methods.

Analysis of the Six Sigma Principle in Pre-analytical Quality for Hematological Specimens.

Introduction Blood tests are essential for detecting and treating hospitalized individuals with diseases. Laboratory blood tests provide doctors with critical information required to treat their patient's illnesses. The most common sources of error in clinical laboratories are pre-analytical errors. Although quality control measures can remediate analytical errors, there is a requirement for stringent quality checks in the pre-analytical sector as these activities are performed outside of the laboratory. Pre-analytical errors when combined with the sigma value can reflect a better picture as the sigma value represents the laboratory's performance.  Aim In this study, six sigma and the Pareto principle were utilized to assess pre-analytical quality indicators for evaluating the performance of a clinical hematology laboratory.  Methodology  This is a retrospective observational study conducted from 2015 to 2023 (for a period of eight years). Information about the frequency of pre-analytical errors was retrieved from the hematology section of the central diagnostic research laboratory information system and the data was entered into an MS Excel sheet and data was evaluated utilizing SPSS version 23 (IBM Corp., Armonk, NY). Results In the current research, total of 15 pre-analytical errors were noted. Out of the total 15 pre-analytical errors studied, 55.4% of pre-analytical errors were noted among which 80% errors were due to lack of mention of sample type or received time and 20% of errors were attributed to no mention of diagnosis in requisition forms. The next most common errors noted were insufficient samples (8.26%) followed by absence of physician's signature (7%), incomplete request form (5.4%), age (4.2%), unique hospital identification (UHID) number (3.7%), clotted samples and transportation of the samples (3.6%), date and incorrect vials (2.6%). Gender (0.95%), hemolysed (0.85%), and lipemic samples (0.45%). Hemolysed and lipemic samples had a sigma value of 4.4 and 4.6, respectively, whereas gender and age had a sigma value of 4.3 and 3.8, inadequate sample for testing and an incorrect anticoagulant to blood ratio had a sigma value of 3.6, indicating that sample collection has to be improved as the inverse relationship is noted between sigma value and laboratory performance. Conclusion Pareto chart and sigma value can help recognize most common pre-analytical errors, which consequently will help to prevent further recurrence of pre-analytical errors. Adequate training with regard to best practices in phlebotomy for interns, clinicians and technicians must be provided to decrease quantitative errors, which will further enhance total quality management in the laboratory.

Comparing the Efficacy of Intra-articular Platelet-Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial.

Introduction Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary. Platelet-rich plasma (PRP) has emerged as an alternative therapy for adhesive capsulitis, but the literature on its effectiveness is limited. This study aimed to compare the efficacy of IA PRP and CS injections in managing FS. Methods In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP, and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder. Outcome measures included pain; shoulder range of motion (ROM); the condensed version of the disabling conditions of the arm, shoulder, and hand (QuickDASH) score; and the shoulder pain and disability index (SPADI) score. Participants were monitored via follow-up for 24 weeks, with pain and function assessed at each evaluation using the visual analog scale (VAS) score, the SPADI score, and the QuickDASH score. Results The IA PRP injections demonstrated better long-term outcomes than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance. After 24 weeks, the mean VAS score in the PRP and methylprednisolone acetate groups was 1.00 (1.0 to 1.0) and 2.00 (2.0 to 2.0), respectively (P≤0.001). The mean QuickDASH score was 41.83 ± 6.33 in the PRP group and 48.76 ± 5.08 in the methylprednisolone acetate group (P≤0.001). The mean SPADI score was 53.32 ± 7.49 in the PRP group and 59.24 ± 5.80 in the methylprednisolone acetate group (P≤0.001), indicating a significant improvement in the PRP group's pain and disability scores after 24 weeks. The rate of complications was similar between the two groups. Conclusions Our findings suggest that IA PRP injections provide better long-term results than IA CS injections for managing FS. Platelet-rich plasma can be used as a treatment modality for better outcomes, particularly when the patient is contraindicated or refuses CS treatment. Further research is needed to evaluate the efficacy of these treatment modalities at different stages of FS and explore the potential benefits of ultrasound-guided injections.

Evaluation of CD44 Expression in Prostatic Adenocarcinoma: An Institutional Study.

INTRODUCTION: Prostate adenocarcinoma is the second-most common cause of cancer. Globally, many cancer-related deaths among men were noted due to prostate adenocarcinoma. CD44 plays a key role in mediating cell-to-cell and cell-to-matrix interaction, which further helps to maintain the integrity of tissue and also inhibits tumor metastasis. MATERIALS AND METHODS: Cross-sectional study was done on chips from transurethral resections of the prostate (TURP) and prostatic core biopsy specimens. All specimens with clinically diagnosed and histopathologically confirmed prostatic adenocarcinoma were included in the study. Prostatic intraepithelial neoplasia (PIN), recurrent cases, and patients who had undergone radiotherapy/ chemotherapy prior to biopsy were excluded from the study. The sample size for the current study was 57 with an 8% prevalence value, 95% confidence interval, and 8% absolute error. Immunoreaction to CD44 antibody is membranous and was evaluated by calculating positively stained cell percentage and staining intensity. These two parameters were added to obtain a final score; a score of 0-3 was considered as negative, and a score of 4-6 was regarded as positive. RESULTS: A statistically significant difference was only found between Gleason grade (p<0.001), clinical staging (p<0.002), nodal metastasis (p<0.015), and distant metastasis (p<0.020) with CD44 positive expression. The rest of the parameters like PSA (p=0.642) and age (p=0.051) did not correlate with CD44-positive expression. Out of 29 cases with positive CD44 expression, 100% positivity was seen in Gleason's grades 1, 2, and 3. This indicates that CD44 expression showed lesser positivity in poorly differentiated carcinoma. CD44 positivity was seen in 83.3% in the T2 stage. An inverse relationship between tumor staging and CD44 expression was observed with positive CD44 expression in lower tumor staging which implies loss of CD44 expression was associated with greater tumor aggressiveness. Lymph node metastasis cases showed more negative CD44 expression (59.5%) and the same was noted in patients without distant metastasis, that is in 61% of the subjects.  Conclusion: Cells tend to lose the ability of CD44 expression as they progress from well-differentiated adenocarcinoma to poorly differentiated adenocarcinoma. CD44 expression suggests that the tumor is in a well-differentiated and gland-forming state as compared to Gleason's grade. Loss of CD44 expression suggests tumor aggressiveness. Thus, the upregulation of CD44 expression can be considered as a potential target for targeted therapy. As many targeted and gene therapies are in clinical trials, large-scale multicentered studies are needed for a better understanding of the clinical course of the disease.

Comparison of Functional Outcome of Single Versus Multiple Intra-articular Platelet-Rich Plasma Injection for Early Osteoarthritis Knee.

Background Osteoarthritis (OA) is a leading cause of pain and disability and has a negative impact on patients' quality of life. Platelet-rich plasma (PRP) has emerged as a promising treatment for various orthopaedic conditions, such as tendinopathies, nonunion, and arthritis of the knee. We sought to determine whether a single intra-articular platelet-rich plasma injection has better functional and pain outcomes when compared with multiple (two) articular platelet-rich plasma injections given in the early stages of OA of the knee, measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the visual analogue scale for pain (VAS) at the sixth week, third month, and sixth month. Materials and methods The prospective observational study was conducted among patients diagnosed with early OA who presented to the Department of Orthopaedics, R. L. Jalappa Hospital and Research Centre, Kolar, Karnataka, India, between January 2020 and June 2021. A total of 64 patients were divided into: (i) S-PRP group (34 patients), which received a single PRP injection, and (ii) M-PRP group (30 patients), which received multiple (two) PRP injections, one on presentation and the second in the thirdmonth. VAS and WOMAC scores to assess functional outcomes were used at the first visit before the intervention and at the sixth week, third month, and sixth month. Results The average age of the patients was 55.26 years in the S-PRP group and 51.13 years in the M-PRP group. Both genders were equal among study participants in the M-PRP group, but 79.4% were females in the S-PRP group. In the S-PRP group, 74% had grade II OA and 26% had grade I OA. In the M-PRP group, 60% had grade II OA and the remaining 40% had grade I OA. The decreasing trend of pain and functional limitation, which was measured by VAS and WOMAC, respectively, was observed in both groups at pre-injection, sixth week, third month, and sixth month. These differences were statistically significant. The mean difference in VAS score between the pre-injection period and at six months was 4 in the S-PRP group, whereas it was 5.77 in the M-PRP group, and this was statistically significant (p-value = 0.001). Thus, multiple PRP injections have a greater response to pain reduction when compared to single PRP injections, according to the VAS score. According to the WOMAC score, there is no statistically significant difference in the treatment response with PRP injection between the S-PRP and M-PRP groups at any follow-up period. Conclusion According to the VAS score, single PRP injections have a lower pain score than multiple PRP injections until three months of follow-up, while at six months, single PRP injections have no better effect than multiple PRP injections. But multiple PRP injections have a higher reduction in the intensity of pain when compared to single PRP injections during the follow-up period. According to the WOMAC score, there is no statistically significant difference in the treatment response with PRP injection between S-PRP and M-PRP groups.

An immunohistochemical evaluation of tumor-associated macrophages (M1 and M2) in carcinoma prostate - An institutional study.

Background: Tumor-associated macrophages (TAM) are the main component of inflammation along with leukocytes, endothelial cells and fibroblasts together form a tumor microenvironment, with immune cells representing its vital component. Many studies suggested that TAMs cumulating in tumors correlate with a poor prognosis. In prostate cancer, TAMs can increase cancer cell invasion by stimulating tumor angiogenesis, degrading the extracellular matrix, and also suppresses the antitumor functions of cytotoxic T cells resulting in poor prognosis. Aims and Objectives: : 1. To determine the expression of M1 (CD68) and M2 (CD163) in prostate carcinoma (Pca). 2. To find the association between M1, M2 macrophage with Gleason's score and stage of Pca. Materials and Methods: : This is a retrospective observational study. All transurethral resection prostatic (TURP) chips positive for Pca and the clinical details were collected. Radiologic findings with respect to stage of disease, size of lesion, were noted. Results: Among the 62 cases studied, majority of the cases were in-between the age of 61-70 years. Highest cases were seen in Gleason's score 8, 9, and 10 (62%), prostatic specific antigen (PSA) levels 20-80 ng/mL (64%), tumor size 3-6 cm (51.6%), T3 stage (40.3%), N1 lymph node stage (70.9%). M1 stage of (31%). CD68 and CD163 expression was analyzed with Gleason's score, TNM stage and PSA levels. CD68 score 3 correlated with low distant and nodal metastasis 6.2% and 6.8%, respectively. CD163 score 3 correlated with high metastasis to lymph nodes and distant metastasis of 86.3% and 25%, respectively. On further analysis, statistically convincing association between the CD163 expression and Gleason's score, PSA levels, nodal and distant metastasis was found. Conclusion: CD68 expression was correlated with good prognosis with less nodal and distant metastasis and Cd163 expression has poor outcome with increased chances of nodal and distant metastasis. Further exploration of TAM mechanisms and immune checkpoints in the prostate tumor microenvironment can furnish new light and motives for the treatment of Pca.

Evaluation of Cyclin D1 and Human Epidermal Growth Factor Receptor 2 Neu Protein Expression in Head and Neck Squamous Cell Carcinoma.

Background Head and neck cancers are highly aggressive, frequently occurring cancers that are prevalent worldwide. The mainstay of their treatment is surgery, followed by adjuvant therapy. Various studies have documented the usefulness of molecular markers in carcinogenesis and have proven helpful in the diagnosis and treatment of head and neck cancers. Cyclin D1 is a proto­oncogene, overexpression of which leads to the accelerated entry of cells in the S phase of the cell cycle, causing uncontrolled proliferation of the cells. The dysregulation of human epidermal growth factor receptor 2 (HER2) neu is also related to multiple features of malignancy, including loss of cell cycle control, induction of angiogenesis, and resistance to apoptotic stimuli. This study seeks to identify a subset of patients with a bad prognosis who may require aggressive treatment strategies. Aim This study aims to determine the proportion of the expression of cyclin D1 and HER2 neu in head and neck squamous cell carcinoma (HNSCC) and analyze the association between the expression of cyclin D1 and HER2 neu using histological grading, tumor, node, and metastasis (TNM) staging, and nodal status of the tumor. Furthermore, this study also aims to document clinical outcomes, such as locoregional control, depth of invasion (DOI), and regional metastasis regarding the expression of cyclin D1 and HER2 neu in HNSCC. Setting and design This study is a laboratory-based observational study. Materials and methods Seventy histologically proven cases of HNSCC were studied for various histopathological parameters, and further immunohistochemistry (IHC) was performed for cyclin D1 and HER2 neu. The expression and intensity of cyclin D1 were multiplied, and the total score was derived. The College of American Pathologists/American Society of Clinical Oncology (CAP/ASCO) guidelines for HER2 neu testing in breast cancer were used for scoring. Result Out of 70 cases, 52 (75%) demonstrated strong and moderate positivity for cyclin D1, and the p-values were 0.017, 0.001, and 0.032 for depth of invasion, TNM stage, and lymph node metastases, respectively, for cyclin D1, which was considered statistically significant. For HER2 neu, five out of 70 cases were positive, and the p-value was significant for depth of invasion (0.008). Conclusion The expression of the above marker cyclin D1 increases with stage, DOI, and positive lymph node status. Hence, cyclin D1 immunoexpression can be helpful in the early assessment of HNSCC behavior and can serve as an independent prognostic marker. Furthermore, it was observed that HER2 neu was significant with an increase in depth of invasion of tumor, which, in the American Joint Committee on Cancer (AJCC) eighth edition, is considered an important factor for determining the stage of the tumor. Further research is needed to examine whether HER2 neu can act as a prognostic factor for HNSCC and if it can be targeted for treatment options.

Post pancreaticoduodenectomy hemorrhage: A retrospective analysis of incidence, risk factors and outcome.

BACKGROUND: The operative mortality after pancreaticoduodenectomy (PD) has declined but morbidity still remains considerable. Post pancreaticoduodenectomy hemorrhage (PPH) occurs in 3-13% of patients following PD. We studied the incidence and outcomes of patients with PPH after PD to determine the associated risk factors and effect on hospital stay. METHODS: We retrospectively analyzed from a prospectively collected data of patients developing PPH following PD between January 2007 and May 2018. ISGPS definition and grading system were used. By using univariate and multivariate analyses, independent predictors of PPH were identified. RESULTS: Of the 340 patients undergoing PD, PPH occurred in 39 patients (11.5%), of whom 5 (12.8%) had Grade A, 22 (56.4%) had Grade B and 12 (30.8%) had Grade C PPH. Six (15.4%) of the 39 patients with PPH died against an overall mortality in the study population of 16 out of 340 patients (4.7%), reflecting higher mortality (P = 0.019) in patients with PPH . The independent risk factors for PPH were a high pre-operative bilirubin (mean 4.7 vs. 7.4 mg/dl, P = 0.01) and INR (mean 1.2 vs. 1.72, P = 0.024), whereas it was closely followed by but, but not significantly associated with pre-operative biliary stent placement (P = 0.09). Pancreatico-jejunostomy (PJ) leak was seen in 20.7% in non-hemorrhage group vs. 41% in hemorrhage group (P = 0.008) and was an independent risk factor for PPH. CONCLUSION: PPH occurred in 11.5% of patients and resulted in a mortality four times greater than those without a PPH. It occurred more frequently in patents with a high pre-operative serum bilirubin, INR, biliary stenting or those with a PJ leak.

Pattern of cancer in adolescent and young adults--a ten year study in India.

BACKGROUND: Cancers in adolescent and young adults are different from those in older adults and are more likely to relate to genetic predisposition and exposure to risk factors early in life. They also have the greatest impact on those individuals who have most of their potential years of life ahead of them. OBJECTIVE: To determine the incidence and pattern of cancers in adolescent and young adults. METHODOLOGY: A ten year retrospective study from January 1997 to December 2006 was performed at the Department of Pathology. All malignancies diagnosed between the ages of 15-44 years were retrieved from our records and socioepidemiological data regarding each case were collected from the hospital record section. The cases were analyzed for incidence, site of involvement, age/sex distribution and year wise distribution by descriptive analysis. RESULTS: In this study, cancer in adolescent and young adults accounted for 26.6% of all the cancers diagnosed. Maximum cases were seen between 35-39 years age group in both genders. The male:female ratio was 1:2. Year wise there was steady rise in number of cases from 1997 to 2006 in both genders. The top five common sites in males were cancer of mouth, stomach, testis, bone and penis and in females were mouth, cervix uterus, breast, thyroid and stomach. CONCLUSION: In the present study, cancer of mouth predominated in both genders, followed by stomach in males and cervix uterus and breast in females, reflecting potential lifestyle and environmental factors.

Spectrum of gastro-intestinal cancers--a ten-year study.

Pattern of gastro-intestinal malignancies differ in different geographical areas and depends upon the genetic, cultural, dietary and socioeconomic factors. Therefore studying pattern of gastro-intestinal cancers help to identify high risk groups, recommend preventive measures or advise appropriate screening in high risk population. The present study was undertaken to determine the pattern of gastrointestinal malignancies at Kolar, situated in south-eastern part of Karnataka. A ten-year retrospective study from January 1997 to December 2006 was done at the department of pathology at Sri Devaraj Urs Medical College, Kolar, Karnataka. All the gastro-intestinal malignancies diagnosed were retrieved from pathology department records and socio-epidemiological data regarding each case was collected from hospital record section. The cases were analysed for site of involvement, age distribution, histological types and yearwise distribution by descriptive analysis. Gastro-intestinal malignancies constituted 22.96% of all the malignancies diagnosed. Males were more frequently affected than females, M:F ratio was 1:0.6. Peak incidence was in 7th decade. Stomach was the commonest site (48.4%) followed by oesophagus (27.7%), rectum (6.5%), colon (5.0%) and primary liver cancer (4.76%). Majority of histological type was adenocarcinoma. Yearwise distribution showed gradual increase in incidence of cancer. In the present study gastro-oesophageal malignancies was the most common gastro-intestinal malignancy in this part of Karnataka which in turn reflects on potential lifestyle and environmental factors.

Adenomatatoid tumor: Cytological diagnosis of two cases.

Adenomatoid tumor is a benign neoplasm of mesothelial cell origin that occurs in both male and female genital tracts. Fine needle aspiration cytology has an important role in the preoperative diagnosis of the male genital adenomatoid tumor and is a rapid, reliable, conclusive, and cost-effective diagnostic tool that can be used to take appropriate surgical decisions. Pathologists should be aware of the cytological features of such lesions so as to avoid diagnostic pitfalls. We present here two cases, one in the testis and another in the epididymis in a 35 year-old and a 30 year-old male respectively, which were diagnosed by fine needle aspiration cytology and later confirmed by histopathology. We present the cytological features and histopathological correlation of these cases.

A varied presentation of hydatid cyst: a report of four cases with review of literature.

Contrary to the popular perception, hydatosis does not remain restricted to certain geographical locales but is a global health concern, particularly in the rural countryside. Although liver and lung involvement account for the majority of the lesions, primary breast, bone, kidney and soft tissue hydatosis with features of cystic echinococcosis are extremely rare. We report four such rare cases of cystic echinococcosis which were diagnosed and treated in our institute.