Frozen section evaluation of lymph nodes in Oral squamous cell carcinoma: a retrospective study

The principal indication of performing a frozen section is to obtain a definite immediate diagnosis, on the basis of which a surgical decision will be made. Immediate diagnosis allows the surgeon to proceed with further therapy without any delay. A definite immediate diagnosis is said to be dependent on the reliability of frozen sections. Many authors have carried out frozen section study on soft tissue tumors and lymph node evaluation in different parts of the body with varying percentages of reliability. However, it appears that lymph node evaluations specifically in oral squamous cell carcinoma cases were not performed, or limited. Hence the present study was undertaken to determine the reliability of frozen section diagnosis in the lymph nodes of oral squamous cell carcinomas. This study was performed so that the surgeons would have an intraoperative assessment of the extent of local metastasis and to determine the adequacy of resection before the wound is closed. The objectives of the present study are to assess microscopically the frozen section of the palpable and non palpable lymph nodes of neck for metastasis in patients with squamous cell carcinoma of oral cavity. To compare the micros- copic features of paraffin embedded lymph node sections with those of frozen sections. To assess the reliability of frozen section evaluation of cervical lymph nodes in oral squamous cell carcinoma. The present research work gives 100% accuracy of frozen sections with due care by additional staining to frozen sections by phloxine methylene blue stain, however cannot be in any way superior to the magnetic resonance imaging, computed tomography, immunoscintigraphy and lymphangioscintigraphy

Cost variation analysis of antimalarial drugs available in India

Background: Malaria has been a problem in India for centuries. There are innumerable brands of antimalarial present in the market. Malaria can be extremely fatal if not treated promptly. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non-compliance leads to incomplete treatment which tends to increase morbidity. Increase in the patient medication cost was found to be associated with decreased adherence to prescription medication. Hence this study was done to assess the cost variation of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2017 edition and Drug Today January to March 2017, Vol 2. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets was calculated in case of oral drug and the cost of 1 ampoule or vial was noted in case of injectable drug. At last the cost ratio and % cost variation of various brands was compared.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Artemether injection showed the highest cost ratio and cost variation (cost ratio = 16.96 and % cost variation = 1596). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents. Chloroquine which is one of the most used antimalarial showed very low values for cost variation and cost ratio.Conclusions: The analysis showed that there is not much significant price variation among oral antimalarial drugs. The maximum variation shown by oral antimalarial was found to be for fixed dose combination of Artemether and Lumefantrine [cost ratio>2 (2.03) and % price variation >100 (103.7)]. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment

A study on cervical cancer screening using pap smear in urban area in state of Meghalaya, India

Background: Cancer cervix is fourth most common cancer in world second most common in India. The objective of the study is to identify abnormal pap smear cytology in women undergoing the test.Methods: This retrospective study conducted in 200 women attending gynae OPD of Military Hospital, Shillong, Meghalaya, India between January 2016 to December 2017. Pap smear test was done, and classification was done as per Bethesda system 2014.Results: 105 women had normal cytology findings and 23 had abnormal cytology.Conclusions: Cervical cancer is the most common cancer for which screening is done. If pap smear is done every 3 years as per the guidelines mortality due to cervical cancer can be reduced. Every woman should undergo pap test at least once in her life before the age of 45 years. Timely screening of preinvasive lesion allows prevention from invasive cervical cancer

To study the prevalence of latent tuberculosis infection among medical students

Background: Risk of developing latent tuberculosis infection increases in medical students with their higher exposure to TB care facilities. Objective: To study the prevalence of latent TB infection among students attending professional degrees MBBS, BDS, MD, MS, MDS at King George’s Medical University, India. Methods: This study was carried out with Tuberculin skin testing among students and active TB cases were excluded. A standard dose of 0.1?mL of purified protein derivative was slowly injected intra dermally into non-dominant forearm. After 48-72 hours, the reaction was estimated by measuring the transverse diameter of the induration. Results: Total 561 students had given consent to get enrolled. Prevalence of latent tuberculosis infection was significant with period of clinical exposure (p-value < 0.05), average size of induration (p-value < 0.001), and history of prior Tuberculin Skin Test (p-value < 0.001). However it was not significant with the age (p-value > 0.05), gender (p-value > 0.05), and history of contact with active cases of TB (p-value > 0.05). Conclusion: The prevalence of latent tuberculosis infection is higher in post graduate students followed by interns and final year students due to more exposure to patients in wards and clinics at King George’s Medical University, India

Investigating the Hubble Tension: Effect of Cepheid Calibration

Recent observations of Type Ia supernovae (SNe) by SH0ES collaboration (R11 and R16) diverge from the value reported by recent CMBR observations utilising the Planck satellite and application of the $\Lambda CDM$ cosmological model by at least $3 \sigma$. It is among the most challenging problems in contemporary cosmology and is known as the Hubble tension. The SNe Ia in R11 and R16 were calibrated through cepheid variables in three distinct galaxies: Milky Way, LMC, and NGC4258. Carnegie Hubble Program (CHP) observations of type Ia SNe calibrated using the tip of the red giant approach yielded a somewhat different estimate for the Hubble constant. This decreased the Hubble tension from over 3$\sigma$ to below 2$\sigma$. It is a legitimate question to answer whether there are any issues with SNe Ia calibration and to investigate whether the Hubble tension is real or not. We use statistical techniques namely, ANOVA, K-S test, and t-test to examine whether the cepheid calibration is host-dependent. Our analysis shows that (i) both R11 and R16 data suffer from non-Gaussian systematic effects, (ii) $H_0$ values in the sub-samples (different anchor-based) in both R11 and R16 groups are significantly different at a 99\% confidence level, and (iii) neglecting the metal-rich MW sample does not reduce the $H_0$ value significantly, and thus Hubble tension persists. A small reduction in the Hubble constant could be linked to the differences in the host environment. Hence instead of using a single universal relation environment based slope and zero point should be preferred.Comment: 15 pages (single column), 7 figure

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anaesthesia for cesarean section fails to obtain any sensory or motor block.Methods: This study is aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to caesarean section under spinal anaesthesia following preload with either crystalloid or colloid. This study was carried out on 100 healthy pregnant women with single term foetus and not in labor admitted at the labor room of Gynecological department of RIMS. Blood pressure, Pulse rate, O2 Saturation and episodes of hypotension were recorded every 5 minutes from the spinal block.Results: The study showed that maximum number of caesarean sections here performed for the indication of foetal distress which is seen in 44%, 48%, 52%, and 48% in Group A, Group B, Group C and Group D respectively. This is followed by scar tenderness and obstructed labour. In Group A maximum number of patients developed hypotension during 11-20 minutes duration which is 13 (61.9%) followed by 5 (23.8%) patients during first 10 minutes.Conclusions: The study concludes that the combined use of volume preloading to compensate for vasodilatation and vasopressor to counteract arterial dilatation is a very effective method in reducing the incidence, severity and duration of spiral hypotension. The combination group with decreased volume of preload and reduced dose of vasoconstrictor provides better haemodynamic stability when compared to preloading of vasoconstrictors alone

Meta-analysis and forest plots for sustainability of heavy load carrier equipment used in the industrial mining environment

It is a common recommendation not to attempt a reliability analysis with a small sample size. However, this is feasible after considering certain statistical methods. One such method is meta-analysis, which can be considered to assess the effectiveness of a small sample size by combining data from different studies. The method explores the presence of heterogeneity and the robustness of the fresh large sample size using sensitivity analysis. The present study describes the approach in the reliability estimation of diesel engines and the components of industrial heavy load carrier equipment used in mines for transporting ore. A meta-analysis is carried out on field-based small-sample data for the reliability of different subsystems of the engine. The level of heterogeneity is calculated for each subsystem, which is further verified by constructing a forest plot. The level of heterogeneity was 0 for four subsystems and 2.23% for the air supply subsystem, which is very low. The result of the forest plot shows that all the plotted points mostly lie either on the center line (line of no effect) or very close to it, for all five subsystems. Hence, it was found that the grouping of an extremely small number of failure data is possible. By using this grouped TBF data, reliability analysis could be very easily carried out.The authors are grateful to FCT—Fundação para a Ciência e Tecnologia—who financially supported this work through the RD Units Project Scope: UIDP/04077/2020 and UIDB/04077/202

Study the cases of rupture uterus in a tertiary care teaching hospital, Jharkhand, India and its maternal and perinatal outcome

Background: Rupture of a pregnant uterus is a serious obstetric emergency and a common cause of maternal death. Study was done to evaluate the incidence, risk factors, management, maternal and fetal outcome of rupture uterus at RIMS.Methods: The present study was carried out in 80 cases of rupture uterus admitted in labour room in the department of Obstetrics and Gynaecology, RIMS, Ranchi, India from March 2014 to September 2015.Results: It was observed that the incidence rate of 0.763%. About 53.75% of ruptures of uterus were noted after 38 weeks of pregnancy. The cause of rupture uterus during labour in most of the cases was spontaneous (49.34%). scar rupture was the next frequent cause (45.33%) and traumatic rupture were 5.33%. Malpresentation and malposition contributed the most important aetiological factors causing spontaneous rupture during labour (43.24%). Hysterectomy was performed in 53.75% (subtotal, 32 cases i.e. 40% and total, 11 cases i.e. 13.75%).Conclusions: Rupture uterus is a serious and life threatening complication for both mother and the fetus. The leading cause of uterine rupture was found to be neglected and obstructed labor due to mismanagement by local untrained birth attendants. Timely recognition and referral to higher centers can reduce the maternal and fetal morbidity and mortality due to uterine rupture. Education and proper care especially of high risk patients like previous caesarean by competent personnel, proper use of oxytocin and early referral may help to reduce the incidence of rupture uterus

Comparison of proximal femur locking compression plate with dynamic hip screw in management of inter-trochanteric fracture

Background: Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the patients and family. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Materials & Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw [DHS] and Proximal femur locking compression plate [PFLCP]. It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014.Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm

Implications of hydrophobic interactions and consequent apparent slip phenomenon on the entrance region transport of liquids through microchannels

The implications of entrance region transport in hydrophobic microchannels are theoretically and experimentally investigated in this work. Detailed analytical solutions are derived, depicting the dependences of the liquid phase velocity profiles, entrance lengths, and friction factor variations on the relative thickness of a nanobubble-dispersed layer formed in the vicinity of the microchannel wall as a consequence of localized hydrophobic interactions. It is revealed that even for a layer of nanobubbles formed with a typical thickness in the tune of three orders of magnitude lower than the characteristic microchannel dimensions, the entrance length can be enhanced to the limit of about 1.5 times than that for the cases devoid of any hydrophobic interactions. The pressure drop characteristics in the entrance region, as obtained for such cases, can turn out to be of significant consequence with regard to the design of typical pressure-driven microflow systems involving hydrophobic substrates. Closed-form expressions for the effective friction factor are also derived so that more accurate and scientific guidelines can be provided for design of hydrophobic microchannels, rather than trivially overruling the consequences of entrance region transport that is commonly exercised on a routine basis