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Introduction: FNAC has a pivotal role in the evaluation of breast lesions. Cytological grading systems are being utilized for the categorization of breast lesions. Modified Masood’s scoring System (MMSS) is used to improve the grading system for accurate pre-operative diagnosis. This study aims to assess the effectiveness and accuracy of the Modified Masood Scoring System for evaluating breast lesions and their correlation with histopathological diagnosis. Materials and Methods: This is a prospective study conducted in the Department of Pathology, MGM Medical College, Navi Mumbai which included 40 patients who presented with clinically palpable breast lump and were subjected to FNAC along with histopathological examination. The cytological smears were grouped into four categories according to MMSS. Correlation and concordance analysis between cytological categories and histopathological diagnosis was carried out. Observations and Results: The age of the patients ranged from 17 to 70 years with a mean age of 38.12 years, right-sided breast lesions were more common as compared to the left side. Of the total 40 cases, 27 cases were benign, and 13 cases were malignant on histopathology. The most common benign breast lesion was Fibroadenoma [Figure 1] and the malignant lesion was infiltrating duct carcinoma [Figure 2]. The sensitivity, specificity, Positive predictive value, Negative predictive value, and diagnostic accuracy were 76.9%, 100%, 100%, 90%, and 92.5% respectively. Conclusion: MMSS is simple, cost-effective, easily reproducible, reliable, and can be applied to FNAC aspirates to increase the diagnostic accuracy of Breast Lesions. [ABSTRACT FROM AUTHOR]

Background: FNAC is a simple, safe and cost-effective method and is one of the triple diagnostic triads along with clinical breast examination and radiology methods (mammography/ ultrasonography).Cytological diagnosis is very beneficial for the preoperative assessment of various breast lesions. The application of LBC technique along with conventional smear can strengthen the efficacy of diagnosing various breast lesions on FNAC. Aim: Comparison of liquid-based cytology versus conventional smears in fine needle aspiration cytology of breast lesions. Materials and Methods: A prospective study of 50 cases conducted over a period of 16 months included all female patients referred to the cytology department for FNAC. Two different passes were given, the first pass was used to prepare conventional smears and second pass was used for LBC smears. Results: Among 50 cases, 38 (76%) were benign and 12 (24%) were malignant. The commonest benign lesion was fibroadenoma and malignant lesion was Infiltrating Ductal Carcinoma. The difference between LBC and conventional smears was statistically significant pertaining to background blood debris (p < 0.00001), informative background (p = 0.0004) and cellular architecture (p = 0.0075) while it was not statistically significant for cellularity, mono layering, nuclear and cytoplasmic details The sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC in both LBC and conventional smears were similar, being 80%, 100%, 100%, 95.23% and 96% respectively. Conclusion: LBC cannot replace conventional cytology but can be used as a supplement with the conventional method to minimize false negative cytology rate and to increase the diagnostic accuracy of breast lesions. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) is the most prevalent infectious disease which is brought by the mycobacterium tuberculosis. In addition to the lung tissue, TB also affects the bone marrow. Significant haematological and coagulation abnormalities are associated with TB. Therefore the diagnosis, prognosis, and therapeutic response can also be indicated by these haematological and coagulation markers. These coagulation abnormalities can lead to stroke and DIC leading to increased mortality. Aims To evaluate the haematological and coagulation parameters in pulmonary tuberculosis patients. Methods and Materials: In this study a total of 50 patients with confirmed tuberculosis were chosen using purposive sampling. Four millilitres of venous blood were drawn while taking the necessary aseptic precaution. Sysmex XN 1000 6-part haematology analyser was used to perform hematologicalanalysis on two millilitres of ethylenediamine tetra acetic acid (EDTA)vacutainer tubes. Rest two millilitres of blood in sodium citrate vacutainer tube was used to perform coagulation parameters analysis on ACL elite pro coagulation analyser for measurement of D dimer and fibrinogen. Results Hemoglobin and other blood indices were marginally lower in both sexes compared to healthy controls. Patients with tuberculosis show significantly greater levels of white blood cells (WBC), platelets, D-dimer, and fibrinogen when compared to healthy controls. P-value < 0.05 indicated that these increases were statistically significant. [ABSTRACT FROM AUTHOR]

Aims: Buprenorphine is effective at reducing relapse to opioid misuse, morbidity and mortality in opioid‐dependent patients. Urine drug screening (UDS) to assess adherence is used routinely in opioid agonist treatment (OAT). The primary aim of this study was to determine factors which may be associated with a negative qualitative urine drug screen for buprenorphine in OAT patients. Methods: This prospective pilot study was conducted at a tertiary addiction medicine centre. Twenty participants on stable treatment underwent supervised administration of sublingual buprenorphine. Matched urine and blood samples were collected prior to and 2, 4 and 6 hours after buprenorphine administration. Qualitative urine drug screen results were obtained using gas chromatography–mass spectrometry (GC–MS), while quantitative blood and urine results were obtained using ultra‐performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS). Results: Qualitative urine assay yielded a negative result for buprenorphine in 57% of tested samples. The median concentration of urinary buprenorphine was 167 mcg/L (range: 2–1730 mcg/L). Thirty percent of all blood samples did not detect buprenorphine (range 0–18 mcg/L). Positive qualitative urine drug screen results were associated with higher urine (343 mcg/L compared with 75 mcg/L; P <.05) and blood (4 mcg/L compared with 2 mcg/L; P <.05) buprenorphine concentrations. Median urine concentrations of buprenorphine were highest at 2 hours and were higher in participants receiving CYP3A4 inhibitors. Conclusion: Interpretation of qualitative urine drug screens to assess adherence in OAT is complex. Poor adherence with treatment cannot be assumed in patients returning a negative qualitative GC–MS urine drug screen. [ABSTRACT FROM AUTHOR]

Proteinuria, in particular albuminuria, is a potentially significant modifiable risk factor for cardiovascular disease and the progression of kidney disease. Current treatment guidelines for albuminuria recommend a single renin-angiotensin-aldosterone inhibitor. This can be an ACE inhibitor or an angiotensin receptor antagonist. The routine use of combined renin-angiotensin-aldosterone inhibition for albuminuria is not supported by current evidence. Combination therapy is associated with higher rates of adverse events such as hyperkalaemia and progressive renal impairment. [ABSTRACT FROM AUTHOR]

We report a case of acute interstitial nephritis with associated nephrogenic diabetes insipidus in a patient treated with temozolomide and sulfamethoxazole‐trimethoprim for glioblastoma multiforme. Kidney biopsy demonstrated focal tubulointerstitial change with tubular dilatation, epithelial change and interstitial inflammation. The patient's kidney function improved with cessation of sulfamethoxazole‐trimethoprim and treatment with hydrochlorothiazide for nephrogenic diabetes insipidus. Recommencement of temozolomide did not result in further deterioration in kidney function. In this case report, we discuss the novel association between sulfamethoxazole‐trimethoprim‐induced acute interstitial nephritis and nephrogenic diabetes insipidus, and suggest possible mechanisms involved. SUMMARY AT A GLANCE: A novel association between the sulfamethoxazole/trimethoprim and acute interstitial nephritis and nephrogenic diabetes insipidus is described in a patient treated with temozolomide for glioblastoma multiforme. Kidney biopsy confirmed acute tubular changes and the patient's kidney function improved with cessation of the drug. [ABSTRACT FROM AUTHOR]

Introduction: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is complex. Immunoassay often does not detect BPN and gas chromatography-mass spectrometry (GC-MS) is needed. A limited understanding of testing can negatively influence UDS interpretation and clinical decision making., Objectives: The primary aim was to determine detection rates of BPN in UDS in participants on BPN or buprenorphine/naloxone (BNX) treatment. The secondary aim was to identify if comorbidities, sex, co-prescribed medications, or dosing site and observation were associated with BPN detection., Setting: Public outpatient clinic in a specialist addiction treatment service., Design/participants: In this retrospective observational study, records of clients on supervised BPN/BNX treatment between September 2017 and 2018 were reviewed., Measures: Data extracted included UDS results, age, sex, indication for BPN, frequency of observed doses, dose of BPN, dosing site, comorbid medical conditions, and medications., Results: One hundred and sixty-one medical records were reviewed. Ninety-seven (60 percent) underwent screening urine immunoassay. Of these 97, 51 (53 percent) had further GC-MS testing for BPN of which 22 (43 percent) did not detect BPN despite directly observed OAT. Co-prescription of medications known to interact with cytochrome P450 3A4 was associated with nondetection of BPN (p < 0.05). No significant association between median dose, dosing site, and observed dosing and BPN detection was identified., Conclusion: Urine drug testing for BPN is complex. Failure to detect BPN does not betoken nonadherence to treatment and is associated with co-prescription of drugs interacting with cytochrome P450 3A4.