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Introduction: The introduction of Competency Based Medical Education (CBME) curriculum in 2019 in India has endorsed many new concepts like Early Clinical Exposure (ECE), Self-Directed Learning (SDL) etc. SDL is an active learning approach in which case-based scenarios are provided and learners are guided by questions, leading them to answers using recommended learning resources. Aim: To evaluate the outcome of introducing case study-based panel discussion as SDL and analyse student and faculty perception. Materials and Methods: This was a cross-sectional study conducted in Department of Pathology of ESIC Medical College, Faridabad, Haryana, India from May 2021 to October 2021 on 100 Bachelor of Medicine and Bachelor of Surgery (MBBS) phase 2 students. First, Didactic Lecture (DL) was taken on Diabetes Mellitus (DM). Then case study-based panel discussions were done during the practical classes assigned for SDL. Students were divided into five cohorts of 20 students each. Two faculty members were assigned for each cohort of 20 students. The assigned faculties observed and gave their inputs to their respective cohorts. Data from pre and post-test questionnaires having 15 Multiple Choice Questions (MCQ's) both theory (n-7) and problem based learning questions (n-8) was analysed statistically. Feedback from students and teachers was collected using a questionnaire in the five-point Likert scale format. Results: The pre (8.43±1.79) and post-test (12.53±1.46) scores comparison revealed statistically significant (p

Detecting z-drugs, a sedative-hypnotic medication, is also misused for criminal activities. Therefore, the analysis of urine samples is crucial for clinical and forensic purposes. We conducted a study where we developed, validated, and compared an analytical method for simultaneously detecting z-drugs in urine samples. Our approach uses the QuEChERS method for sample preparation, combined with liquid chromatography (LC) and gas chromatography (GC) coupled with tandem mass spectrometry (MS/MS). We optimized the QuEChERS method to effectively extract z-drugs from urine samples while minimizing matrix effects and achieving high recovery rates. After extraction, we split the samples into two parts for analysis using LC-MS/MS and GC–MS/MS. We validated our methods, and the results showed good linearity over a broad concentration range (1–200 ng/mL) for each z-drug. The limits of detection and quantification were within clinically relevant ranges, ensuring sensitivity for detecting z-drugs in urine samples. We compared the two chromatographic techniques by analyzing a set of urine samples spiked with known concentrations of z-drugs using both LC-MS/MS and GC–MS/MS methods and then applied to the real samples. The results were statistically analyzed to assess any significant differences in accuracy and precision above 95 %, and both methods offered reliable and consistent results with the samples as well. In conclusion, our analytical method coupled with both LC-MS/MS and GC–MS/MS using the QuEChERS approach provides a comprehensive and robust solution for the simultaneous detection of z-drugs in urine samples. The choice between the two chromatographic techniques can be based on the specific z-drugs of interest and the required analytical performance. This method holds promise for applications in clinical toxicology, forensic analysis, and monitoring z-drug usage.

Ovarian tumors are a common form of neoplasia in women and it accounts for about 30% of female genital cancers. A coexistence of ovarian tumors with the same histogenetic origin such as germ cell or epithelial or sex cord stromal, but different histologic subtype is relatively common, whereas a synchronous occurrence of tumors with different histogenetic origin is rare. We report a case of 58-year-old woman with the synchronous presentation of adult granulosa cell tumor with fibroma (ovarian tumors with the same origin (sex cord stromal) but different histologic type) in one ovary and Brenner tumor (epithelial origin) in other ovary. Our patient presented with postmenopausal bleeding and was diagnosed with this rare combination of ovarian tumors on histopathology supplemented with immunohistochemistry. On extensive literary search, there is only a single report of mixed ovarian tumor composed of Brenner tumor and adult-type granulosa cell tumor. Our case is different from the above-mentioned report as although, in our patient both tumors coexisted, but in contralateral ovaries.

Background: Understanding the protein's subcellular localization and secretory nature can greatly improve the target identification for diagnostic assays and drug discovery, although their identification in laboratory experiments is a time-consuming and labor-intensive process. In order to identify proteins that could be targeted for therapeutic intervention or the development of diagnostic assays, we used a variety of computational tools to predict the subcellular localization or secretory nature of mycobacterial proline-glutamate/proline-proline-glutamate (PE/PPE) proteins. Methods: PSORTb version 3.0.3, TBpred, and Gpos-mPLoc analyses were performed on 30 selected PE/PPE protein sequences, while, SignalP 6.0, SignalP 5.0, Phobius, PSORTb version 3.0.3 and TBpred were used for signal sequence predictions. Results: Gpos-mPLoc and TBpred had the highest concordance for extracellular prediction, while PSORTb and TBpred had the highest concordance for prediction of membrane localization. The tools for predicting the secretory nature of proteins had little agreement. Conclusion: Multiple computational tools must be considered to provide an indication of the subcellular localization of PE/PPE proteins. Laboratory experiments should be used to confirm the findings of the tools.

Xanthogranulomatous inflammation, a specific form of chronic inflammation, is marked by parenchymal destruction, proliferative fibrosis, and infiltration of typical foamy histiocytes admixed with hemosiderin-laden macrophages and foreign-body giant cells. Myometrial xanthomatosis, a term designated for nodular or diffuse histiocytic hyperplasia of the myometrium, has been reported in association with pregnancy-related procedures. Moreover, a 2–3-fold increase in histiocytic counts has been observed in leiomyomatous areas than in adjacent normal myometrium. The first evidence of collections of lipid-laden macrophages was documented in the form of yellowish degeneration of uterine leiomyomas. We report a case of xanthogranulomatous change in a leiomyoma in a 47-year-old female who presented with abnormal uterine bleeding. To the best of our knowledge, this is the first report of xanthogranulomatous variant/degenerative change in a leiomyoma. This case highlights a new variant of leiomyoma which both gynecologists and pathologists should be aware of as it may pose a diagnostic challenge both clinically as well as pathologically.

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has compelled medical education institutes to impart knowledge to the undergraduate MBBS students through online medium. In order to adopt the new online pedagogy it is important to understand perceptions of students and their educators. Further, it is imperative for us to know the shortcomings of online teaching methodologies to develop and inculcate newer teaching methods to maintain quality education. Aim: To understand the perception and challenges faced by the first year MBBS students, faculty and their parents during the compelling online classes as teaching methodology compared to Offline. Materials and Methods: The present study was questionnaire- based, cross-sectional conducted in the Department of Biochemistry, Employees’ State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, Haryana, India, between August 2021 and October 2021. The present study included students of MBBS first year (n=123), faculty (n=27) from ESIC Medical College and Hospital, Faridabad, India, and parents/ guardians of students (n=94). A five-point Likert scale was used to determine the perception of students/faculty/parents. Mean value calculated greater than 3 was considered disagreement and less than 3 as agreement. Online mode (Edumarshal software, Google forms) was used. Statistical analysis was done calculating mean, Standard Deviation (SD) and Paired t-test was used to study significance of study parameters on continuous scale. Results: Student’s perception was that offline teaching was significantly better than online classes in term of enthusiasm, interaction, clarity, periodic assessments (p-value

Introduction: Smoking is associated with the occurrence and progression of cardiovascular diseases, inflammatory disorders and malignancies. Objective: To study the platelet indices, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in smokers and their correlation with smoking pack-years. Method: A total of 110 smokers and 110 non-smokers were included. The smokers were grouped into three groups: mild (10 pack-years). The platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) were noted. The NLR and PLR were calculated and the statistical analysis was made using the Student’s T-test, Analysis of Variance (ANOVA) and Spearman’s correlation coefficient. Results: The platelet count, PCT and PDW were significantly higher with mean values: 218.56 ± 121.31 vs 203.23 ± 80.35 (p-value = 0.038), 0.27 ± 0.10 vs 0.26 ± 0.10 (p-value = 0.041) and 12.54 ± 1.45 vs 11.99 ± 1.70 (p-value = 0.001) in smokers and non-smokers, respectively. The PLR differed significantly with mean values: 119.40 ± 84.81 in smokers and 181.99 ± 313.09 in non-smokers, with a p-value of 0.045. A significant positive correlation was found between pack-years of smoking and platelet count and PLR with the Pearson correlation coefficient of 0.250 and 0.198 and p-values, 0.008 and 0.037, respectively. The Platelet Count, PCT, MPV and PDW varied significantly between mild, moderate and heavy smoker groups, with p-values of 0.045, 0.010, 0.015 and 0.017, respectively. Conclusion: The platelet indices and inflammatory markers NLR and PLR are derived from routine blood investigations, which are easily available and inexpensive. The monitoring of platelet indices, along with the PLR, can be used as early predictors of morbidity in smokers.

Introduction: Cigarette smoking is considered a major risk factor for atherosclerosis, coronary heart disease, stroke and cancer. Objectives: To compare the Complete Blood Count, Lipid Profile and Coagulation profile (PT, aPTT) in the smokers and non-smokers and to study the correlation of pack years of smoking with the above parameters. Methodology: The study was a case control study (110 smokers as cases and 110 non smokers as controls). The cases were grouped into mild smokers (10 pack years).A complete blood count including Differential leucocyte count, Lipid Profile and Coagulation profile was done. Observation and Results: The RBC count and TLC were significantly elevated, however, MCV and MCH were significantly reduced in the smokers with a p value

Background: Breast carcinoma is the most prevalent malignancy in females globally and also the leading cause of cancer-related mortality. The immunohistochemistry (IHC)-based molecular subtyping has put newer insights into the biological behaviour and clinical management of breast carcinoma. We conducted the present study to correlate the four IHC-based molecular subtypes: Luminal A, Luminal B, Human epidermal growth factor receptor 2 positive, and triple negative breast carcinoma with various clinicopathological parameters amongst the industrial population of Haryana. Method: This cross-sectional study was conducted on 92 cases of invasive breast carcinoma, who underwent modified radical mastectomy over a period of 2.5 years with the prior approval of Institutional Ethical Committee at ESIC Medical College and Hospital, Faridabad. We performed routine histopathological examination along with IHC (Estrogen receptor, Progesterone receptor and Human epidermal growth factor receptor 2) study. The correlation of the four molecular subtypes with various clinicopathological parameters were also studied. We analysed the data using SPSS software. Results: The mean age of the patients in this study was 47 years with a maximum number of cases in the 3rd and 4th decade of their life. The most common subtype was luminal B (40.9%) with the maximum number of cases presenting in stage II (53.26%) and with grade II (51.1%). Triple-negative breast cancer was found to be associated with brisk mitosis, lymphovascular invasion (66.67%), necrosis (77.78%), and ductal carcinoma in situ (66.67%). These findings were clinically significant. (P

Endometrial stromal sarcomas (ESSs) account for approximately 0.2% of all uterine malignancies. Cellular leiomyoma (CL) often simulates low-grade ESS due to similar cytology. We report the case of a 34-year-old female with a mass per abdomen. Frozen sections showed a tumor with many thin- and thick-walled vessels along with hyaline material. A differential diagnosis of CL and endometrial stromal tumor was suggested. The index case was diagnostically challenging to pathologists. Paraffin sections supplemented by immunohistochemistry (smooth muscle actin, CD10, and beta-catenin) favored CL. Frozen section sometimes leads to over/underestimation of tumor in view of small sampling area of tumor.

Background: Rapidly growing mycobacteria (RGM) are increasingly being recognized as potential pathogens. RGM, particularly Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae, have been observed in both pulmonary and extrapulmonary infections including cutaneous, soft-tissue, and wound infections. However, there are limited reports of these potential pathogens from skin and soft-tissue infections. Moreover, the drug susceptibility profile of RGM is largely unknown in several regions of the world. Methods: We analyzed reports on RGM isolated from skin and soft-tissue infections globally for details of RGM species and drug susceptibility profile. We also analyzed the drug susceptibility profile of four RGM isolates, obtained from skin and soft-tissue infections in our laboratory, by broth microdilution method. Results: In the reports reviewed, the most common RGM isolated from skin and soft-tissue infections were M. abscessus (184/475, 38.7%), M. fortuitum (150/475, 31.5%), M. chelonae (72/475, 15%), and M. chelonae–M. abscessus complex (46/475, 9.6%). However, drug susceptibility was tested only in 26/39 (66.6%) reports. In our own laboratory, we obtained three isolates of M. abscessus and one isolate of M. fortuitum from one case of breast abscess and three cases of postsurgical wound infections. Maximum susceptibility of M. abscessus was observed to clarithromycin, amikacin, and linezolid. The M. fortuitum isolate was susceptible to clarithromycin, amikacin, clofazimine, and linezolid. Conclusion: Paucity of information available on RGM isolated from skin and soft-tissue infections highlights the need to be aware of the pathogenic potential and the drug susceptibility profile of these organisms.

Introduction: Iron deficiency anemia (IDA) is a global health burden with an increasing prevalence in children and adult females. Traditionally, absolute iron deficiency has been based on low serum iron and ferritin. In recent years, the development of new automated hematologyanalyzers has paved the way for analysis of new parameters for mature red blood cells and reticulocytes in diagnosis of anemia. Materials and methods: Blood samples of adult females of reproductive age group (15-45 years) were collected and processed within 6 hours of collection. Based on hematological and biochemical findings, patients were segregated into four subgroups: Iron deficiency anemia (IDA, n = 40), Anemia of chronic disease (ACD, n=40), Latent iron deficiency (n=40) and Controls (n=40). Observations and results: The novel hematological parameters- Reticulocyte hemoglobin content (Ret-He), percentage of microcytic red blood cells (MicroR), hemoglobin content of erythrocytes (RBC-He) and percentage of hypochromic erythrocytes (HypoHe) had a statistically significant difference between the four groups (p < 0.05). The correlation between reticulocyte indices and iron parameters depicted that levels of Ret-He among all study participants (160) increased as the serum iron and serum ferritin increased indicating a significant positive correlation. Ret-He and RBC-He demonstrated better predictive power as per area under curve of ROC as compared to MicroR and HypoHe indices for latent anemia identification. Conclusion: The present study emphasized upon the importance of novel and cost effective routine new parameters in early and accurate diagnosis of IDA and ACD. Moreover Ret-He emerged as a sensitive and specific marker for diagnosis of latent iron deficiency.

L,D-transpeptidase function predominates in atypical 3 → 3 transpeptide networking of peptidoglycan (PG) layer in Mycobacterium tuberculosis. Prior studies of L,D-transpeptidases have identified only the catalytic site that binds to peptide moiety of the PG substrate or β-lactam antibiotics. This insight was leveraged to develop mechanism of its activity and inhibition by β-lactams. Here, we report identification of an allosteric site at a distance of 21 Å from the catalytic site that binds the sugar moiety of PG substrates (hereafter referred to as the S-pocket). This site also binds a second β-lactam molecule and influences binding at the catalytic site. We provide evidence that two β-lactam molecules bind co-operatively to this enzyme, one non-covalently at the S-pocket and one covalently at the catalytic site. This dual β-lactam-binding phenomenon is previously unknown and is an observation that may offer novel approaches for the structure-based design of new drugs against M. tuberculosis.

Tramadol (TD) has been prescribed frequently in many countries for more than 40 years, but there is a risk of its misuse and trafficking. As a result, drug analysis has numerous legal and socially relevant implications, making it an essential part of modern analytical chemistry. Thus, the method for the detection of TD and its phase I and phase II metabolites in human urine has been developed and validated using a rapid and efficient approach combining liquid chromatography-tandem mass spectrometry (LC-MS/MS) with electrospray ionization. The sample preparation was best performed using dispersive liquid–liquid microextraction. Analysis was performed using an HyPRITY Cl8 column, and isocratic elution with methanol: water (35:65) with 0.2% formic acid was used. TD and its metabolites were detected at 264.2 (TD/M0) with a base peak at 58.2, 250.3758 (M1), 250.3124 (M2), 236.3976 (M3), 222.5361 (M4), and 236.4475 (M5) m/z peaks. TD showed linearity between 0.1 and 160 ng/mL (R2 = 0.9981). The accuracy ranged from 95.56 to 100.21% for the three concentration levels, while the between- and within-day RSD ranged from 1.58 to 3.92%. The absolute TD recovery was 96.29, 96.91, and 94.31% for the concentrations of 5, 50, and 150 ng/mL, respectively. TD’s phase I metabolites, M1–5 along with nine phase II metabolites, such as sulfo- and glucurono-conjugated metabolites, oxidative TD derivatives, and sulfo-conjugated metabolites were also identified in the urine samples. The pharmacokinetics and metabolism data given provide information for the design of possible future research disorders, evaluating drug mechanism and neurotoxicity and for the effective application screening of TD.

Background: Rapidly growing mycobacteria (RGM) comprise nearly half of the validated species of nontuberculous mycobacteria (NTM) and have been reported to have a higher incidence in Asia as compared to Europe and America. There is limited information on RGM infections from South Asia. Hence, the present study aimed to ascertain the incidence of pulmonary infections due to RGM in Delhi and to review the status of available information on the prevalence of RGM in South Asia, a region endemic for tuberculosis. Methods: We analyzed 933 mycobacterial isolates obtained from pulmonary samples in Delhi and performed species identification by polymerase chain reaction (PCR)-restriction analysis (restriction fragment length polymorphism) and line probe assay. Drug susceptibility testing (DST) was performed by broth microdilution method. We also reviewed reports available on pulmonary infections in South Asia, attributed to RGM. Results: Of the 933 mycobacterial isolates studied, NTM were identified in 152 (16.3%). Of these, 65/152 (42.8%) were RGM comprising Mycobacterium fortuitum (34/65; 52.3%), Mycobacterium abscessus (25/65; 38.5%), Mycobacterium chelonae (3/65; 4.61%), Mycobacterium mucogenicum (2/65; 3.1%), and Mycobacterium smegmatis (1/65; 1.5%). On applying the American Thoracic Society/Infectious Diseases Society of America guidelines, 11/25 (44%) M. abscessus, 3/3 (100%) M. chelonae, and both isolates of M. mucogenicum were found to be clinically relevant. DST revealed that maximum susceptibility of the RGM was seen to linezolid, clarithromycin, and amikacin. Conclusions: Of the RGM isolated in the present study, 16/65 (24.6%) were found to be clinically relevant. Hence, it is important to recognize these organisms as potential pathogens to identify patients with RGM disease to initiate appropriate therapy.

Abstract The study of network representations of physical, biological, and social phenomena can help us better understand their structure and functional dynamics as well as formulate predictive models of these phenomena. However, due to the scarcity of real-world network data owing to factors such as cost and effort required in collection of network data and the sensitivity of this data towards theft and misuse, engineers and researchers often rely on synthetic data for simulations, hypothesis testing, decision making, and algorithm engineering. An important characteristic of infrastructure networks such as roads, water distribution and other utility systems is that they can be (almost fully) embedded in a plane, therefore to simulate these system we need realistic networks which are also planar. While the currently-available synthetic network generators can model networks that exhibit realism, they do not guarantee or achieve planarity. In this paper we present a flexible algorithm that can synthesize realistic networks that are planar. The method follows a multi-scale randomized editing approach generating a hierarchy of coarsened networks of a given planar graph and introducing edits at various levels in the hierarchy. The method preserves the structural properties with minimal bias including the planarity of the network, while introducing realistic variability at multiple scales. Reproducibility: All datasets and algorithm implementation presented in this work are available at https://bit.ly/2CjOUAS

Objective: Granulomatous mastitis is a rare inflammatory condition of the breast clinically mimicking breast carcinoma and pyogenic abscess, thereby creating a diagnostic dilemma. Tuberculous mastitis is a rare clinical entity accounting for approximately 3% of all mammary lesions. All cases of granulomatous mastitis diagnosed cytologically over a period of 3 years were evaluated to ascertain the cases with tuberculous etiology. Material and Method: Fine needle aspiration cytology of the breast lump was performed and all the cytological parameters were evaluated. Wherever histopathology was available, the diagnosis was confirmed on Hematoxylin & Eosin stained sections and the Ziehl Neelsen (ZN) stain was applied. Results: A total of 10 cases of granulomatous mastitis were diagnosed on cytology during the 3-year period. On cytological smears, four cases showed presence of ill-formed granulomas and one case had scattered epithelioid histiocytes; however, the rest of the cases had well-formed granulomas. Finally, four out of ten cases were labeled as tuberculous mastitis based on the ZN stain/Tuberculosis-Polymerase chain reaction (TB-PCR) and the other six cases were granulomatous mastitis. Conclusion: Cytology plays a significant role in the diagnosis of granulomatous mastitis. This study re-emphasizes the role of the cytopathologist in the accurate and early diagnosis of these lesions so that unnecessary surgery can be avoided, and also highlights the fact that all granulomatous mastitis cases are not tuberculous.

Background: Preeclampsia is one of the major health problems causing maternal morbidity and mortality, complicating 3–8% of pregnancies. It has been suggested that the alterations in the coagulation and fibrinolysis play a role in the pathogenesis of preeclampsia. The markers of platelet activation include platelet count, platelet distribution width, mean platelet volume and plateletcrit. Study design: It was a case-controlled study which included a total of 60 patients (30 cases and 30 controls). Blood samples were collected and the platelet indices – platelet count, plateletcrit, mean platelet volume and platelet distribution width – were evaluated using the Sysmex XN1000 and compared between the two groups. Results: The MPV and PDW also showed a significant difference (p > 0.05) between the two groups, with a significant positive correlation with increasing blood pressure (MPV – r = +0.6126, p

Introduction: Type 2 diabetes mellitus, characterized by insulin resistance, corresponds to approximately 90% of cases of diabetes worldwide. Hyperglycemia in diabetes contributes to hyperfibrinogenemia and activates the coagulation cascade thereby producing atherothrombotic events. Objectives: This study was designed to evaluate the coagulation profile (activated partial thromboplastin time, prothrombin time and fibrinogen) in Type 2 diabetes and to analyze correlations between body mass index, fasting blood glucose, glycated hemoglobin and duration of diabetes with coagulation parameters. Methods: This study included 60 type 2 diabetics and 30 controls. Diabetic patients were grouped in two sets based on the presence or absence of microvascular complications. The demographic profile and clinical details were recorded. Fasting blood glucose, glycated hemoglobin, coagulation parameters such as prothrombin time, activated partial thromboplastin time and fibrinogen along with other biochemical parameters were investigated. Results: There were statistically significant differences in the coagulation parameters between the two groups of diabetics (with and without complications). The present study also found significant correlations between age and the duration of diabetes with and without complications and coagulation parameters such as the activated partial thromboplastin time, which was found to be significantly lower, and fibrinogen, which was found to be significantly higher in subjects with complications compared to subjects without complications. Conclusion: Clinical tests for prothrombin time, activated partial thromboplastin time and fibrinogen are relatively inexpensive and readily available. The present study shows that shortened prothrombin time, activated partial thromboplastin time and increased fibrinogen levels might be useful hemostatic markers in diabetic patients, especially in those at high-risk for thrombotic complications. Keywords: Diabetes mellitus, Coagulation, HbA1c, PT, APTT

Background: Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM–COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario. Materials and Methods: Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM–COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM–COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM). Results: Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with P < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis. Conclusion: A good clinicopathological correlation was seen in the cases when classified according to PALM–COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.

Primary neuroendocrine tumours of the cervix are extremely rare, with an incidence of only 0.5–1%; as such, these entities can present a clinical and diagnostic challenge. Small-cell neuroendocrine carcinomas of the cervix are highly aggressive tumours that have a tendency to metastasise. We report a 44-year-old woman who presented to the Gynaecology Clinic of the Employees State Insurance Corporation Medical College & Hospital, Faridabad, India, in 2016 with menorrhagia. Based on a clinical examination, she was provisionally diagnosed with a cervical fibroid. However, a biopsy revealed features of a small-cell neuroendocrine carcinoma of the cervix which was subsequently confirmed via immunohistochemistry. An accurate diagnosis of a neuroendocrine carcinoma is vital as it forms the basis for treatment decisions as well as informing predictions for long-term survival.

Background: Platelet function plays a crucial pathophysiological role in the development of atherothrombosis in patients with type 2 diabetes mellitus (DM). Platelet count (PC) and mean platelet volume (MPV) are simple, effective, and cheap tests that may be used to predict angiopathy in type 2 DM. Objectives: The aims of this study were to analyze various platelet parameters including PC, plateletcrit (total mass of platelets) (PCT), and mean platelet indices that are MPV, platelet distribution width (PDW), and platelet-large cell ratio (PLCR) in the type 2 DM patients, to compare various platelet indices between DM patients (with and without complications) and controls. Materials and Methods: This was a cross-sectional study conducted over a period of 3 months. Complete blood count along with blood glucose and HbA1c was estimated. The study population was divided into three groups: Group 1: Normal controls (n = 30); Group 2: DM patients without complications (n = 30); and Group 3: DM patients with complications (n = 30). Based on HbA1c levels among the diabetic patients, the diabetic groups were also classified as DM with HbA1c 7%. Results: All the platelet parameters were found to be higher among DM with complication as compared to DM without complication, and this was found to be statistically significant. Among the platelet parameters, MPV, PCT, and PDW were found to be higher among DM with HbA1c >7% as compared to DM with HbA1c

Endometriosis is defined as the presence of functioning endometrial tissue outside the endometrial cavity. Scar endometriosis, also known as spontaneous abdominal wall endometriosis, is an unusual clinical presentation which often goes unnoticed. It usually develops after pelvic operations. The incidence has been estimated to be only 0.03%–0.15% of all cases of endometriosis. It can be either asymptomatic or present as abdominal wall pain at the site of surgical incision. It is most commonly diagnosed clinically or on ultrasonography. The treatment of choice predominantly remains surgical excision. We present a case of a 24-year-old female (known case of bicornuate uterus) who presented with chief complaints of abdominal pain for 1 month and 6 months after metroplasty. The patient was clinically diagnosed as a case of scar endometriosis with rudimentary horn and fistulous tract and taken up for surgery. Both the scar tissue and fistulous tract were removed and histopathology revealed only endometrial glands without stroma or hemosiderin-laden macrophages. Diagnosis of scar endometriosis was established on positive immunohistochemistry for estrogen and progesterone receptor in endometrial glands. Timely diagnosis and surgical excision of scar endometriosis along with close follow-up are necessary to prevent complications and recurrence.

The aim of this paper is to inaugurate power graphic (F,ψ)-contraction pair and to establish fixed point results for such mappings defined on partial b-metric spaces endowed with a graph. It is mentioning that, first time, we launch a class of fixed point results in the frame of partial b-metric spaces involving a graph. Results of this paper extend and generalize known results from metric, partial metric, and partial b-metric spaces in partial b-metric spaces with a graph. Further, appropriate examples are presented to emphasize the utility of the obtained results. At the end, an attempt to correlate the given work with application is turned out as solution for an integral equation.