Comparison of MRCP and ERCP in the evaluation of common bile duct and pancreatic duct pathologies.

Background: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging modality that has high diagnostic accuracy for a wide range of bile duct and pancreatic duct pathologies. Endoscopic retrograde cholangiopancreatography (ERCP) is still the gold standard for the exploration of the biliopancreatic region. Aim: The aim of the study was to compare the diagnostic accuracy of MRCP with that of ERCP in the diagnosis of bile duct and pancreatic duct pathologies. Material and methods: A total of 60 patients with common bile duct (CBD) and pancreatic duct pathologies detected on MRCP were subsequently evaluated by ERCP in this observational study. A comparison of MRCP findings with ERCP was made. Results: MRCP had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.1%, 94.4%, 97.3%, 72.7%, and 90%, respectively, in diagnosing choledocholithiasis in comparison to ERCP. For CBD dilation, the sensitivity was 90.91%, specificity was 93.75% and the PPV, NPV, and accuracy were 97.56%, 78.95%, and 91.67%, respectively, for MRCP. In CBD stricture, MRCP showed a sensitivity, specificity, PPV, NPV, and accuracy of 83.33%, 97.92%, 90.91%, 95.92%, and 95%, respectively. In pancreatic duct dilatation, the sensitivity, specificity, PPV, NPV, and accuracy were all 100%. Pancreatic duct stricture showed a sensitivity, specificity, PPV, NPV, and accuracy of 80%, 98%, 88.89%, 96.08%, and 95%, respectively. For the diagnosis of periampullary carcinoma, the sensitivity, specificity, PPV, NPV, and accuracy rate of MRCP were 80%, 98%, 88.89%, 96.08%, and 95%, respectively. Conclusion: No significant difference was found between MRCP and ERCP in diagnosing those six pathologies.

Expression of Claudin-4 and D2-40 and their significance in prostatic adenocarcinoma.

BACKGROUND: Claudins are a clan of proteins that are the most important component of tight junctions. The claudin-4 expression has been linked to tumour cell invasion and progression in a variety of primary malignancies. Evaluation of lymphovascular density (LVD) correlates with tumour aggressiveness and may correlate with prognosis. D2-40 is a highly specific marker of lymphatic vessels. AIMS: To evaluate the claudin-4 expression in relation to LVD by D2-40 expression and with clinicopathological parameters in prostatic adenocarcinoma. SETTINGS AND DESIGN: Prospective study. MATERIALS AND METHODS: 39 cases of prostatic adenocarcinoma were taken, the D2-40 and claudin-4 immunohistochemical stains were performed and correlation was done with clinicopathological parameters. STATISTICAL ANALYSIS USED: Statistical analyses such as mean, median, standard deviation, Mann-Whitney U test, Fischer exact test, Spearman's rank-order correlation coefficient, Chi-square test and T-test were used. RESULTS: The claudin-4 expression was seen higher in cases with higher Gleason score but it was statistically non-significant (P = 0.778). The claudin-4 expression did not correlate with any clinicopathological parameters. LVD in the peritumoral area was significantly higher as compared to the intratumoral area (P = 0.005). Intratumoral LVD and perineural invasion were found to be statistically significant (P = 0.048). CONCLUSION: The claudin-4 expression may correlate with adverse prognostic parameters. Higher lymphatic vessels can be responsible for the higher metastatic potential of prostatic adenocarcinomas.

Estimation of Total Platelet Count From Peripheral Blood Smear Needs a Correction Factor.

Background Despite many advances in platelet counting by cell counters, the problem of falsely low or falsely high total platelet counts (TPC) is common. Many laboratories estimate platelet count on the peripheral smear to cross-check the platelet counts. However, due to the lack of a standard calculation method, discrepant results are obtained from different laboratories leading to confusion among clinicians. We aimed to formulate a standard estimation method for platelet count on peripheral smear. Methodology In the first step (in 100 blood samples), we determined the ratio of the TPC obtained by the automated cell counter and the total number of platelets per oil immersion field (filed size: 0.22 mm) of the corresponding blood smears. The mean of the ratios thus obtained was designated as the "multiplication factor" to be used for visual platelet count estimation on the peripheral blood smear. In the subsequent step, validation of the same was done on another 100 samples. TPC on the peripheral smears of these samples was estimated using the above "multiplication factor" and compared with the corresponding TPC obtained on the automated cell counter. Results The "multiplication factor" obtained was 9.4 x 103 in the first set of 100 blood samples. It was used to estimate the platelet value of the second set of 100 blood samples. Conclusions We found an excellent agreement between the platelet counts obtained by automated cell counters and the estimation method. We suggest the multiplication factor 9.4 x 103 may be used with correction for microscopic field size to estimate platelet count on peripheral smears. This method is, however, not so reliable for very low platelet counts.

New twist to an old problem: COVID-19 and idiopathic pulmonary fibrosis.

Iidiopathic pulmonary fibrosis (IPF) diagnosis and treatment during this COVID-19 pandemic have been affected. COVID-19 has not only impacted the prognosis of these patients but also the approach to these patients. Pulmonary function tests (PFT) and lung biopsies are less encouraged now. Traditional antifibrotics used in IPF should be encouraged irrespective of patient lung function and in those with non-definite usual interstitial pneumonia in high resolution computed tomography.