Importance of Routine Histopathological Examination of Gallbladder Specimen in Detecting Incidental Malignancies

Introduction: Gallbladder carcinoma is the most common cancer of biliary tree and the 5th most common gastrointestinal malignancy.  An early diagnosis is essential as this malignancy progresses silently with a late diagnosis and poor prognosis. Epidemiological studies have identified striking geographic and ethnic variation with high occurrence in Southeast Asia, yet low elsewhere in the world. Gallbladder carcinoma, in 15-30% of patients, show  no preoperative  or intraoperative evidence and are detected only on histopathological examination. They are called as incidental gallbladder cancer (IGBC). The objective of this study was to find out the occurrence of IGBC in cholecystectomy specimens received in our histopathology laboratory and to analyze their clinico-pathological features. Methods: This was a prospective study carried out in the Department of Histopathology, Lumbini Medical College Teaching Hospital during a period of two years from May 2014 to April 2016. The study included 800 cases of cholecystectomized Gall bladder specimens. Result: Ninety seven percent of the specimens (n=776) revealed benign pathology. Malignancy was detected incidentally in 8 cases (1.25%). The mean age of patients with incidental Gall bladder carcinoma was 69 years (SD=4.1) and F:M ratio was 9:1. Out of 10 incidental malignancies, cholelithiesis was found in 8 (80%) cases. Fundus was the most common location (n=5, 50%) and focal fragile necrotic area was most common (n=3, 30%) gross morphology. On pathological staging, all the incidentally detected malignancies (n=10) were found to be in surgically resectable stages. Conclusion: IGBC was found in 1.25% of the gallbladder specimen. Detailed gross and histopathological examination of gallbladder specimen is mandatory for every cholecystectomy specimen, even for benign diseases, to detect incidental carcinoma at potentially curable stage

Fine Needle Aspiration versus Fine Needle Capillary Sampling Technique in Cyto-diagnosis of Thyroid Lesions

Introduction: In diagnosis of thyroid lesions, the negative pressure applied during fine needle aspirationcytology (FNAC) frequently produces bloody smears. This results in a compromise in cellular concentrationand architecture which may lead to improper interpretation. Fine needle capillary sampling cytology(FNCC), on the other hand, avoids active aspiration as it depends on capillary tension to collect tissuesamples in the needle bore. This study evaluated the diagnostic performance of FNAC and FNCC in thyroidlesions. Methods: A total of 120 patients were included in this study conducted over a duration of 19months. All thyroid swellings advised for cyto-diagnosis were sampled by both fine-needle aspiration(FNAC) and non-aspiration (FNCC) techniques. The slides were assessed according to the Mair et al.scoring system. Results: In the FNCC group, 72 (60%) smears were diagnostically superior while 54 (45%)smears were diagnostically superior in the FNAC group. Blood contamination (p=0.003), cellular trauma(p=0.019), and degree of cellular degeneration (p=0.026) were less and cellular architecture (p=0.047) waspreserved more in FNCC in comparison to FNAC groups. Conclusion: This study showed the superiority ofFNCC for the interpretation and diagnosis of thyroid lesions. However, the combination of both FNAC andFNCC could maximize the diagnostic yield

Antimicrobial and antioxidative activities in the bark extracts of Sonneratia caseolaris, a mangrove plant

The present study deals with the phytochemical contents, antimicrobial and antioxidative activities of bark tissue of Sonneratia caseolaris, a mangrove plant from Sundarban estuary, India. Phytochemical analyses revealed the presence of high amounts of phenolics, flavonoids, tannins, alkaloids and saponins. Antimicrobial efficacies of various extracts of S. caseolaris were assessed by disc diffusion method against two Gram-positive (Bacillus subtilis and Bacillus coagulans), two Gram-negative (Escherichia coli and Proteus vulgaris) bacteria and one fungus (Saccharomyces cerevisiae). The methanolic extract among others showed significant minimum inhibitory concentration (MIC) values. The antioxidant activity as indicated by 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity of the bark tissue extract from the species was found to be quite appreciable. The extracts were found to retain their antimicrobial activities despite pH and thermal treatments, thus indicating the stability of their activity even at extreme conditions. The antioxidant activity was also found to be considerably stable after thermal treatments. The components of the tissue extracts were subjected to separation using thin layer chromatography (TLC). The constituents with antimicrobial and antioxidative properties were identified using TLC-bioautography by agar-overlay and DPPH spraying methods respectively. A number of bioactive constituents with antimicrobial and radical scavenging properties were observed on the developed bioautography plate. The fractions with antimicrobial properties were isolated from the reference TLC plates and subjected to gaschromatography-mass spectrometry (GC-MS) analysis for partial characterization and identification of the metabolites that might be responsible for the activities. The study suggests Sonneratia caseolaris bark as a potential source of bioactive compounds with stable antimicrobial and antioxidative properties and can be used as natural antimicrobial/antioxidative agents in clinical, pharmaceutical and food processing industries

Histopathological Study of Endometrial Biopsy Specimens for Abnormal Uterine Bleeding

Introduction: Endometrial specimen for abnormal uterine bleeding (AUB) is the one of the commonest specimens received in histopathology laboratory. Histopathological characteristics of endometrial tissues, as assessed by light microscopy, remains the diagnostic standard for the management of AUB. The objective of study is to find out the histopathological pattern of endometrium in AUB in the light of clinical details. Methods: This was a prospective observational study carried out in the department of Pathology, Lumbini Medical College Teaching Hospital for a period of two years from June 2014 to May 2016. Formalin fixed endometrial specimens were processed, paraffin embedded, sectioned at 3-4 µm, stained with hematoxylin and eosin, and studied under light microscopy along with their demographics. Data were collected, entered and analyzed using SPSS version 20. Results: The study included 100 cases of endometrial biopsy specimens with clinical diagnosis of AUB. Menstrual disturbances was found in wide age range between 17-75 years with the mean age of 45 (SD=13.36) years. Menorrhagia was the commonest (n=60, 60%) clinical presentation. Most (n=85; 85 %) endometrium had non-neoplastic lesions. Among them, normal endometrial patterns were commonest (n=50, 50 %). Neoplastic lesions (n=15, 15%) were distributed in all menstruation status with majority in postmenopause (n=7, 7%) and included malignant cases (n=5, 5%) among others. Conclusion: Post-menopausal bleeding was common presentation among women with malignant and premalignant disease which was present in 15% of the cases together. Timely evaluation of AUB  by histopathology can be life saving with early tissue diagnosis and management

Acute myocardial infarction in labor: a rare case report

Myocardial infarction (MI) presenting first time in labor is rare with incidence of 3 case per 1,00,000 and its management during labor is rarely seen in literature. In this case, a 29-year-old gravida 2 para 1 with previous caesarean section 1 year back with history of postpartum eclampsia presented with acute breathlessness and lower abdominal pain. She was diagnosed with acute MI. Patient had emergency caesarean section due to scar tenderness. Post operatively patient was managed in ICU with multi-disciplinary team of critical care, cardiologist and obstetrician.

Psoriatic Arthritis in the Eastern Part of Uttar Pradesh

Aim: This original research article aims to study Psoriatic Arthritis in the Eastern Part of Uttar Pradesh. Material & Method: Two hundred twenty-eight patients of psoriasis regardless of age, sex, religion, occupation, attending the skin, and V. D. outpatients Department, B.R.D. Medical College, Gorakhpur for were taken because of the subject of this study. The bulk of patients belonged to the Eastern U.P. and adjoining areas of Bihar and Nepal. The clinical criteria for diagnosis of psoriasis were the presence of Erythematous and papulosquamous lesions with loosely adherent silvery-white scales. The auspitz's sign was demonstrated all told the cases. The detailed clinical history and examination were recorded with Tests for Rheumatoid factor and serum uric acid, Radiographs of both hands and feet, Radiographs of the lumbosacral Spine and both sacroiliac joints and Radiographs of affected joints (if any). Each patient was categorised into mild to severe psoriasis. Result: The total number of psoriatic arthritis cases was found, 26 of which male were 17 and female were 9. The maximum number of Arthritis cases, 18.5%, were seen with severe disease (PASI score > 15) with higher occurrence in males. The maximum number of joints involved distal interphalangeal joint was 69.2 3%, and the minimum number of joints involved was significant joint 7.69%. Conclusion: Psoriasis care is unbalanced, with men being more likely to undergo specialist treatment than women, causing higher distal interphalangeal (D.I.P.) joint arthropathy

Living rough: surviving city streets, a study of homeless populations in Delhi, Chennai, Patna, and Madurai

"It is remarkable that so little is known about the lived experience of homelessness in town and cities in India: of how urban homeless men, women and children survive and cope; how they sleep, bathe and eat; why do they live on the streets and the work they do; their denials and access to public services and food schemes; and how they organise and plan their personal and social lives and their relationships. This neglect is not just of official studies, but even by economists, sociologists, anthropologists, nutritionists and development students. This paper records the findings of a small investigation into a fragment of this lived experience, and into the social, economic, nutritional situation of urban homeless men, women, boys and girls in four cities: the metropolises of Delhi and Chennai, and the cities of Madurai and Patna. The study finds that the lived experience of urban poverty, and even more so of urban homelessness, differs in many significant ways from that of rural poverty: it may ensure better prospects of livelihoods and earnings (although our study indicates that for urban homeless people work still tends to remain casual, exploited and without dignity and security). Life on the streets usually involves surviving in a physically brutalised and challenging environment, with denial of even elementary public services and assured healthy food; and illegalisation and even criminalisation by a hostile State of all self help efforts for shelter and livelihoods by urban poor residents. There are both grave ruptures - but also continuities - of bonds with their families and communities. These together pose important and mostly unmet challenges for public policy and academic research, in measuring and estimating urban poverty, and in acknowledging and realizing a vast range of social, economic and cultural rights of urban poor residents.

Study of Fatal Firearm Cases in Allahabad Region, India

Abstract This study was done to assess the pattern of firearm injuries in Allahabad amongst medicolegal autopsies in the mortuary of Swaroop Rani Nehru Hospital, MotiLal Nehru Medical College, India. It was a descriptive study including fatal cases of firearm injury which underwent autopsy from 1st of January 2015 to 30th July 2016. The demographic information regarding the victims was obtained from the inquest report, person accompanying the victim, their friends and relatives. Autopsy reports were also used to gather additional information. Parameters studied included age and sex of the victim, site of firearm injury and manner of death. In our study, out of 4,445 autopsies, 63 were cases of firearm injury. From these cases, 58 were homicidal, 3 were suicidal, and 1 was accidental. The results show that the age group most commonly affected was 31-40 years (26.98%). Male to female ratio was 6.9:1. The most common targeted part of the body was the chest (61.0%)

A service evaluation of weight management for glycaemic control and remission of type 2 diabetes using traditional food in Nepal (Ho-DIRECT NEPAL): a single-arm trial

Summary Background Remission of early type 2 diabetes (T2D) is possible; however, diet programmes proven effective are unaffordable in many southeast Asian populations where T2D is more frequent and more aggressive at lower body weight and younger age. We evaluate an entirely food-based service. Methods This study employed a single-arm intervention and follow-up design for intervention evaluation in existing hospital people with T2D of under 5 years known duration. Individuals attending a diabetes clinic in Kathmandu with early T2D (<5 years) aged 30–70 years, BMI ≥23 kg/m2, were offered a low-cost nutritionally complete diet-programme, using traditional Nepali foods to provide 8-weeks ∼850 kcal/day weight loss induction, and then weight maintenance. The participants received 4-weekly dietetic appointments (30–45 min) and verbo-pictorial leaflets using household measures. Glucose-lowering medications (49/70 at baseline) were stopped at baseline or soon after. The study was registered as ISRCTN10671396, testing a traditional food-based intervention for weight loss and T2D remission. Findings For 70 individuals (45 female) invited between March 19, 2022 and September 19, 2023, baseline mean (SD) age was 48.6 (9.9) years, bodyweight 74.6 (9.5) kg, BMI 29.7 (3.6) kg/m2, known diabetes duration 2.5 (1.9) years, HbA1c on treatment 8.1 (1.6) %. At 12, 24 and 52 weeks respectively, evaluating n = 44, 46, 45, bodyweight was 70.1 (8.5), 69.8 (8.9), 70.0 (8.8) kg, HbA1c 6.8 (0.9), 6.9 (1.5), 7.1 (1.3) %; HbA1c 3 months) in 43%, 39% and 29%. The main reported adherence barriers were fears of weakness, hunger, and inconvenience during travel. Incentives were ease of the diet, reduced doses and costs of medications, and improved appearance. Interpretation Traditional food-based weight management can valuably improve control, reduce medication needs, and generate remissions of established T2D, but adherence barriers must be overcome to optimise outcomes