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Aim: Histomorphological study of urothelial carcinoma on TRBT and Cystectomy specimen and its categorization on the basis of WHO grading & pTNM staging and to nd out the correlation between CK20 and CD44 exprression with tumour grade, pTNM staging. Material And Method: This descriptive cross sectional prospective study was conducted in the Department of Pathology, R G Kar Medical College & Hospital Kolkata in collaboration with Department of Urosurgery, R G Kar Medical College & Hospital, Kolkata, West Bengal. The present study is intended to nd out over expression of CD44 & CK20 in Urothelial Carcinoma of Bladder and correlate with tumour grade and clinical features. Result: There is strong association between CD44, CK20 expression and Stage of Urothelial Carcinoma cases and had a strong association between CD44 expressions and grade Urothelial Carcinoma cases. Conclusion: CK20 overexpression was seen more signicantly in High Grade tumours HGPUC (p < 0.05) as well as advanced stage pT2 and CD44 overexpression was more signicantly in lower grade tumours LGPUC (p

Aim of this study is to assess the expression of p16 as an immunohistochemical marker (which is a predictor or surrogate marker of high risk HPV infection) in oropharyngeal, head and neck squamous cell carcinoma and its correlation with different histomorphological features. Our study was an observational, descriptive study with cross-sectional design, done in the Department of Pathology, in collaboration with the Department of Plastic Surgery. It was conducted on a group of patients admitted in Department of plastic Surgery, R G KarMedical College & Hospital, and Kolkata. The samples included 54 specimens of, oropharyngeal & head neck SCC. Here, in this study, the expression of P16 in oropharyngeal & head neck SCC was shown& correlated with their histomorphological features. In present study median age of p16 positive patients were 54 years and male were more commonly affected than female. According to Socio economic status p16 positive cases were most commonly found in Lower status. Present study also showed that most of the p16 positive patients with SCC were married and literate. In most of the p16 positive cases history of one or more predisposing factors were present. Tobacco chewing came out as a most common risk factor. Most of the p16 positive cases were located at Oropharynx that came out as most common site. In all p16 positive cases, most of them had Non Keratinizing SCC which was statistically significant.

Introduction: The class mammalian is remarkable for the evolution of modied skin appendages that provide complete nourishment and immunological protection to the young. The breasts form a secondary sexual feature of females and are the source of nutrition for the neonate. They are also present in a rudimentary form in males. Aims And Objectives: Histomorphological study of invasive breast carcinoma on mastectomy specimens and its categorization on the basis ofhistologic grading and PTNM staging. Expression prole of immunohistochemical marker CD44 on invasive breast carcinoma. Correlation between CD44 expression with tumour grade and PTNM staging. Microscopic diagnosis and histopathological analysis of invasive breast carcinoma and its categorization on histologic grading and PTNM staging. Expression of CD44 in invasive breast carcinoma after histopathological diagnosis. Correlation of CD44 expression with that of tumour grade and PTNM staging. Materials And Methods: This study was conducted on a group of patients admitted in Department of General Surgery in collaboration with the Department of Pathology, R G Kar Medical College & Hospital, Kolkata over a period of 18 months. Cross sectional observational descriptive study. Conclusion: The main strength of our study was tertiary care hospital set-up, having infrastructure supportive enough to enable us to study invasive breast carcinoma from various socio-economic background, with diverse mode of presentation. We were able to do the necessary investigations in each case. There were some limitations in our study as limited duration of time, small sample size, unable to follow up results. This study needs to be extrapolated to a large population based sample with nancial support sufcient enough to nd relationship of expression of biomarker with grade and stage of tumour. In short, the present study has revealed various facets of breast carcinomas keeping comparable results with different studies. These ndings need to be conrmed by a larger prospective cohort.

Background Surgical site infections (SSIs) are among the most common healthcare-associated infections. Under-nutrition is an important risk factor for SSIs and can lead to delayed wound healing and longer hospital stays. Oral nutritional supplements are prescribed to reduce the risk of infection and improve health status, but data from randomised controlled trials (RCTs) have shown mixed results. Thus, the objective of our planned systematic review is to evaluate oral nutritional supplements on preventing SSIs in adult surgical patients Methods RCTs conducted in adult surgical patients who receive oral nutritional support will be included. The primary outcome will be the incidence of SSIs (within 30 days of surgery or within 90 days for joint replacement surgery). Secondary outcomes will be changes in nutritional status, mortality, health-related quality of life and costs. Literature searches will be conducted in several electronic databases (from inception onwards): MEDLINE, Embase, CINAHL and The Cochrane Central Register of Controlled Trials (CENTRAL). Grey literature will be identified through searching clinical trial registers and dissertation databases. Two reviewers will independently screen all citations, full-text articles and abstract data. The study methodological quality (or bias) will be appraised using the Cochrane risk of bias tool. If feasible, we will conduct random effects meta-analysis where appropriate. Discussion This systematic review will evaluate the evidence for pre- and post-surgical intervention with oral nutritional supplements in adults. Findings from this planned review may inform subsequent nutritional interventions for hospitalised patients who undergo surgery. Systematic review registration PROSPERO CRD42020140954

BACKGROUND Cytological evaluation of effusion fluid has become integral part of management especially in suspected malignant cases. Conventional Cytosmear (CS) is relatively simple, but sometimes become challenging to differentiate between reactive mesothelial cells and malignant cells. Hence, Cell Block (CB) preparation is increasingly gaining popularity for management, though it is time consuming, costly and little more cumbersome. MATERIALS AND METHODS All the fluid samples received in the departmental laboratory were divided into two parts for Leishman-Giemsa and Papanicolaou (PAP) stained conventional cytosmear and Haematoxylin-Eosin stained cell block preparation. Diagnoses obtained by CS and CB method were statistically analysed. RESULTS Out of total 115 fluid samples, 84 were pleural fluid, 24 ascitic fluid and 7 pericardial fluids. 9 cases in pleural fluid and 6 cases in ascitic fluid were false-negative by CS, which were proved to be malignant by CB method. So, additional 13.1% yield were obtained by CB method to diagnose malignant cases. CONCLUSION CB is superior to CS for diagnosis of malignant effusions and hence it should be used in adjunct to CS in difficult or suspected malignant cases for better yield.

BACKGROUND Corneal ulcer is one of the leading causes of ocular morbidity in developing country. Early diagnosis and targeted therapy is indispensable. Sociodemographic variables along with predisposing factors plays a major role in its development and clinicopathological correlation in diagnosis is very much helpful in diagnosis and subsequent management. The aim of the study is to identify the epidemiological factors and causative organism of the suppurative corneal ulcer. MATERIALS AND METHODS In this observational cross-sectional study, after taking proper history, patients with suppurative corneal ulcer are examined for clinical diagnosis. Applying sterile method of swab collection from the ulcer for standard microbiological examination (staining, culture) swabs are taken for predetermined laboratory investigations. Sociodemographic variables (age, gender, occupation) relevant injury history, microbiological data are tabulated for statistical calculations. RESULTS After application of inclusion and exclusion criteria wiling 81 patients, M:F=55:26 were assessed. Major number of patients (n=61, 75.30%) are middle aged between 33-62 years of age. Occupation played a major role as evidenced by 44.44% (n=36) contribution from agricultural workers (tea garden worker, pineapple farmer, other agricultural worker) followed by household worker (n=13, 16.05%). Positive history of prior corneal injury is common in fungal corneal ulcer (n=22, 51.16%) as well as in bacterial (n=8, 66.66%). Among the prior corneal injury associated fungal ulcer vegetative matter injury in 15 patients (32.60%), while in bacterial variety, it is 5 (10.86%) in number. In laboratory investigations, pure fungal growths are found in 37 patients (45.68%), while pure bacterial are 12 in number (14.81%). A good number (n=8, 9.81%) shows mixed infection. Culture negative ulcers are good in number (n=24, 29.63%) among which 6 (7.47%) are microscopically positive. The sensitivity and specificity of clinical diagnosis of fungal corneal ulcer are 84.61% and 72.41% respectively with a high correlation between clinical and microbiological diagnosis of fungal corneal ulcer (either smear positive or culture positive and a quiet high positive predictive value for clinical diagnosis (84.61%). But, in case of bacterial corneal ulcer, the positive predictive value is 41.37%, while negative predictive value is 84.61% in our study. CONCLUSION Middle-aged agricultural workers are more prone to develop corneal ulcer and fungal corneal ulcers are more prevalent in this region of India than bacterial. History of prior corneal injury is a major risk factor. Fungal corneal ulcers have high correlation between clinical and microbiological diagnosis than bacterial.

Habitual smokers are known to be at higher risk for developing oral cancer, which is increasing at an alarming rate globally. Conventionally, oral cancer is associated with high mortality rates, although recent reports show the improved survival outcomes by early diagnosis of disease. An effective prediction system which will enable to identify the probability of cancer development amongst the habitual smokers, is thus expected to benefit sizable number of populations. Present work describes a non-invasive, integrated method for early detection of cellular abnormalities based on analysis of different cyto-morphological features of exfoliative oral epithelial cells. Differential interference contrast (DIC) microscopy provides a potential optical tool as this mode provides a pseudo three dimensional (3-D) image with detailed morphological and textural features obtained from noninvasive, label free epithelial cells. For segmentation of DIC images, gradient vector flow snake model active contour process has been adopted. To evaluate cellular abnormalities amongst habitual smokers, the selected morphological and textural features of epithelial cells are compared with the non-smoker (-ve control group) group and clinically diagnosed pre-cancer patients (+ve control group) using support vector machine (SVM) classifier. Accuracy of the developed SVM based classification has been found to be 86% with 80% sensitivity and 89% specificity in classifying the features from the volunteers having smoking habit.

Aim: This study aims to develop a novel noninvasive method for early cancer trend diagnosis in habitual smokers by corroborating cytomorphological and autofluorescence alterations. Materials & methods: A total of 120 subjects were included and categorized into nonsmoker, smoker and clinically diagnosed oral potentially malignant disorder (OPMD) patients. Oral exfoliative epithelial cells were studied through differential interference contrast and fluorescence microscopy. Fuzzy trend analysis was performed using measured parameters for determining the risk factors among smokers. Results: The risk assessment in this study showed a positive correlation of smoking duration with early cancer risk factors with a correlation co-efficient of 0.86. Conclusion: Alterations in cellular morphology and autofluorescence intensities showed positive correlation with OPMD. The present study will benefit to investigate early prediction of OPMD among susceptible individuals.

Introduction: Adenocarcinoma of the prostate may be clinically suspected based on elevated serum PSA (Prostate Specific Antigen) and/or abnormal digital rectal examination. Serum PSA has been used in prostatic carcinoma screening and for diagnostic, therapeutic and prognostic purposes. Aim: To evaluate the role of serum PSA to differentiate between benign and malignant pathology of prostate diagnosed by Transrectal Ultrasound (TRUS) guided prostatic core biopsy with special emphasis on its correlation with risk stratification based on Gleason score and Grade grouping system. Materials and Methods: Total 45 cases of Prostatic core biopsy specimens of the patients where serum PSA value was known were included in this cross-sectional observational study. Biopsy specimens were processed for routine HaematoxylinEosin stain and diagnosed as benign or malignant by histopathological examination along with Gleason score and Grade-Grouping was done. The comparison of PSA value between benign and malignant cases along with its significance of association with higher Grade-Grouping was statistically judged by unpaired t-test. Results: Out of total 45 cases, 23 (51.11%) cases showed presence of adenocarcinoma and rest 22 cases were of benign pathology. Mean PSA value (ng/mL) was significantly higher in malignant cases i.e., 58.47 (±22.191) compared to benign cases i.e., 3.45 (±0.987). However, in malignant cases which have been categorised as low to intermediate risk group (Gleason score

Teratoma is a germ cell tumor common in anterior mediastinum but intrapulmonary location is rare. Gonadal and extra-gonadal primary site needs to be ruled out first to call the tumor as intrapulmonary teratoma. Here, we report a case of benign intrapulmonary cystic teratoma in a 28 year old female who presented with left sided chest pain and shortness of breath and was initially provisionally diagnosed to have hydatid cyst in lung.

Background: The adequacy of haemodialysis in patients of type 2 diabetes mellitus with chronic kidney disease stage 5 depends on several clinical as well as laboratory parameters. Previous studies from Western literature have identified several clinical and laboratory markers for predicting adequacy of dialysis. There is a dearth of literature regarding the same in Indian patient populace. Authors aimed to find correlation, if any, between glycemic control and adequacy of dialysis in this cohort of patients.Methods: A set of 200 patients of type 2 diabetes mellitus who have undergone hemodialysis at a tertiary care hospital were included in the study. Random blood sugar (RBS), Glycated hemoglobin (HbA1c) were measured at admission. After 4 hours of dialysis, the urea reduction ratio (URR) and Kt/V was measured for each patient. The correlation coefficient as well as linear equation of the association between these variables were calculated. Standard statistical method and software were used in the process.Results: The study revealed a linear negative correlation between the variables RBS, HbA1c and URR as well as Kt/V. This suggests the importance of pre dialysis glycemic control in patients undergoing hemodialysis.Conclusions: Authors formulate the hypothesis that glycated hemoglobin and random blood sugar at admission correlate well with the outcome and adequacy of dialysis in patients of stage 5 chronic kidney disease undergoing haemodialysis. Good glycemic control (HbA1c

Introduction: The Pap stained cervical smear is a screening tool for cervical cancer. Commercial systems are used for automated screening of liquid based cervical smears. However, there is no image analysis software used for conventional cervical smears. The aim of this study was to develop and test the diagnostic accuracy of a software for analysis of conventional smears. Materials and Methods: The software was developed using Python programming language and open source libraries. It was standardized with images from Bethesda Interobserver Reproducibility Project. One hundred and thirty images from smears which were reported Negative for Intraepithelial Lesion or Malignancy (NILM), and 45 images where some abnormality has been reported, were collected from the archives of the hospital. The software was then tested on the images. Results: The software was able to segregate images based on overall nuclear: cytoplasmic ratio, coefficient of variation (CV) in nuclear size, nuclear membrane irregularity, and clustering. 68.88% of abnormal images were flagged by the software, as well as 19.23% of NILM images. The major difficulties faced were segmentation of overlapping cell clusters and separation of neutrophils. Conclusion: The software shows potential as a screening tool for conventional cervical smears; however, further refinement in technique is required.

Oral cancer is one of the biggest health care burdens in the Indian subcontinent (40% of the cancer risk). In most of the cases, it is evident that, like any other cancer, oral cancer is usually detected at advanced stages, which considerably reduce the survival rates. Hence, early detection of cancer is of utmost importance to enhance the survival rates. Among various carcinogenic agents, tobacco smoking has detrimental effect on oral cancer. So routine screening of habitual smokers may improve the early detection possibilities. In this chapter, an attempt has been taken to analyze the importance of computer-aided diagnosis in early cancer monitoring. In our previous study, we have shown the application of SVM to detect the precancer risk in habitual smokers by classifying them on the basis of selected features. Along with morphological features in previous study, the texture features were extracted by GLCM method. However, in many cases, ambiguous results had been obtained by this method. So, in the proposed work, we have used LBP method for extraction of texture features and the performance measures are calculated in terms of sensitivity, specificity, and accuracy in order to improve the diagnostic accuracy. According to our study, the LBP method is proved as better feature extractor as classification accuracy has been improved. To classify habitual smoker in comparison to nonsmoker and precancer by SVM method, the present study is 91.66% sensitive, 87.3% specific, and 88.33% accurate.

Advancements in our understanding of vestibular physiology and how it is changes in different diseases have established that of the three therapeutic approaches to treat disorders of the vestibular system viz. pharmacotherapy, surgery and physical therapy, it is the later i.e., physical therapy which is the most efficacious modality in the management of balance disorders. The futility of vestibular sedatives in the correction of vestibular disorders and in the restoration of balance and the very limited role of surgery has now been recognised. Advancements in vestibulometry now enable us to localise any lesion in the vestibular system with utmost precision and also determine the exact cause of the balance disorder. The site of lesion and the specific organ that is defective can now be very precisely identified. Treatment modalities especially that for physical therapy hence have to be organ specific, and if possible, also disease specific. The study aims at evaluating the efficacy of physiotherapy in the management of balance disorders and also assesses the efficacy of organ targeted physical therapy, a new concept in restoring balance after vestibulometry has identified the offending organ. The study was conducted in the specialised physical therapy unit for balance and gait disorder patients which is a part of Vertigo and Deafness Clinic in Kolkata, India. Special instruments for physical therapy devised by the first author were used for stimulation of specific sense organs in the vestibular labyrinth that were found to be defective in vestibulometry. Specially made Virtual reality programs were used in patients suffering from psychogenic balance disorders. The pre and post therapy status was evaluated by different standard scales to assess balance and dizziness. Very promising results were obtained. Organ targeted physiotherapy where defective sense organs were specifically stimulated showed remarkable improvement in different measures. Virtual reality exercises too showed very promising results in patients of psychogenic vertigo.

Honey is known as a popular healing agent against tropical infections and wounds. However, the effects of honey dilutions on keratinocyte (HaCaT) wound healing under hypoxic condition is still not explored. In this study, we examined whether honey dilution have wound healing potential under hypoxic stress. The antioxidant potential and healing efficacy of honey dilution on in vitro wound of human epidermal keratinocyte (HaCaT cells) under hypoxia (3% O2 ), and normoxia is explored by nitro blue tetrazolium assay. The cell survival % quantified by MTT assay to select four honey dilutions like 10, 1, 0.1, and 0.01 v/v% and the changes in cellular function was observed microscopically. Further, the cell proliferation, migration, cell-cell adhesion, and relevant gene expression were studied by flow cytometry, migration/scratch assay, immunocytochemistry, and reverse transcription-polymerase chain reaction, respectively. The expression pattern of cardinal molecular features viz. E-cadherin, cytoskeletal protein F-actin, p63, and hypoxia marker Hif 1α were examined. Honey dilution in 0.1% v/v combat wound healing limitations in vitro under normoxia and hypoxia (3%). Its wound healing potential was quantified by immunocytochemistry and real-time PCR for the associated molecular features that were responsible for cell proliferation and migration. Our data showed that honey dilution can be effective in hypoxic wound healing. Additionally, it reduced superoxide generation and supplied favorable bioambience for cell proliferation, migration, and differentiation during hypoxic wound healing. These findings may reveal the importance of honey as an alternative and cost effective therapeutic natural product for wound healing in hypoxic condition.

Aim: The present study was carried out to compare the associated role of micro minerals and hormones in repeat breeding animals with the normal crossbred cows. Materials and Methods: Blood samples were collected from 10 normal cycling and 10 repeat breeding crossbred cows of Ramakrishna Mission Ashram, Narendrapur to study the plasma mineral profile and hormonal activities. Results: Zn was found to be highly significant (p

Steroid cell tumors of ovary constitute an uncommon group of ovarian neoplasms composed of large cells with intracellular lipid that resemble leydig cells or luteinized stromal cells. They are characterized by their clinical manifestations which are reflections of the underlying hormonal disturbances. This case report is of a 22yrs old female with an abdominal mass whose presenting symptom was just amenorrhea for 9 months. However the final diagnosis after excision of the mass and histopathological examination left the unsuspecting physicians in surprise.

Introduction: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease where assessment of disease activity is essential for management of patient. Currently, many composite scoring systems are used for evaluation of disease activity but they are mainly clinical-based. As several haematological parameters are altered due to systemic inflammatory process in RA, this study was intended to evaluate role of common haematological parameters to assess disease activity in RA. Aim: To find out the association of disease activity of Rheumatoid Arthritis (RA) with platelet count, Mean Platelet Volume (MPV) and Haemoglobin (Hb) level so that these costeffective haematological parameters can be used as additional factors to assess disease activity. Materials and Methods: This hospital based cross-sectional study was done on newly diagnosed patients of RA along with age and sex matched healthy control population. Patients suffering from malignancies, renal failure, diabetes mellitus or RA patients on drug therapy were excluded. Clinically, disease activity of RA was measured using DAS 28-3 Score (Modified Disease Activity Score using three variables- tender joint count, swollen joint count and ESR). Haematological parameters were measured by automated cell counter. Results: Total 80 cases were selected (60 female and 20 male). 48 patients with high disease activity (DAS 28-3>5.1) were labelled as Group-A and 32 with low to moderate disease activity (DAS 28-3 ≤5.1) as Group- B. Mean platelet count of patients of group A and group B were 4.53 lac/cmm and 2.17 lac/cmm respectively (p

Increasing incidents of diabetes (mellitus) induced non-healing lower extremity wounds and disease associated amputations have raised significant concerns related to quality of life of afflicted patients. High glucose level in diabetic wounds inhibits the transactivation of angiogenesis related molecules resulting delayed healing progression. Present study investigates the impact of a natural medicine like honey in angiogenesis of non-healing diabetic lower limb wounds. Quantitative assessment of different vessel parameters was performed on in vitro CAM model for validation of angiogenic potential of honey. Further the upregulation of angiogenesis related prime molecular markers like HIF-1α, VEGFA, VEGFR2 is under the therapeutic intervention of honey indicated improved angiogenesis which in turn promote the healing rate. These results may facilitate in determining the healing impact of this natural product in treatment of diabetic wounds and it may also help in developing alternative cost effective therapeutic modality.

The degree of increase in foetal haemoglobin (HbF) synthesis in haematological malignancies may be associated with the degree of malignancy. The aim of the present study was to quantify HbF levels in various childhood haematological malignancies and also, to ascertain its prognostic significance by comparing the results with the already established standard prognostic factors. Newly diagnosed cases of haematological malignancies in the paediatric age group were included in the study. HbF levels were estimated in each case of the study group along with HbF levels of control group comprising healthy children of same age group. The estimation was done by HPLC and Modified Betke's method. 50 cases of newly diagnosed haematological malignancies were studied out of which most of the cases were of acute lymphoblastic leukaemia (ALL) [n = 30(60 %)] followed by acute myeloid leukaemia (AML) [n = 8(16 %)], Hodgkin's lymphoma [n = 7(14%)], non-Hodgkin's lymphoma [n = 5(10 %)]. Raised HbF levels were found in 43.3 % cases of ALL (13/30) and 37.5 % cases of AML (3/8). No significant rise in HbF level was found in cases of lymphomas. There was correlation between raised HbF level and poor prognostic factors in cases of ALL but no such correlation was found in cases of AML. HbF levels are often elevated in childhood leukaemias as compared to childhood lymphomas. Thus, the concentration of HbF in acute childhood leukaemia may be considered as a prognostic factor.

Evaluating molecular attributes in association with its epithelial and sub-epithelial changes of oral sub-mucous fibrosis is meaningful in exploring the plausibility of an epithelio-mesenchymal transition (EMT) and malignant potentiality of this pathosis. In this study histopathological and histochemical attributes for basement membrane and connective tissue in biopsies of oral sub-mucous fibrosis (n = 55) and normal oral mucosa (n = 16) were assessed and expressions of p63, E-cadherin, β-catenin, N-cadherin and TWIST were analyzed immunohistochemically. The p63 and its isoforms (TA and ∆N), PARD3, E-cadherin and β-catenin were also assessed transcriptomically by q-PCR and EMT players like TWIST1, ZEB1, MMP9 and micro-RNA 205 were searched in gene expression microarrays. Oral epithelium demonstrating impairment in progressive maturation in oral sub-mucous fibrosis concomitantly experienced an increase in basement membrane thickness and collagen deposition along with alteration in target molecular expressions. In comparison to non-dysplastic conditions dysplastic stages exhibited significant increase in p63 and p63∆N expressions whereas, E-cadherin and β-catenin exhibited loss from the membrane with concurrent increase in cytoplasm. Further the N-cadherin and TWIST were gained remarkably along with the appearance of nuclear accumulation features of β-catenin. The microarray search had noticed the up-regulation of TWIST1, ZEB1 and MMP9 along with down regulation of micro-RNA 205. The simultaneous increase in basement membrane thickness and sub-epithelial collagen deposition were the plausible indicators for increased matrix stiffness with expected impact on oral epithelial functional homoeostasis. This was corroborated with the increase in expressions of epithelial master regulator p63 and its oncogenic isoform (∆N) along with membranous loss of E-cadherin (EMT hallmark) and its associate β-catein and gain of mesenchymal markers like N-cadherin and TWIST. These also became indicative for the induction of epithelial to mesenchymal transitional mechanism in oral sub-mucous fibrosis when connoted here with the relevant modulation in expressions of EMT regulators.

Precise histopathological localization of E-cadherin and p63 is of immense importance in understanding the integrity of oral mucosal stratified epithelium in normal and diseased conditions. Necessarily immunohistochemical imaging should have minimum bleaching impact on the dyes and ability to produce clear and crisp images. Here ApoTome provides an alternative with metal halide light source and structured illumination under the assistance of grids, along with integrated image processing modality to generate crisp images with digital interface. The current study demonstrates the applicability of such microscopic system in capturing fluorescence images of immunohistochemical sections of normal and precancerous biopsies in respect to the expression of p63 and E-cadherin in the epithelial cells. The ApoTome images localize the nuclear and membranous expressions of p63 and E-cadherin, respectively, with remarkable specificity. The findings on E-cadherin expression have enormous diagnostic significance as these images clearly differentiate the early and advanced stages of oral submucous fibrosis based on their cytoplasmic and membranous location. Thus, this study clearly depicts a remarkable performance of ApoTome with diagnostic significance.

Absorption and effectiveness of vaginally administered misoprostol tablets may vary according to the medium in which it is placed. This study was directed to compare the outcomes of vaginal administrations of acetic acid-moistened misoprostol tablets with those of dry tablets for induction of second-trimester abortion. A randomized comparative trial where 322 women at 13–20 weeks gestation, requiring medical abortion, were randomly assigned to vaginal administration of either acetic acid-moistened or dry misoprostol tablets with a dose schedule of 400 μg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in nonresponders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction–abortion interval, failure rate and side effects. A difference of 15% in success rates at 24 h was used to calculate the sample size required with a power of 0.8 at the 5% significance level. No statistically significant differences in the complete abortion rates were observed at 24 h (70.95 vs. 68.71%, P = 0.675) and at 48 h (86.49 vs. 84.35%, P = 0.604) when both groups were compared. The difference in mean induction–abortion interval was also statistically insignificant between the groups (12.5 ± 1.6 vs. 12.8 ± 1.5 h, P = 0.97). Other outcome measures were also comparable in both groups. Moistening misoprostol tablets with 5% acetic acid before vaginal application creates no difference in outcomes when compared with those after the vaginal application of dry tablets for the termination of second-trimester pregnancy.

The assessment of malignant potential of oral submucous fibrosis grades vis-à-vis their progression towards malignancy is associated with expression of possible multiple molecular markers.To analyse p63, E-cadherin and CD105 expression in this premalignant pathosis with a view to unravel and understand the expression of these molecules as markers.The oral mucosal biopsies (normal, oral submucous fibrosis with and without dysplasia) were studied with routine HE, and by immunohistochemistry for p63, E-cadherin and CD105 expression. p63 was assessed as percentage of positive nuclei. E-cadherin expression was estimated through (i) distance between basement membrane and E-cadherin expression initiation point, (ii) ratio between epithelial thickness and epithelial thickness displaying E-cadherin, and (iii) E-cadherin intensity variation along the expression path. CD105 expression was assessed qualitatively.The p63+ cells were highest in severely dysplastic tissues followed by other dysplastic grades, normal oral mucosa and non-dysplastic conditions. However, the p63+ cells displayed the feature of progressive maturation only in normal mucosa. There was a loss of membranous E-cadherin in basal layers of all diseased conditions; it was highest in severe dysplasia. There was significant variation (p0.0001) in E-cadherin intensity within and between the tissues (normal and diseased). CD105 expression increased abruptly in dysplasia.The malignant potential of this pre-cancerous condition is likely to be correlated with an increase in p63 and CD105 expression and a concomitant loss of membranous E-cadherin. This may lead to marker identification through greater validation.

Introduction: Fine-needle aspiration cytology (FNAC) for identification of papillary carcinoma thyroid is a moderately sensitive and specific modality. The present machine learning tools can correctly classify images into broad categories. Training software for recognition of papillary thyroid carcinoma on FNAC smears will be a decisive step toward automation of cytopathology. Aim: The aim of this study is to develop an artificial neural network (ANN) for the purpose of distinguishing papillary carcinoma thyroid and nonpapillary carcinoma thyroid on microphotographs from thyroid FNAC smears. Subjects and Methods: An ANN was developed in the Python programming language. In the training phase, 186 microphotographs from Romanowsky/Pap-stained smears of papillary carcinoma and 184 microphotographs from smears of other thyroid lesions (at ×10 and ×40 magnification) were used for training the ANN. After completion of training, performance was evaluated with a set of 174 microphotographs (66 – nonpapillary carcinoma and 21 – papillary carcinoma, each photographed at two magnifications ×10 and ×40). Results: The performance characteristics and limitations of the neural network were assessed, assuming FNAC diagnosis as gold standard. Combined results from two magnifications showed good sensitivity (90.48%), moderate specificity (83.33%), and a very high negative predictive value (96.49%) and 85.06% diagnostic accuracy. However, vague papillary formations by benign follicular cells identified wrongly as papillary carcinoma remain a drawback. Conclusion: With further training with a diverse dataset and in conjunction with automated microscopy, the ANN has the potential to develop into an accurate image classifier for thyroid FNACs.

SummaryIn a prospective comparative study we screened 112 women with a past history either of pre-eclampsia, eclampsia, recurrent abortion, IUGR, IUFD or abruptio placentae, with no apparent aetiology and a demographically matched cohort of 106 women having a past history of uncomplicated pregnancy outcome for the presence of antiphospholipid antibodies (aPL) and their significance. In the former group, the prevalence of aPL ranged from 10–46.87% compared with 8.49% in the later group. In women with the presence of aPL, the incidence of pre-eclampsia, early onset pre-eclampsia and abruptio placentae were 25%, 14.58% and 18.75%, respectively. In the same group, the abortion rate was 25% and live-birth rate was 64.58% with IUFD rate of 10.42%. Fetal morbidity rates were also higher in the mothers with aPL positivity, the incidence of IUGR was 27.08% and oligohydramnios was 33.33% in them. All these complications were statistically significant when compared with those of aPL negative mothers.

Background Food allergy may be defined as an immunoglobulin E-mediated immune response to food proteins. Such studies have previously not been done in Calcutta, India. The present study was therefore undertaken to record the sensitivity to commonly consumed foods in patients with allergic rhinitis and asthma.Materials and methods A survey of 800 patients (410 males and 390 females) reporting to the Allergy Unit of the Institute of Child Health, Calcutta, were selected for the study conducted from May 2006 to April 2007. Respiratory allergic patients in the age group of 5 to 60 years were evaluated using a standard questionnaire, and skin prick test was performed using common food and aeroallergens.Results/Conclusions Out of the 684 patients with a history of food allergy, most of them, that is, 338, are in the age group 16 to 40 years, 192 of them were in the age group 41 to 60 years, and 154 were in the age group 5 to 15 years. Most of the patients with food allergy had asthma (65.05%), rhinitis and asthma (20.03%), and skin allergies (4.97%), such as itching, eczema, and urticaria. The foodstuffs that were found to elicit symptoms of hypersensitivity were egg, milk, wheat, pulses, vegetables, fishes, and fruits.The patients aged between 16 and 40 years (male-female ratio, 1:1.19) were mostly sensitive to prawn, brinjal, banana, ladyfinger, papaya, wheat, and egg. The age group 41 to 60 years (male-female ratio, 1:1.04) had high skin reactivity to brinjal, egg, banana, fish, and Phaseolus mungo. Patients younger than 16 years (male-female ratio, 1:1.33) were sensitized to brinjal, prawn, banana, spinach, and egg. We observed that food hypersensitivity also reflects different genetic factors and variations in cultural and dietary habits of each individual. Keywords: food allergens, Calcutta, India, skin prick test

Background: Misoprostol is the drug of choice for medical abortion worldwide but consensus is yet to be reached regarding its preferred route of administration. Aims: To compare the outcome of sublingual with vaginal administrations of misoprostol for induction of second trimester abortion. Methods: A randomised comparative trial where 300 women at 13–20 weeks gestation, requiring medical abortion, were randomly assigned to sublingual or vaginal route for misoprostol administration with a dose schedule of 400 µg three-hourly, up to a maximum five doses over 24 h. The same doses were repeated for another 24 h in non-responders. Primary outcome measure was complete abortion rate at 24 and 48 h, and the secondary outcome measures were induction–abortion interval, failure rate, side-effects and patients’ preference to the route. Results: No statistically significant differences in the complete abortion rates were observed at 24 h (64.03% vs 61.59%, P = 0.767) and at 48 h (79.14% vs 82.01%, P = 0.651) when sublingual and vaginal groups were compared. Mean induction–abortion intervals in sublingual and vaginal groups were 14.1 and 14.5 h, respectively (P = 0.066). Other outcome measures were also more or less similar in both groups. Differences in the incidence of side-effects were also statistically insignificant when both groups were compared. Sublingual administration of the drug was preferred by most of the women as compared to vaginal administration (P

Homeobox (Hox) genes are involved in body plan of embryo along the anterior-posterior axis. Presence of several Hox genes in white adipose tissue (WAT) and brown adipose tissue (BAT) is indicative of involvement of Hox genes in adipogenesis. We propose that differentiation inducing agents viz. isobutyl-methyl-xanthine (IBMX), indomethacin, dexamethasone (DEX), triiodothyronine (T3) and insulin may regulate differentiation in brown adipose tissue through Hox genes. In vitro culture of brown fat stromalvascular fraction (SVF) in presence or absence of differentiation inducing agents was used for establishing relationship between fat accumulation in differentiated adipocytes and expression of Hox genes. Relative expression of Pref1, UCP1 and Hox genes was determined in different stages of adipogenesis. Presence or absence of IBMX, indomethacin and DEX during differentiation of proliferated pre-adipocytes resulted in marked differences in expression of Hox genes and lipid accumulation. In presence of these inducing agents, lipid accumulation as well as expression of HoxA1, HoxA5, HoxC4 &HoxC8 markedly enhanced. Irrespective of presence or absence of T3, insulin down regulates HoxA10. T3 results in over expression of HoxA5, HoxC4 and HoxC8 genes, whereas insulin up regulates expression of only HoxC8. Findings suggest that accumulation of fat in differentiated adipocytes is linked with expression of Hox genes.

En1, Nr2f1, Gpc4, Sfrp2, Shox2, Tbx15 and Thbd are among the genes involved in development process of an organism in a number of tissues, in particular adipose tissue. Considering the involvement of isobutyl-methyl-xanthine (IBMX), indomethacin, dexamethasone (DEX), triiodothyronine (T3), and insulin in adipocyte differentiation, we propose that these differentiation-inducing agents may regulate differentiation in brown adipose tissue through a developmental process. Stromavascular cells isolated from interscapular brown fat of mice were cultured in DMEM-LG medium. Proliferating brown preadipocytes were differentiated in the presence of IBMX, indomethacin, DEX, T3 and insulin. Pref1 (marker of proliferation stage) and uncoupling protein 1 (UCP1, marker for differentiation stage) were upregulated during proliferation and differentiation, respectively. Relative expression of Pref1, UCP1 and developmental genes was determined in different stages of adipogenesis. En1, Gpc4, Nr2f1, Sfrp2 and Shox2 were upregulated during differentiation. Differentiation of preadipocytes in the absence of IBMX, indomethacin, and DEX resulted in drastic reduction in fat accumulation in differentiated adipocytes with simultaneous decrease in En1, Gpc4, Nr2f1, Sfrp2, Shox2 and Tbx15 gene expression. T3 upregulated the expression of En1, Gpc4, Sfrp2 and Tbx15 genes during differentiation and downregulated Shox2 expression as compared to proliferated state. Insulin upregulated the expression of Shox2.

BackgroundWe have previously reported that increased glucose levels were associated with higher serum nitric oxide (NO) levels in fructose-fed insulin resistant rats. However, the relationship between hyperglycemia and serum NO level was not clear. Therefore, the present study was designed to find the association between hyperglycemia and serum NO levels in Type 2 diabetic (T2DM) patients and T2DM with cardiovascular complication.MethodsEndothelial cells (HUVEC) were treated with of D-glucose (10-100mM), and NO levels and NOS gene expression was measured. Hyperglycaemia was induced in Sprague-Dawley rats, and serum NO levels were measured after 8 weeks. For clinical evaluation, five groups of patients were recruited: Control (CT, n=48), Type 2 diabetes (T2DM, n=26), T2DM with hypertension (DMHT, n=46), Coronary artery diseases (CAD, n=29) and T2DM with coronary artery diseases (DMCD, n=38). NO (nitrite + nitrate) levels were measured from human serum.ResultsWe found a significant (pConclusionIn conclusion, high NO levels were observed in South Indian diabetic patients. Higher glucose levels in serum might be responsible for activation of endothelial cells to enhance NO levels.

Background: Lymph node fine needle aspiration cytology (FNAC) is the first line investigation for evaluation of lymph node disease. Existing literature reports high degree of correlation between lymph node FNAC and histological examination. The aim of the present study is to re-evaluate the diagnostic accuracy of FNAC in view of frequent discordance between FNAC and diagnosis on biopsy.Methods: Among a total of 495 lymph node FNACs and 291 biopsies, 69 adequate FNACs which were followed up with biopsy were evaluated with standard statistical methods for assessment of diagnostic accuracy.Results: The commonest diagnosis on biopsy was reactive lymph node (34.71%) followed by granulomatous disease (26.12%) and lymphoid neoplasms (20.96%). Reactive lymphadenitis and granulomatous disease were also the two commonest categories on FNAC (34.34% and 24.85% respectively). However, the sensitivity of FNAC in diagnosis of granulomatous disease was found to be 45.83%, which increases to 70.03% if necrosis is included as a marker of granulomatous disease. The greatest sensitivity was achieved in diagnosis of metastatic disease (88.89%), followed by lymphoid neoplasms (69.23%).Conclusions: FNAC is a useful tool for excluding specific categories of lymph node diseases, esp. metastatic disease. However, the technique needs improvement as to sample more representative areas of the node, to improve its sensitivity.

Intracranial teratomas represent a rare lesion accounting for 0.1%–0.7% of all intracranial tumors. Those in the fourth ventricle have rarely been reported. The present case is that of a 28-year-old man with occipital headache for two months. MRI examination revealed a well-defined extra-axial cystic lesion in posterior fossa in the midline herniating through the foramen magnum. Pre operatively, the mass was seen to be occupying the whole of the posterior fossa and arising from the roof of the fourth ventricle. On gross examination, the lesion had both solid and cystic components. Histopathological examination showed multiple cystic areas lined by brain tissue admixed with islands of cartilage and salivary gland elements and intestinal type glands. A diagnosis of mature cystic teratoma was made.

Direct noninvasive visualization of wound bed with depth information is important to understand the tissue repair. We correlate skin swept-source-optical coherence tomography (OCT) with histopathological and immunohistochemical evaluation on traumatic lower limb wounds under honey dressing to compare and assess the tissue repair features acquired noninvasively and invasively. Analysis of optical biopsy identifies an uppermost brighter band for stratum corneum with region specific thickness (p < 0.0001) and gray-level intensity (p < 0.0001) variation. Below the stratum corneum, variation in optical intensities is remarkable in different regions of the wound bed. Correlation between OCT and microscopic observations are explored especially in respect to progressive growth and maturation of the epithelial and subepithelial components. Characteristic transition of uniform hypolucid band in OCT image for depigmented zone to wavy highly lucid band in the pigmented zone could be directly correlated with the microscopic findings. The transformation of prematured epithelium of depigmented area, with low expression of E-cadherin, to matured epithelium with higher E-cadherin expression in pigmented zone, implicated plausible change in their optical properties as depicted in OCT. This correlated evaluation of multimodal images demonstrates applicability of swept-source-OCT in wound research and importance of integrated approach in validation of new technology.

Honey is recognized traditionally for its medicinal properties and also appreciated as a topical healing agent for infected and noninfected wounds. This study evaluates impact of honey-based occlusive dressing on nonhealing (nonresponding to conventional antibiotics) traumatic lower limb wounds (n=34) through clinicopathological and immunohistochemical (e.g., expression of p63, E-cadherin, and Collagen I and III) evaluations to enrich the scientific validation. Clinical findings noted the nonadherence of honey dressing with remarkable chemical debridement and healing progression within 11–15 days of postintervention. Histopathologically, in comparison to preintervention biopsies, the postintervention tissues of wound peripheries demonstrated gradual normalization of epithelial and connective tissue features with significant changes inp63+epithelial cell population, reappearance of membranous E-cadherin (P<.0001), and optimum deposition of collagen I and III (P<.0001). Thus, the present study for the first time reports the impact of honey on vital protein expressions in epithelial and connective tissues during repair of nonhealing lower limb wounds.

Non-invasive visualization of wound bed with depth information is important to understand the tissue repair under therapeutic interventions. In this context, present study performs skin swept source-optical coherence tomography (i.e. optical biopsy/OCT) and correlates findings with histo-pathological observations on different types of traumatic non-healing wounds under honey dressing. Correlation between OCT and microscopic observations were explored especially in respect to progressive growth and maturation of the epithelial and sub-epithelial components. Characteristic transition of uniform hypo-lucid band for de-pigmented zone to wavy highly lucid band for the pigmented zone in the OCT images could be directly correlated with the microscopic findings on transformation of flattened pre-mature epithelium of de-pigmented area to thicker and matured epithelium with rete-pegs in pigmented zone. This correlated evaluation of multimodal images demonstrates the applicability of SS-OCT in wound research and importance of integrated approach in validation of newer technology.

Background : Fine needle aspiration cytology (FNAC) may be diagnostic in candidates with indeterminate solitary pulmonary nodules (SPNs) suspicious of bronchogenic carcinoma. Aims : The study was performed to evaluate the usefulness of computed tomography (CT)-guided FNAC in our centre. Materials and Methods : All the cases had a strong clinical suspicion of lung cancer, negative bronchoscopy, negative sputum cytology for malignant cells and acid fast bacilli. A thorough radiological evaluation was made to rule out primary malignancy elsewhere. Results : A total of 94 patients were studied in one year. May-Grόnwald-Giemsa stain was used for the smears. The cytological diagnosis was correlated with clinical-radiological follow-up and biopsy to arrive at a final diagnosis. The procedure had a high sensitivity and specificity. Chi-square test was used to calculate statistical significance. Tumor of more than three centimeter and immediate cytological assessment significantly increased the yield. Review of slides added two cases of malignancy that were missed initially. There were very few complications. Conclusions : CT-guided FNAC was an accurate and safe procedure for SPNs.

The incidence of endometriosis of the appendix is reported to be just

Summary To identify risk factors for scrub typhus in Darjeeling, India, we compared 62 scrub typhus cases (acute fever with eschar and specific IgM) with 62 neighbourhood controls. Cases were more likely to live close to bushes [matched odds ratio (MOR) 10; 95% CI 2.3–63] and wood piles (MOR 3.5; 95% CI 1.5–9.5), to work on farms (MOR 10; 95% CI 2.7–63), to observe rodents at home (MOR 3.6; 95% CI 1.4–11) and at work (MOR 9; 95% CI 2.4–57), and to rear domestic animals (MOR 2.4; 95% CI 1.1–5.7). Cases were less likely to wash after work (MOR 0.4; 95% CI 0.1–0.9) and change clothes to sleep (MOR 0.2; 95% CI 0.1–0.5). A cleaner, rodent-controlled environment may prevent exposure to scrub typhus. Personal protection measures and better hygiene could further reduce individual risk.