A Comparative study between conventional method and the Bethesda system for reporting thyroid cytopathology (TBSRTC)

Background: FNAC is widely used for the diagnosis of thyroid lesions. TBSRTC was introduced to streamline the reporting of thyroid aspirates. Objectives was to study the spectrum of various thyroid lesions in and around Meerut and comparison of conventional method and TBSRTC.Methods: A total of 464 patients were evaluated both by conventional system and TBSRTC.Results: As per conventional system of reporting, maximum number of cases were diagnosed as benign (87%), followed by malignant (6.4%), follicular neoplasia (2.5%), equivocal (2.1%) and inadequate (1.7%). As per TBSRTC, maximum number of cases were reported as category 2, 86.2% followed by category 6, 6%, category 1, 2.5% and cat 3,2.5%, category 4, 1.5% and category 5, 1%. Among benign category, maximum number of cases were of colloid goiter/multinodular goiter (MNG) (65%) followed by Hashimoto`s thyroiditis (15%), Grave`s disease (6%). Among the malignant category, maximum number of cases were of papillary carcinoma thyroid (PCT) (5.3%) followed by medullary carcinoma thyroid (MCT) (0.43%), non-Hodgkin`s lymphoma NHL (0.21%), metastatic carcinoma (0.21%), and anaplastic carcinoma (0.21%) of each.Conclusions: In present study it was found that there is an excellent agreement between the conventional system and TBSRTC. Results of both systems of reporting are comparable. In some cases, TBSRTC is almost equivalent to the conventional system in the pattern of reporting (viz. benign and malignant cat) while in some cases, TBSRTC is better in reporting (viz. FN and equivocal cat). The sensitivity of TBSRTC (93%) is slightly more as compared to the conventional system (90%) while its specificity (86%) slightly less as compared to conventional system (88%). Thus, as compared to the conventional system, TBSRTC may be viewed as a better screening test for thyroid lesions, though at the cost of specificity

Role of p63 expression in non-proliferative and proliferative lesions of breast

Background: Breast lump among females, is a fairly common complaint. Breast lump have a variety of etiologies ranging from inflammatory to benign to malignant lesions. Myoepithelial markers are useful in helping to distinguish invasive carcinoma from benign proliferations with a similar morphological appearance, benign proliferative lesions and most pre-invasive lesions with an intact myoepithelium. Invasive carcinomas lack the myoepithelial cell layer that normally surrounds benign breast glands. p63 antibody is a myoepithelial cell marker that selectively stains nuclei. Also, it is negative in stromal, myofibroblastic and adipocytic cells. This makes p63 more specific and superior to other myoepithelial markers.Methods: The present study was done on a total of 151 cases of breast diseases, received in the form of core biopsy, tru cut biopsy, lumpectomy, and mastectomy specimens. Clinical history and examination findings of the patients were collected in all the cases. All specimens were routinely processed and stained with haematoxylin and Eosin (H and E) stain and only 50 cases were subjected to immunohistochemical staining for p63.Results: Out of total 151 cases, 09 were inadequate for evaluation, 96 cases benign and 46 malignant. In benign category, fibroadenoma was most common and infiltrating ductal carcinoma (NOS) was the most common in malignant category. Mean size of benign tumors was found to be less than that of malignant tumors. All malignant cases were negative for p63 expression. In the benign category, 88.6% cases showed positive expression for p63 while 11.4% were negative. Among the benign category, non-proliferative lesions were continuous positive, proliferative showed discontinuous positivity for p63.Conclusions: Myoepithelial markers are useful in helping to distinguish invasive carcinoma from benign proliferations with a similar morphological appearance, benign proliferative lesions and most pre-invasive lesions with an intact myoepithelium. Invasive carcinomas lack the myoepithelial cell layer while in the benign category, non-proliferative lesions are continuous positive, proliferative lesions show discontinuous positivity for p63

Incidence of bone tumors and tumor like lesions at a tertiary centre - a study of 64 cases

Background: Primary bone tumors are uncommon lesions constituting less than 1% of all cancers. Although open biopsy has high accuracy, it increases risk of tumor dissemination in patients with highly malignant tumors. FNAC eliminates the complications that may occur in surgical procedures and also gives quick results. This study was conducted to determine the spectrum and demographic characteristics of bone tumors and tumor like lesions at a tertiary care centre in western Uttar Pradesh and also to assess the role of FNAC in their diagnosis.Methods: This is a three-year, retrospective as well as a prospective study done on a total of 64 cases. All the cases were subjected to detailed history, physical examination and radiological investigations. FNAC smears were stained with Giemsa and Papanicolaou stain. H and E staining was done for histopathology.Results: Mean age affected was 26 years. Male-female ratio was 2.8:1. Out of total 64 cases of bone tumors and tumor like lesions, maximum was chondrogenic tumors (17; 26.56%), followed by osteogenic tumors (15; 23.44%). Osteochondroma (08; 47.06%), Osteosarcoma (07; 46.66%) and Aneurysmal bone cyst (04; 50.0%) were the most common chondrogenic tumor, osteogenic tumor and tumor like lesion respectively. The most common bone affected was tibia (16; 25.0%), followed by femur (15; 23.4%). Sensitivity and specificity of FNAC as a diagnostic modality were 90.0% and 91.67% respectively.Conclusions: A good correlation is observed between cytological and histological diagnoses which implies that FNAC can be used as a preliminary diagnostic approach to bone tumors, although histopathology remains the gold standard

Clinico-pathological correlation of ovarian tumors and tumor like lesions with role of CA125 and HE4 as biomarkers for discrimination of benign and malignant ovarian tumors

Background: Ovarian tumors and tumor like lesions of ovary frequently form pelvic masses and are associated with hormonal manifestations. Clinically or surgically they can mimic malignancy but pathologically they could be benign tumors or tumor like lesions.Methods: The aim of present study is to do clinico-histopathological correlation of ovarian tumors and tumor like lesions of ovary and also evaluate the role of serum CA125, HE4 and calculate risk of ovarian malignancy algorithm (ROMA), for differentiation of benign and malignant ovarian tumors.233 cases of ovarian tumors and tumor like lesions were studied. Tumors were classified according to WHO classification. Clinical and histological findings were compiled on proforma and subjected to analysis.Results: In present study, out of total 233 cases, 41.2% were ovarian tumors and 58.8% tumor like lesions of ovary. Among tumor like lesions, follicular cyst was commonest lesion while among ovarian tumors, benign serous surface epithelial tumor was commonest. In patients with ovarian tumors, blood samples were collected, before and after the treatment for analysis of CA125, HE4 and ROMA.Conclusions: Serum values of CA125and HE4 as well as ROMA were highly elevated in women with malignant epithelial tumors as compared to women with benign lesions. Also, all the parameters i.e. HE4, CA125 and ROMA showed significant difference before and after surgery. Hence measuring serum HE4 and CA125 along with ROMA calculation may provide higher accuracy for detecting malignant epithelial ovarian tumor

Can peripheral blood smear examination be totally replaced by automated hematology analyser - with special reference to anemia?

Background: The aims and objectives of present study was to correlate typing of anemia based on RBC indices obtained from an automated analyzer with peripheral blood smear (PBS) examination and also to find out whether the number of PBS examination can be reduced with the help of automated hematology analyzer.Methods: A total of 2500 blood samples showing anemia as per WHO reference range were collected in central pathology lab of SVBP Hospital attached to L.L.R.M. Medical College, Meerut, Uttar Pradesh, India over a period of one year. Samples were reported by auto-analyzer and PBS examination simultaneously.Results: Out of total 2500 cases, there were 1623 females (64.9%) and 877 males (35.1%) with male: female ratio 0.54:1. By auto-analyzer and PBS examination, MCHC anemia (49.8%) was the commonest anemia followed by NCNC anemia (36.5%) and Macrocytic anemia (4.2%). Discordant typing of anemia between two methods was found in 284 (11.4%) cases only. These cases were diagnosed as normocytic normochromic (NCNC) anemia with raised RDW by autoanalyzer while as Dimorphic Anemia (DA) on PBS examination. Also morphological changes such as RBC inclusions, spherocytes, RBC fragments, schistocytes, nucleated RBCs were seen only on PBS examination.Conclusions: The Study concluded that even today PBS examination is very important and cannot be totally replaced by automated analyzer and both methods are complementary to each other

Enhancing Thermoelectric Performance in Single-Crystal-Like Semiconducting Films by Tuning the Carrier Scattering Mechanism

College of Engineering-Interdepartmenta

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe