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Keen observational skills are essential for veterinarians; however, the development of these skills is not usually an explicit part of the veterinary curriculum. Fine arts–based (FAB) observation training has been shown to improve medical students’ observational skills and might also improve veterinary students’ observational skills. We compared FAB and pathology-based (PB) observation training in a veterinary cytology course. Students initially wrote a pre-test in which they described two cytology images and one art image, followed by participation in either FAB or PB observation training. Both groups completed a similar post-test immediately after training and a delayed post-test 4 weeks later following instruction in cytology. Differences between groups were noted only in the immediate post-test cytology descriptions. The PB group used significantly more specific vocabulary terms and significantly more accurate observations than the FAB group, suggesting an immediate benefit to the discipline-specific information gained in the PB observation training. In the delayed post-test, results for both groups were similar. The FAB group significantly increased their use of specific vocabulary terms and maintained but did not increase accurate observations following cytology instruction, while accurate observations decreased significantly for the PB group. The FAB group might have been able to generalize their observation skills to the discipline of cytology and to better retain these skills. Neither type of training resulted in both achievement and maintenance of the highest recorded scores for accurate observations. Both FAB and PB training led to improved observational skills, and explicit observation training may be useful for veterinary students.

Introduction Analysing morbidity and using this to improve the quality of patient care is an important component of clinical governance. Several methods of data collection and clinical analysis have been suggested, but to date none have been widely adopted. Method All adult patients sustaining facial fractures were prospectively identified between 01 March 2019 and 28 February 2020, and matched to those who required a return to theatre for surgical complications. Morbidity resulting in a return to theatre was determined using the Clavien-Dindo classification and the Northwestern University error ascribing method. Results During this period, return to theatre occurred for 33/285 (11.6%) procedures and 23/173 (13.3%) of patients being treated for facial fractures. According to the 27 procedures discussed, Clavien-Dindo Grade IIIb was most commonly found (20/27). Error in judgement (13/35) and nature of disease (12/35) were ascribed as the most common causes of error. Presence of a consultant was associated with increased odds of a return to theatre (p=0.014). Conclusions Standardised national data collection of morbidity and error is required for comparisons of outcomes within a single institution or between institutions. This is the first paper to utilise these widely used methods of morbidity analysis for facial fracture surgery. We would recommend further development of an error analysis method that is more specific to those complications from facial fracture surgery.

Background: Local changes and needs in blood bank operations, allowed us to increase our Medical Laboratory Science (MLS) blood bank rotation to four weeks by reducing rotation length for clinical chemistry, microbiology and hematology from six weeks to five weeks. We evaluated the impact of this change on American Society for Clinical Pathology (ASCP) Board of Certification Exam (BOC) performance. Methods: We compared BOC scores for 119 MLS graduates with six-week clinical rotation lengths in chemistry, microbiology and hematology (2009-2013) and 127 MLS graduates with five-week rotation lengths in these disciplines (2014-2018). We evaluated first time pass rates, overall certification scores, specific discipline scores, and student rotation length satisfaction surveys. Results: Mean + SD overall BOC scores for six-week rotations (547 +74) was not significantly different from overall BOC scores for five-week rotations. Similarly, there was no significant effect on BOC scores for chemistry, microbiology, or hematology. The mean first-time pass rate for six week rotations was 97% compared to 96% for five-week rotations. Student satisfaction surveys received from 282 out of 307 (92%) students during 2014-2018 indicated that the five-week rotation length was adequate. Conclusion: Reducing rotation length had no detrimental effect on BOC scores or student satisfaction. These findings allowed us to respond to changing patterns in laboratory medicine. Beginning in 2018, students will receive a one week rotation in one of six molecular diagnostic testing laboratories, including hematopathology, virology, microbiology, genetics and blood bank. These rotations may be expanded as laboratory testing moves in this direction.

We examined and treated 472 patients with influenza, 72 of them had radiologically confirmed pneumonia, and 69 were hospitalized in the intensive care unit of Kyiv Municipal Clinical Hospital N 4. We analyzed clinical and laboratory pattern of flu in adults caused by influenza A virus (H1N1). Pneumonia is one of the most frequent complications of influenza, which significantly affects the prognosis. It was shown that unfavorable prognostic criteria are: late medical help (day 5–6 of the disease), the development of acute respiratory distress syndrome, increased white blood cell count and the presence of severe comorbidity., Обследованы и пролечены 472 больных гриппом, из них у 72 пациентов рентгенологически диагностирована пневмония, 69 из которых были госпитализированы в отделение реанимации и интенсивной терапии киевской городской клинической больницы № 4. Проведен анализ клинико-лабораторных данных больных гриппом, вызванным вирусом гриппа А (H1N1). Пневмония — одно из самых частых осложнений гриппа, которое существенно влияет на прогноз. Показано, что прогностически неблагоприятными критериями являются: позднее обращение за медицинской помощью (5–6-е сутки заболевания), развитие острого респираторного дистресс-синдрома, повышение или снижение лейкоцитов в крови и наличие тяжелой сопутствующей патологии., Обстежені та проліковані 472 хворі на грип, із них у 72 пацієнтів рентгенологічно діагностовано пневмонію, 69 з яких були госпіталізовані у відділення реанімації та інтенсивної терапії київської міської клінічної лікарні № 4. Проведений аналіз клініко-лабораторних даних хворих на грип, спричинений вірусом грипу А (H1N1). Пневмонія — одне з найчастіших ускладнень грипу, що суттєво впливає на прогноз. Показано, що прогностично несприятливими критеріями є: пізнє звернення за медичною допомогою (5–6-та доба захворювання), розвиток гострого респіраторного дистрес-синдрому, підвищення чи зниження лейкоцитів у крові та наявність тяжкої супутньої патології.

Introduction Fungal infections have risen exponentially in the last decade. In fact, candidiasis has become the most frequent type of hospital acquired infection especially in patients receiving treatment for chronic and terminal illnesses in a hospital. A retrospective analysis for a period of twenty year was undertaken to analyze the incidence rate of candidiasis, especially of Candida species, patients treated in a tertiary care center. Materials and methods Clinical data was collected from samples of patients who were receiving tertiary care were presenting with clinically suspected fungal infections. Direct microscopy with 10% potassium hydroxide was done to visualize the presence of fungal elements, and Gram staining was done for any suspected yeast infection. The samples were inoculated on Sabouraud’s Dextrose Agar and kept at 22 °C. Results A total of 1256 samples with presumed fungal etiology were included in the study. The maximum number of fungal infections were present in elderly (70–79 years age). Females (53.8%) were more affected (45.5%). 21% isolates were identified as yeast but belonged to non-Candida fungi. Among Candida species, Candida albicans was the most dominant species (58.3%) followed by Candida glabrata (6.4%). The year-round data of fungal cases showed that the highest incident of Candida albicans infection were in January with a mean value of 3.80, while the lowest infections were reported in June, with prevalence of 2.32 of C. albicans. The twenty-year data analysis showed that the years 2001 and 2000 showed the highest incidents of C. albicans, with a mean prevalence of 7.50 and 6.83, respectively. Specimen vs fungal prevalence data showed that 38% of the C. albicans were isolated from body aspirate specimens, followed by 26% from swab specimens. Conclusion The high prevalence of Candida spp. in the present study suggests increased susceptibility of patients with critical or chronic illnesses to fungal infections.

Contains fulltext : 249895.pdf (Publisher’s version ) (Open Access) AIM: The aim of this study was to evaluate interobserver variability between individual pathologists and a panel of pathologists in the histopathological assessment of advanced colorectal neoplasms in the Dutch bowel cancer screening population. METHODS AND RESULTS: Histological slides of adenomas with high-grade dysplasia and early colorectal carcinomas (CRC) from 20 different laboratories were reviewed by the pathology panel of the Dutch bowel screening programme. Interobserver variability was reported by descriptive statistics. In addition, potential clinical consequences of discrepancies were evaluated. A total of 104 cases of adenomas with high-grade dysplasia and 83 early CRCs were reviewed. Discrepancies were observed in 41 of 104 (39.4%) adenoma cases, which potentially had clinical consequences in 16 (15.4%) cases. For CRC, discrepancies were shown in 44 of 83 cases (53.0%) and would have potentially led to alternative treatment strategies in 25 (30.1%) cases. Most frequently, discrepancies were observed in the assessment of lymphovascular invasion (23 of 73 cases, 31.5%). CONCLUSION: This study showed that considerable interobserver variability is present in the histopathological assessment of advanced colorectal neoplasia, which may impact upon treatment choices. Additional stains and education, as well as intercollegial consultation, might decrease this variability.

Background Therapeutic studies against human immunodeficiency virus type 1 (HIV-1) infection have become one of the important works in global public health. Methods Differential expression analysis was performed between HIV-positive (HIV+) and HIV-negative (HIV-) patients for GPL6947 and GPL10558 of GSE29429. Coexpression analysis of common genes with the same direction of differential expression identified modules. Module genes were subjected to enrichment analysis, Short Time-series Expression Miner (STEM) analysis, and PPI network analysis. The top 100 most connected genes in the PPI network were screened to construct the LASSO model, and AUC values were calculated to identify the key genes. Methylation modification of key genes were identified by the chAMP package. Differences in immune cell infiltration between HIV + and HIV- patients, as well as between antiretroviral therapy (ART) and HIV + patients, were calculated using ssGSEA. Results We obtained 3610 common genes, clustered into nine coexpression modules. Module genes were significantly enriched in interferon signalling, helper T-cell immunity, and HIF-1-signalling pathways. We screened out module genes with gradual changes in expression with increasing time from HIV enrolment using STEM software. We identified 12 significant genes through LASSO regression analysis, especially proteasome 20S subunit beta 8 (PSMB8) and interferon alpha inducible protein 27 (IFI27). The expression of PSMB8 and IFI27 were then detected by quantitative real-time PCR. Interestingly, IFI27 was also a persistently dysregulated gene identified by STEM. In addition, 10 of the key genes were identified to be modified by methylation. The significantly infiltrated immune cells in HIV + patients were restored after ART, and IFI27 was significantly associated with immune cells. Conclusion The above results provided potential target genes for early diagnosis and treatment of HIV + patients. IFI27 may be associated with the progression of HIV infection and may be a powerful target for immunotherapy.

BACKGROUND T-cell leukemia/lymphoma accounts for roughly 30% of all types of lymphoproliferative neoplasia in dogs. Two forms of T-cell lymphoma (T-zone and peripheral T-cell lymphoma) exhibit breed-specific predilections. During the course of routine immunophenotyping, we observed a breed-specific presentation of a unique form of T-cell leukemia in young English bulldogs. OBJECTIVE To describe the clinical presentation and outcome of a novel T-cell leukemia in English bulldogs and determine the frequency of this neoplasm in other breeds. METHODS The Clinical Hematopathology database, containing immunophenotyping data from peripheral blood of nearly 11,900 dogs, was queried for the phenotype observed in young English bulldogs: CD45+ CD4- CD8- CD5+ CD3+ class II major histocompatibility complex (MHC)ᶫ° T-cell leukemia. Clinical presentation, treatment, and survival data were collected for a subset of cases. RESULTS Fifty-five English bulldog cases and 64 cases of other breeds were identified. No other breed was represented by >5 cases. Complete medical records were obtained for 50 bulldogs. Median age at diagnosis was 3 years and 76% of cases were male. Median lymphocyte count was 44,286 lymphocytes/ul (range, 1,800-317,684/ul) and lymphocytes were described as small to intermediate-sized. Many dogs were thrombocytopenic and had liver and spleen involvement, but not lymphadenopathy. Bulldogs that received multi-agent chemotherapy had longer median survival times (83 days) compared to dogs that received no treatment (6 days) or less aggressive therapy (15 days) (p=0.001). Non-bulldogs had similar outcomes. CONCLUSION CD4- CD8- class II MHCᶫ° T-cell leukemia has an aggressive clinical course and predilection for young English bulldogs. Breed-specific presentation suggests an underlying genetic cause. This article is protected by copyright. All rights reserved.

Tolerance of ambiguity (TOA) is essential for veterinarians because ambiguity and uncertainty are unavoidable aspects of veterinary practice. However, TOA has been little investigated in veterinarians or veterinary students. In this article, the 27-item Tolerance of Ambiguity of Veterinary Students (TAVS) scale, including eight additional clinical pathology-specific items, is used to evaluate TOA in veterinary students at the beginning and end of a clinical pathology course. Clinical pathology is often one of the first subjects in which students encounter ambiguity because real-life cases are used in teaching. The hypotheses are that TOA will increase across the course and that TOA will correlate with the final grade in the course. Analysis of the TAVS scale revealed very good inter-item reliability (α = 0.80) and a positive correlation between the original TAVS items and the new clinical pathology items (ρ = 0.63). Students demonstrated a significant increase in TOA across the course for TAVS items and a similar trend for clinical pathology items. Four items related to affinity for complexity and novice view showed significant increases in TOA. Two items related to discomfort from uncertainty showed significant decreases. There was no correlation between TOA and final grade in the course. Students rated their personal frustration with ambiguity in the course as low and did not think ambiguity in cases was problematic for teaching. The results suggest that the increased TOA at the end of the course might relate to students being taught—and learning how to cope with—ambiguity through the real-life cases used for teaching.

Background To explore the clinical profiles and outcomes of patients with acute respiratory failure (ARF) after esophagectomy. Methods We retrospectively analyzed cases of patients who had been diagnosed with ARF after esophagectomy and compared survivors with non-survivors to explore the risks that may affect their outcomes. Results In total, 62 patients were admitted to the intensive care unit (ICU) with ARF after esophagectomy between January 1, 2010, and December 31, 2017. Of these patients, 69.4% needed mechanical ventilation, with an average time on the ventilator of 304 hours (304.33±374.37 hours). The average length of stay in the ICU and in the hospital were 14 days (14.48±17.64 days) and 50 days (50.15±37.28 days), respectively. Mortality in the ICU and 90 days after the operation was 6.5% and 16.1%, respectively. Compared with the survivors, the 90-day post-operative non-survivors had a poorer N stage in the TNM classification system. The causes of ARF included anastomotic leakage, pneumonia, vocal cord paralysis, sputum plugging, pulmonary embolism (PE), and acute respiratory distress syndrome (ARDS). ARF induced by different factors occurred at different times and had different outcomes. The three most common reasons for mortality in the ICU were ARDS (33.33%), anastomotic leakage (11.76%), and pneumonia (10%). The three most common reasons for mortality in the 90-day post-operative period were pneumonia (40%), anastomotic leakage (23.53%), and ARDS and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) (33.33%). Conclusions Anastomotic leakage, pneumonia, ARDS, and AECOPD were the main causes of death in ARF patients after esophagectomy. We found that the N stage in the TNM classification system may affect 90-day post-operative mortality in these patients.

Clinical-pathologic examination of samples collected from more or less preserved body compartments during necropsy may provide important information and contribute to the list of differential diagnoses without corresponding patho-morphologic findings. It furthermore allows for diagnoses that otherwise may only be achieved clinically. Our review presents diagnostic approaches in examining aqueous humor, urine, ruminal fluid as well as other sample types characterized by a delayed onset of auto- and heterolytic artefacts. An overview is provided concerning post mortem (p. m.) sample types and collection methods with a special focus on cattle. Furthermore, clinical-pathologic methods and parameters are presented and their validity discussed. A summary of pre-analytical caveats relevant for the final interpretation of findings is made available. Based on long-term experience in p. m. clinical pathology as well as literature information we provide practical approaches for daily routine diagnostics as well as for specific case scenarios. Especially aqueous humor, ruminal fluid, and urine are easily accessible sample types. The collection of high-quality cerebrospinal fluid allows for electrolyte and metabolite analyses. Post-mortem clinical pathology may provide an indication concerning the cause of death in specific cases e. g., recumbency and death due to hypocalcemia or hypomagnesemia. This is especially relevant in cases in which ante mortem clinical pathology investigations are hindered by rapid death of the animal as well as in cases in which the gross pathology findings cannot explain the clinical findings. Post-mortem clinical pathology may also be helpful when a clinical examination of the diseased animal is hampered. During necropsy for example uremia and ketosis may be detected based on their characteristic smell; however, the use of clinical chemical analyses allows the verification by an assessment of the metabolites in these cases. Post-mortem clinical pathology may hence help in establishing a diagnosis, narrow down the list of differentials or even reveal relevant differential diagnoses for the first time during the diagnostic process. Our review does not claim to be exhaustive; however, it serves to encourage the pathologist to make use of the so far rarely employed ancillary analyses as well as to promote the collaboration between veterinary and clinical pathologists.

Background Anemia can be categorized into micro-, normo- or macrocytic anemia based on the mean corpuscular volume (MCV). This categorization might help to define the etiology of anemia. Methods The cohort consisted of patients newly diagnosed with anaemia in primary care. Seven aetiologies of anaemia were defined, based on an extensive laboratory protocol. Two assumptions were tested: (i) MCV 100 fl (macrocytic) excludes iron deficiency anaemia, anaemia of chronic disease and renal anaemia as anaemia aetiology. Results Data of 4129 patients were analysed. One anaemia aetiology could be assigned to 2422 (59%) patients, more than one anaemia aetiology to 888 (22%) patients and uncertainty regarding the aetiology remained in 819 (20%) patients. MCV values were within the normal range in 3505 patients (85%). In 59 of 365 microcytic patients (16%), the anaemia aetiology was not in accordance with the first assumption. In 233 of 259 macrocytic patients (90%), the anaemia aetiology was not in accordance with the second assumption. Conclusions Anaemia aetiologies might be ruled out incorrectly if MCV guided classification is used as a first step in the diagnostic work-up of anaemia. We recommend using a broader set of laboratory tests, independent of MCV.

Background/Purpose Epidermolysis bullosa (EB) is a rare disease of skin and mucosa which may causes surgical complications. We review these in a large patient cohort from Saudi Arabia. Methods A retrospective study was conducted at 21 centers between 2003 and 2020. Demographic data and information on EB type [Simplex (EBA), Dystrophic (DEB) and Junctional (JEB)]. The dataset included clinical features, operations, surgical complications, and treatment. Results There were 152 (63 male) children with EB [EBS n = 93 (61.2%); DEB n = 30 (19.7%); JEB n = 25 (16.4%), and Kindler syndrome n = 4, (2.6%)]. Children with JEB and DEB tended to have a higher frequency of skin and musculoskeletal system complications (skin cancer, pseudosyndactyly and recurrent skin infection). Esophageal strictures were mostly seen in DEB (n = 19, 63%) and to a lesser extent in EBS (n = 20, 21%) and JEB (n = 4, 16%). Pyloric atresia was uncommon (n = 4) and limited to those with JEB. Percutaneous gastrostomy for feeding support was used in all types. Ankyloglossia was common but often recurred (76%) after division. Circumcision was usually safe and complication-free in male children except in those with severe JEB. Phimosis was reported in 10% of uncircumcised patients. Conclusions Our series showed that surgeons play a key role in the management of some complications associated with EB. It is also important to be aware of the particular sub-type as this can predict the natural history and likely response to treatment. Level of Evidence 2

The incidence of Osler–Weber–Rendu disease is low, ranging from 1 detected case per 50,000 to 1 per 100,000 population. The disease is hereditary, with autosomal dominant transmission, caused by pathogenic mutations in genes involved in angiogenesis. The disease has a pronounced clinical picture of multiple telangiectasias of the skin and mucous membranes and manifests as spontaneous bleeding. This scientific article presents a clinical analysis of a 65-year-old patient with a diagnosis of Osler–Weber–Rendu disease. Early identification of the manifestations of this disease and careful observation of the patient give a favorable prognosis of the course and prevent the development of severe complications.

Background. Stroke remains the second leading cause of disability and death with the highest reported age­standardized death rates in Eastern Europe compared to Western Europe and the US. Recovery from stroke has been shown to involve reorganization in motor and premotor cortical areas. The resolution of diaschisis has been suggested as a mechanism of early spontaneous recovery. However, there are not enough published prospective studies on the clinical analysis and comparison of different types of cerebral diaschisis, especially in acute stroke patients. We aimed to carry out follow­up analysis of clinical characteristics of cerebrospinal and commissural cerebral diaschisis in acute ischemic stroke patients, to present clinical cases. Materials and methods. We have conducted a prospective, hospital­based, cohort study of acute stroke patients (n = 124) who were admitted to the department of cerebrovascular diseases of the University Hospital (Oleksandrivska Clinical Hospital, Kyiv, Ukraine) within the first 24 hours after the stroke. All cases were reviewed by at least two board­certified neurologists trained in cerebrovascular diseases. All participants underwent comprehensive clinical, neurological, laboratory, ultrasound, and neuroimaging examination. Results. Among 124 patients, 26 were diagnosed with cerebral diaschisis (cerebrospinal (n = 22) and commissural (n = 4)). We have provided detailed clinical analysis of cerebral diaschisis in acute stroke patients. We have described specific neurological changes in variants of territorial cerebral infarctions and mirror brain infarctions caused by diaschisis. Conclusions. Semiotics of acute cerebral stroke is determined, not only by the primary brain infarction, but also by the diaschisis that causes more severe neurological deficit. Cerebral diaschisis is associated with the mirror brain infarction development, depression of tendon and periosteal reflexes, limb muscle atony. During therapy, a sluggish stage of hemiplegia in most cases was followed by the spastic hemiplegia within 9 to 14 days after stroke development.

OBJECTIVE To evaluate the efficiency, postoperative hysterectomy rate, and influencing factors for therapeutic effect of the NovaSure endometrial ablation procedure in abnormal uterine bleeding (AUB). METHODS We conducted a retrospective cohort study of 2152 patients from the Department of Gynecology at the Third Xiangya Hospital, CSU from October 2010 to December 2018. RESULTS From the first year to the eighth year after operation, annual effective rate was above 95.24%, and the differences were not statistically significant. There are statistically significant differences between the effective and ineffective groups with regard to age, intrauterine polyps, total length of the uterus, systemic coagulation disorder, and preoperative hemoglobin. A multivariate logistic regression analysis showed that the risk factors associated with systemic coagulation disorders (P = 0.027) and high total uterine length (P = 0.003) affected NovaSure efficacy in the treatment of AUB. By December 2019, the postoperative hysterectomy rate was 1.86% (40/2152) and the complication rate was 1.67% (36/2152). CONCLUSION NovaSure is a reliable treatment for AUB and serious medical complications because of its simple operation, low amount of bleeding, quick postoperative recovery, and safe and effective short-term and long-term efficacy. However, it should be carefully selected for patients with a total uterus length exceeding 10 cm.

Introduction: Patients of Covid 19 infections present with different severity. Levels of D Dimer in these patients can be correlated with disease severity for management and prognosis. Aims and Objectives: To evaluate the usefulness of D-Dimer levels in blood to correlate with disease severity in COVID 19 patients. Materials and Methods: Retrospective study was done in Department of Pathology of Secondary Care hospital that became designated covid hospital from May 2021 to June 2021 on 60 COVID 19 positive admitted patients. D dimer levels were analysed and correlated with clinical severity of disease. Results: Out of total 60 patients, 33 were in mild, 23 in moderate and 4 were in severe category. In mild cases D Dimer varies from 43 ng/ml to 183 ng/ml. In moderate cases D Dimer varies from 270 ng/ml to 991 ng/ml. In severe cases D Dimer varies from 1043 ng/ml to 2463 ng/ml. The study suggests cut off levels for D Dimer as up to 200 ng/ml for mild, 200-1000 ng/ml for moderate and more than 1000 ng/ml for severe category in COVID 19 patients. Conclusion: D dimer helps in identifying severe disease and can be used as an essential biomarker in developing the management protocol for COVID 19 patients. Keywords: Covid 19, D Dimer, Prognostic indicator.

Introduction: Oral cancers are one of the 10 leading cancers in the world. However, in India, it is one of the most common cancers and constitutes a major public health problem. Oral squamous cell carcinoma is a well-known malignancy that accounts for more than 90% of all oral cancers. Materials and Methods: The study is carried out on 40 biopsy samples received on oral mucosa, in Department of Pathology of our institute. Result: Maximum numbers of patients were from 3th to 6th decade in our study. 38 cases of oral squamous cell carcinoma were observed, out of which 31 (81.57%) were male, and 07 (18.42%) cases were female. The most common site was tongue (50%), followed by buccal mucosa (18.42%), 06 patients (15.78%) had lesion at palate. Thirty-five (92.10%) cases had a significant history of tobacco use/smoking, whereas 03 (7.89%) did not have any history of tobacco use. We observed Ki-67 LI for normal oral mucosa was 14 ± 5.6%. In well-differentiated carcinoma, the KI-67 LI was 28.52 ± 21.25%, which increased to 42.85 ± 18.2% in moderately differentiated carcinoma and 68.57 ± 17.6% in poorly differentiated carcinoma. Conclusion: Ki-67 acts as an excellent marker of cellular proliferation. There is a statistical difference in KI-67 overexpression between various grades of oral squamous cell carcinoma and normal oral mucosa (p value Keywords: Oral cancer, Ki-67, SCC.

Aim & Objectives: To study the MRM specimens for size, grade of the tumor, LVI and LN metastases and the ER/PR receptors of the tumor. To study the association of ER/PR status with the above mentioned prognostic parameters. Materials and Methods: This three-year study includes 72 histopathologically confirmed cases of carcinoma breast. The tumor type, grade, LNM, LVE were reported on H & E. The ER-PR study was done of all 72 cases. The tumor size, grade, LNM, LVE were correlated with receptor status. Observation: Out of 72 cases majority (53%) of cases were in 41-50 years of age group, and tumor size was between 2-4 cm in (54.16%) cases; majority were of grade II carcinoma (60%) of which 59% were ER-PR positive. Out of 46 cases with negative LNM and LVE, 30 cases (65%) were ER-PR positive. Conclusion: In our observation there is no association between higher histological grade and ER-PR status. No obvious correlation with tumor size was noted. But increase in tumor size could also be a poor predictor of ER-PR status. LNM, LVE is poor predictor of ER-PR status. Keywords: Breast carcinoma, Estrogen and progesterone receptor.

Introduction: Cervix is vulnerable to many pathological changes ranging from inflammation to malignancy. Uterine cervix is gateway to several non-neoplastic and neoplastic gynaecological lesions.. Histopathological studies of cervix along with clinical correlation helps in early diagnosis of lesions as they have advantages of being relatively cheap and technically easy. To study the histopathological features of cervical lesions. Materials and Methods: A retrospective study was done in the department of Pathology at Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem for duration of 05 years i.e., from April 2016 to March 2021in 550 cervical samples. Results: Non neoplastic (92.1%) lesions of cervix were more commonly reported in our study and neoplastic lesions were about 7.8%. Conclusion: Histopathology study of cervical biopsy lesions is a valuable diagnostic procedure. Early detection of cervical lesions may provide an opportunity for appropriate interventions to prevent further complications such as progression from benign to malignant conditions. Adequate screening procedure with follow up cervical biopsies helps in early diagnosis and management of premalignant and malignant lesions. Keywords: Cervical biopsy, Cervical carcinoma.

Primary immunodeficiency disorders (PIDs) are a group of genetic abnormalities characterized by defectin one or more constituents of the immune system.This group of disorders are largely undiagnosed and unreported worldwide due to lack of awareness among the medical practitioners,parents as well as lack of state of art diagnostic facilities. Earlier we had reported the distribution pattern of various categories of PID in children of north India; in this report we are appending the data with current findings.In this retrospective study we pooled data from PIDs workup of 706 children with suspected PIDs, below the age of 18Yrs, in the period of May 2017 October 2019. The clinical assessment and presentation of these children was suggestive of PID. The peripheral blood of these children was used for flow cytometry based immunophenotyping of immune cells. PIDs were classified according to the International Union of Immunological Societies’ (IUIS) criteria.A total of 133 (18.38%) children were diagnosed with one or other form of PID with overall median age was 3.25 years (male: 2.3 and female: 4.2Yrs). Chronic infection, persistent diarrhea and retarded growth were the common warning signsin these patients. Combined humoral and cellular immunodeficiency was observed in 32%, phagocytic defect in 23%, antibody defect in 17%, dysregulated innate immunity in 19% and other well defined syndromes in 9% of total diagnosed PID children. Around 15.78% of PID cases were seen in coupleswithconsanguineous marriage, past family history of PID in 20.30% and families with sibling death of unknown cause in 24.06%. The cause of death of the sibling was not known. PID diagnosed children received prophylactic antibiotics and/or antifungals in addition tospecific therapy for the underlying immune deficiency.The field of PID remainsunexplored worldwide. The awareness in the developed countries is more than that of developing countries like India. The developing countries face several challenges in the diagnosis of PIDs such as awareness among patients and medical practitioners, mostly in the rural settings, lack of sufficient number of tertiary care centres, lack of equipped immunological laboratory to diagnose the disease.

Introduction: Diseases of the ovary are diversely arising from the different parenchymal tissue components. This span between reactive functional cysts to more debilitating ovarian carcinoma. Ovarian carcinoma is the sixth most common cancer and one of the leading cause of cancer death among female. This study aims to determine the epidemiological and histopathological patterns of ovarian masses in our setting. Materials and Methods: The study material was all the ovarian tissues biopsy specimen submitted to the Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto over five years. These were fixed in 10% formal saline embedded in paraffin wax, tissue blocks formed and were sections and stained with hematoxylin and eosin on the glass slides. Request cards and case folders were used to extract clinical information. These were reviewed, analysed and presented as frequency distribution figures. Results: There were 112 ovarian biopsies during the study period. Their ages ranged between 13 and 67 years and peaked in the fourth decade of life. Fifty per cent of all the cases were seen between the ages of 21 and 40 years. Benign neoplastic diseases formed 50% of the ovarian masses and matured cystic teratoma was the most common. Others were reactive and functional ovarian cysts (24.1%), malignant neoplastic conditions (14.3%) and inflammatory / infectious diseases (11.6%). Overall mature cystic teratoma constitutes 27% of the entire ovarian masses. Conclusions: Matured cystic teratoma was the most common disease of the ovary in our setting, afflicting young female, while malignant tumours dominated by serous cystadenocarcinoma affect the older age group. The fourth decade of life was the most common age of affectation. We advocate for proper histopathologic evaluation of all ovarian masses to arrive at a definitive diagnosis to offer an appropriate treatment modality. Keywords: Pathology, Ovary, Mature cystic Teratoma, Serous cystadenocarc

Extra-gonadal teratomas are rare and occur at various sites, with the retroperitoneum being an unusual site. We report a case of an adenocarcinoma arising in a mature retroperitoneal teratoma with bilateral lung metastasis in a young female. Around less than 20 such cases have been reported in literature with the present case being probably second in the Indian scenario and the first to have adenocarcinomatous component metastasize to lungs. We hereby emphasize on the importance of looking for such suspicious areas in a teratoma in order to tailor subsequent management. Keywords: Adenocarcinoma, Malignant transformation, Metastasis, Retroperitoneum, Teratoma.

Nodular hyperplasia of parathyroid gland is an advanced state commonly seen in a secondary and tertiary hyperparathyroidism. It shares similarities on histology with parathyroid adenoma creating a diagnostic dilemma. Adequate history, biochemical investigations and radiological studies majorly supports the accurate diagnosis. Identifying correct state of hyperparathyroidism is essential in a view of therapeutic management and its outcome. Keywords: Chronic kidney disease, Nodular hyperplasia, Secondary hyperparathyroidism, Tertiary hyperparathyroidism.

Spindle cell oncocytoma (SCO) of the pituitary is a rare tumor of the adenohypophysis occurring in the sellar/suprasellar region. This tumor has been recognized as a distinct entity by the WHO Classification of CNS tumor in 2007. Spindle cell oncocytoma of the pituitary gland accounts for 0.1–0.4% of all sellar region tumors and is predominantly seen in the older adult population. This rare entity simulates clinical and radiological features of pituitary adenoma and is often misdiagnosed. Though WHO grade 1, the tumor can recur and have invasive properties. Herein, we report a 61-year-old woman with panhypopituitarism and temporal field cut, clinically and radiologically diagnosed as pituitary macroadenoma, while the histomorphological and immunohistochemistry features helped in arriving at a diagnosis of Spindle Cell Oncocytoma. The clinicopathological, histomorphological, immunohistochemical, and molecular properties of the tumor are further discussed. Keywords: Spindle cell oncocytoma, Adenohypophysis, Pituitary, Macroadenoma, Panhypopituitarism.

Context: An “Intra-cranial space occupying lesion” (ICSOL) is defined as a mass in the cranial cavity with a diverse etiology like benign or malignant neoplasm, inflammatory or parasitic lesion, haematoma or arterio-venous malformation. Aims: The aim was to study the histomorphological spectrum of intracranial space occupying lesions at a tertiary care centre hospital in order to give accurate pretherapeutic diagnosis to facilitate better therapeutic results. Setting and Design: This prospective and descriptive type of study of two years duration was carried out from November 2017 to October 2019 in Govt. Medical College and Superspeciality Hospital, Nagpur in the Department of Pathology. A total of 300 samples were received from Department of Neurosurgery. Materials and Methods: Detailed collection of clinical data was done in all patients regarding age, sex, clinical symptoms and radiological findings. The samples were received in 10% formalin and subjected to routine histopathological processing. Slides prepared were stained with hematoxylin and eosin stain. Special stains were done wherever required. Results: Total 300 cases were studied of which 261 cases (87%) were neoplastic in nature and 39 cases (13%) were non neoplastic. Amongst primary tumours, most common were gliomas (48%) followed by meningiomas (20%) and schwannomas (9%). Conclusion: ICSOLs can present with nonspecific clinical features. Radio diagnostic investigations are helpful adjunct tools but cannot give exact diagnosis. Histopathological examination remains a gold standard for diagnosing and grading of tumours on which basis clinician can decide further line of management. Keywords: Histomorphology, ICSOL, Glioma, Meningioma.

Introduction: Salivary gland lesions are one of the most common encounters in clinical practice for the evaluation of which Fine needle aspiration cytology is a well-established technique nowadays. Owing to the heterogenecity and morphological overlap between the various categories of these salivary gland lesions, there was a need for a standardised procedure. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardised evidence based reporting system to assess the risk of malignancy and thus helpful for the management of these lesions. We have undertaken this study for evaluation of salivary gland lesions by this newly introduced grading system for predicting the malignant potential of these lesions. Materials and Methods: We have done a prospective study of all the salivary gland lesions received in our department for a period of 3 years from 2016 to 2019. The clinical history, aspiration cytology and histopathological examination was done for all the cases. Results: We have received 225 salivary gland lesions for aspiration, but histological follow up was done in only 105 lesions, which were thus included in our study. Case distribution into different categories was done in the following way:ND (5.71%), NN (38.01%), AUS (2.57%), NB (33.34%), SUMP (1.9%), SM (2.85%), and M (15%). Overall, ROM reported were 25%, 5%, 20%, 4.4%, 33.3%, 85.7%, and 97.5%, respectively for each category. Overall, sensitivity was 83.34%, specificity was 98.01%, positive predictive value was 94.87%, and negative predictive value was 91.89%. Conclusion: MSRSGC is a six category scheme that was recently proposed that separates the salivary gland FNAC into distinct categories, thus increasing the specificity by limiting the number of false negative and false positive cases. Keywords: Cytology, Malignancy, Milan system, Salivary gland.

Purpose: We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis.Methods: A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group.Results: The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36).Conclusions: Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.