An Unusual Melanocytic Nevus of Conjunctiva : Balloon Cell Nevus

Melanocytic nevi are one of the most common benign tumors of the conjunctiva. The balloon cell nevus is a rare and unusual variant of nevus of melanocytic origin, in which more than 50% of the tumor is composed of large polygonal cells with small nucleus and a clear to vacuolated cytoplasm. We describe a case of balloon cell nevus in a 6-year-old child who presented with pigmented lesion of the right eye since birth. The melanocytic nature of these cells was confirmed by immunohistochemical study. Excision of the tumor results in cure. This report describes a rare balloon cell nevus of conjunctiva which to the best of our knowledge is not documented in Indian literature

Primary Cutaneous Low Grade Mucinous Adenocarcinoma of Eyelid

Primary cutaneous mucinous adenocarcinoma is a rare adnexal neoplasm, eyelid being the most common site of presentation. Clinically it is mistaken for a benign / cystic lesion. Its morphologic similarity to metastatic deposits from breast, gastrointestinal tract (GIT) or any visceral sites adds to the diagnostic difficulty mandating the role of ancillary techniques in precise diagnosis and hence planning the management. We report a case of primary cutaneous mucinous adenocarcinoma of eyelid with emphasis on pathology along with a brief review of literature

Emperipolesis in a Case of Adult T Cell Lymphoblastic Lymphoma (Mediastinal type)-Detected at FNAC and Imprint Cytology

Emperipolesis is a condition in which viable hematopoetic cells are seen intact in the cytoplasm of host cell without damage. This phenomenon is seen in many physiologic and pathologic conditions, its presence in Rosai Dorfman disease (RDD) is characteristic of the disease. However emperipolesis is an uncommon finding in malignant lymphoma both Hodgkins and non-Hodgkin’s lymphoma, wherein it has been described in bone marrow aspirate and tissue culture. In contrast there are only two case reports of emperipolesis phenomenon described in non-Hodgkin’s lymphoma in tissue sections. We report a case of an adult T cell lymphoblastic lymphoma (mediastinal type) with features of emperipolesis demonstrated at fine needle aspiration cytology (FNAC) and imprint cytology of cervical lymph nodes. To our knowledge, this is the first case report of emperipolesis in a case of adult T cell lymphoblastic lymphoma (mediastinal type)-detected at FNAC and imprint cytology

A study to assess the effectiveness of papaya dressing on diabetic foot ulcer among clients admitted in diabetology ward at Rajiv Gandhi Government General Hospital, Chennai.

Diabetic foot ulcers is the one of the most common and devastating complication of diabetes mellitus, which contribute to changes in to the lower extremity called the diabetic foot. Carica papaya have great role in enzymatic debridement in Ulcer/Wound healing. Need for the study: Over 13 million have been diagnosed with diabetes and 15% have the diabetic foot ulcer in their life time, 30-50% will undergo a further amputation of the other foot within 5 years., so many literature have shown the effectiveness of papaya dressing among diabetic foot ulcer patient. OBJECTIVES 1) To assess the demographic and clinical variables among experimental and control group. 2) To assess the pre test and post test level of diabetic foot ulcer among the experimental and control group. 3) To compare the pre test and post test level of diabetic foot ulcer score among the experimental and control group. 4) To assess the Effectiveness of papaya dressing on Diabetic foot ulcer among Experimental group. 5) To find the association between the selected demographic variables and the effectiveness of Papaya Dressing in both experimental and control group. The Result Revealed that Effect of papaya dressing had significant effect on the healing of diabetic foot ulcer for experimental group. This study can be recommended for large scale and used for various setting

Comparison of Single Sputum Smear (Home Collection) by Fluorescent Microscopy Vs Two Smears by Ziehl Neelsen Method (Routine RNTCP)

INTRODUCTION: Tuberculosis (TB) is one of the oldest known diseases worldwide. This disease has been known with different names, since ancient times such as Phthisis, Consumption, Scrofula, White Plague, etc. It is an important public health problem in India. In 1993, World Health Organization (WHO) announced it as an international emergency. As per the WHO Global TB Report 2011, in total there were 9 lakh cases of TB worldwide in 2010. Inspite of India ranking the second country in the world in terms of population , India has more number of new TB patients every year than any other country in the world. Almost 20% of the global incident TB cases are from India. Every year approximately 2 million people acquire TB in India, out of which around 9 lakh are infectious. Every year around 3 lakh Indians die due to TB. Tuberculosis is a chronic infectious disease caused by mycobacterium tuberculosis, a highly obligate aerobe transmitted by droplet infection. The lungs are commonly affected, though any organ in the body can be affected. The common clinical features include cough with expectoration, evening rise of temperature, chest pain, weight loss, haemoptysis and night sweats. The risk factors increasing the development of TB disease are HIV infection, Diabetes mellitus, overcrowding, smoking, etc. Tuberculosis is a potentially curable disease, provided it is diagnosed early. The cornerstone of success of Revised National Tuberculosis Control Programme is case detection as enabled by sputum smear microscopy. It is routinely done by Ziehl Neelsen (ZN) technique used for detecting acid fast bacilli (AFB). Microscopy is a very useful diagnostic tool in highly endemic countries like India. Microscopy can also be done in other pathological materials like lymph node aspirates and body fluids including Cerebro Spinal Fluid. Sputum microscopy is also useful to assess whether the patient is responding to treatment, and to establish whether the patient is cured or to detect treatment failure when the treatment is completed. Although inexpensive and highly specific, it has low sensitivity (40-60%) when compared to culture and is also time consuming. The sensitivity of conventional light microscopy is affected by many factors, such as the prevalence of the disease, its severity, the kind of specimen used for diagnosis, the quality of the specimen collected, the number of mycobacteria in the specimen, the processing method that is used (direct or concentrated), the method of centrifuging the specimen, the staining technique, and the quality of the examination. So, when microscopy is done accurately, a lot of time is consumed. The Ziehl Neelsen (ZN) method used at present is a significant modification of Robert Koch’s original method using alkaline methylene blue. Fluorescent microscopy has been used for detection of acid-fast bacilli since Auramine O based method was introduced by Hagemann and Richard et al. It is easy to identify fluorescent bacilli against a dark background. Thus using the fluorescent microscopy (auramine /rhodamine), the examiner can go through the slide at a lesser magnification and observe a large area than that is seen with Ziehl Neelsen -stained smears. The above factors decrease the time required for screening a slide and lead to an increase in sensitivity. Thus, it is widely accepted that the fluorochrome method must be preferred over the Ziehl Neelsen (ZN) method. There are several reports indicating that fluorescent microscopy (either auramine phenol or auramine rhodamine) of smears significantly increases the sensitivity of direct microscopy. Although many researchers have investigated the significant difference in sensitivity between ZN and FM staining methods, the technical and procedural factors can influence the sensitivity of each staining method. At present, in India under Revised National Tuberculosis Control programme (RNTCP), the use of fluorescence microscopy is linked to the culture and Drug Sensitivity Testing (DST) activities at the level of the Intermediate Reference Laboratories (IRL). In this study, the sensitivity, specificity, efficacy and other advantages of the conventional gold standard ZN method and Flourescent microscopy are compared with each other in the detection of acid fast bacilli in sputum and the results analysed. AIMS AND OBJECTIVES: 1. To assess the value of fluorescence microscopy in diagnosing sputum smear positivity among chest symptomatics when compared to conventional light microscopy by Ziehl Neelsen method for diagnosing cases of pulmonary tuberculosis. 2. To assess the value of fluorescent microscopy in picking up additional smear positive cases among smear negative chest symptomatics. 3. Whether the objectives one and two can be achieved with the single home collection sample compared with routine two smear (Ziehl Neelsen) RNTCP smear microscopy. 4. Age and sex distribution of patients with smear positive pulmonary tuberculosis 5. Additional parameters are also compared such as the incidence of smear positive pulmonary tuberculosis in a. Diabetics, b. Smokers. MATERIALS AND METHODS: This study was conducted at Govt. Stanley Hospital. For this study, chest symptomatics referred from various departments to RNTCP cell of Govt. Stanley medical college for sputum AFB smear microscopy were selected. Patients were selected based on their history and physical examination. All the patients were enrolled in the study after fulfillment of inclusion and exclusion Criteria and getting appropriate consent. Study Period : 6 months from April 2012 to September 2012 The patients were advised routine two sputum smear samples for (Ziehl Neelsen) microscopy as per RNTCP guidelines. From the home collection specimen, two smears were prepared, one for Ziehl Neelsen microscopy and the other for fluorescence microscopy. The technicians were not allowed to cross check the results to avoid bias. Standard stastical methods were used to assess the correlation between the variables. Inclusion Criteria: All chest symptomatics referred for sputum smear Acid Fast Bacilli as per RNTCP criteria 1. Chronic cough >2weeks. 2. Evening rise of temperature. 3. Unexplained weight loss. Exclusion Criteria: 1. ATT treatment failure patients. 2. Relapse of pulmonary tuberculosis. 3. ATT defaulters. 4. Age < 13 years. CONCLUSION: This study found that fluorescent microscpy is more sensitive than Ziehl Neelsen method in identifying acid fast bacilli.The fluorescent method was relatively easy to perform and can be done quickly. The mycobacteria could be detected even under lower magnification. Because of this, many fields could be screened in a short time span. The percentage of false negatives was higher when Ziehl Neelsen method was used. Also Fluorescent Microscopy had a greater sensitivity when single home collection specimen was used when compared with Ziehl Neelsen method done in 2 samples as per routine RNTCP. Hence Fluorescent Microscopy fares as a better screening test when compared with Ziehl Neelsen method. Hence these two approaches, a) Collecting a single early morning sample and b) Screening it using Fluorescent Microscopy could result in rapid as well as accurate diagnosis of Pulmonary Tuberculosis. The major limiting factor in using a fluorescent microscope is installation and maintenance problems associated with the equipment. The cost of the equipment and also the fluorochrome dyes are also high. To overcome all this problems, LED Fluorescent Microscopes have been introduced. There are several studies demonstrating a higher sensitivity while using LED Fluorescent Microscopes when compared to the conventional fluorescent and light microscopy. It is also found that fluorescent microscopy (45%) has a higher sensitivity than the conventional microscopy (29%) in patients co infected with HIV and TB, as fluorescent microscopy identifies more number of pauci bacillary cases , as HIV patients are more likely to be paucibacillary. Fluorescent microscopy is a rapid, useful and a sensitive tool for screening various specimens for mycobacterium tuberculosis. At present it is used only at the level of Intermediate Reference Laboratories. With the advent of LED fluorescent microscopes and demonstration of its superiority over the other techniques in terms of cost effectiveness as well as sensitivity, it should replace the conventional light microscopes in all DOTS centers

Histopathological Analysis of Association of Papillary Carcinoma Thyroid with Thyroiditis and Other Thyroid Lesions.

Papillary Carcinoma Of The Thyroid Is The Most Common Malignant Tumor Of The Thyroid, Accounting For 80% Of All Thyroid Cancers. It Occurs Mostly Commonly In Women Between 3rd To 5th Decades. The Interplay Between Inflammatory And Neoplastic Disorders, Firmly Established In Certain Tissues, Is A Matter Of Controversy In The Thyroid. An Increased Risk For Developing Papillary Carcinoma In Patients With Hashimoto’s Thyroiditis Remains Controversial Ranging From 0-30%1 A Marker Found Frequently In Both Of These Thyroid Disorders Is Described. Expression Of P53 Homologous Nuclear Protein P63 Was Surveyed In A Spectrum Of Thyroid Neoplasms And Inflammatory Disorders. P63 Is Postulated To Regulate The Stem Cell Phenotype In Squamous Epithelia, And In Tumors Of Squamous Origin2. This Work Aims At Histologically Classifying All The Thyroid Lesions And Identifying The Lesions Of Hashimoto’s Thyroiditis With Papillary Carcinoma, And Establishing The Pathobiologic Link Between The Two By Immunohistochemical Detection Of P63 In Papillary Thyroid Carcinoma And Hashimoto’s Thyroiditis. The Expression Of P63 Protein In Hashimoto’s Thyroiditis And Papillary Carcinoma Has Been Studied In This Work To Address The Postulate Of A Common Origin From A Stem Cell Precursor. The Study Herein Describes The Immunohistochemical Detection Of P63 In Papillary Carcinomas Of Thyroid, Hashimoto’s Thyroiditis And Hashimoto’s Thyroiditis With Papillary Carcinoma To Find Out Whether P63 Expression May Constitute A Mechanistic Link Between Hashimoto’s Thyroiditis And Papillary Carcinoma

Evaluation of blood donor deferrals in a government teaching hospital

Background: Blood transfusion is a life-saving intervention. Blood should be accepted from non-remunerated and healthy donors. Proper donor screening procedure minimizes the risk of transfusion transmitted Infections and also wastage of blood and blood products and thus screening of donors is a prerequisite for blood donation. Methods: This is a retrospective study conducted in blood bank center in the Department of Pathology in a Government teaching hospital, Shivamogga from January 2022 to June 2022. All the voluntary and replacement donors were evaluated by the standard questionnaire and medical examination including demographic profile, anthropometry, blood group, vital signs and hemoglobin estimated by cyanmethemoglobin method were collected from the donation requisition forms and online deferred list. The data were represented in the form of percentage, descriptive statistics and analysed. Results: Out of 3,449 blood donors, 252 were deferred. The deferral rate was 7.31%. Among the ineligible donors, males 245 (97.22%) outnumbered females 7 (2.8%). 242 donors (96.03%) were temporarily rejected among which high blood pressure constituted to 23.02% followed by alcohol consumption (11.11%) whereas 10 donors (3.96%) were deferred permanently. 9 donors (3.57%) had low haemoglobin level. Conclusions: Temporary deferrals are more than permanent deferrals thus temporarily deferred donors should be instructed to return for blood donation after their period of deferral days to retain the pool of blood donors

Two-Dimensional Picture Grammar Models.

A new theoretical model of grammatical picture generation called extended 2D context-free picture grammar (E2DCFPG) generating rectangular picture arrays of symbols is introduced. This model which allows variables in the grammar and uses the squeezing mechanism of forming the picture language over terminal symbols, is an extension of the pure 2D context-free picture grammar (P2DCFPG) [13]. The extended picture grammar model E2DCFPG is shown to have more picture generative power than the P2DCFPG and certain other existing 2D models. Certain closure and other properties of this new model are also examine

Light interception and radiation use efficiency (RUE) in maize (Zea mays. L) intercropping with greengram (Vigna radiata L.)

Intercropping is growing two or more crop species simultaneously, different canopy architectures by row configuration, changing light interception, radiation utilisation, and increased yield. The present study aimed to evaluate different intercropping systems affected light interception per cent and radiation use efficiency in maize (Zea mays L.) intercropping with greengram (Vigna radiata L.) different ratios. Field experiments were conducted for Kharif 2022 and Rabi 2022-2023 seasons, which were laid out in a split-plot design and replicated three times. Three Nitrogen levels viz., N1 - 75 % RDN (Recommended dose of Nitrogen), N2 – 100% RDN, N3-125% RDN had taken as the main plot and three intercropping treatments were taken as subplot viz., M2G2- replacement series (two row of maize and two row of Greengram), M4G2- replacement series (four rows of maize and two row of Greengram), M2G3-paired row system (two rows of maize and three rows of Greengram), and sole maize. Both light interception and radiation use efficiency were significantly affected by intercropping systems. Light interception per cent of the main crop (maize) was significantly higher (69.0, 75.5 and 71.0 % during Kharif and 60.1, 78.1 and 76.6 during rabi) at vegetative, flowering and maturity phases, respectively. The Kharif 2022 and Rabi 2022-2023 maximum Radiation Use Efficiency (RUE) of Maize intercropping with green gram (maize + greengram) was higher in T12 (M2G3 paired row with 125 % Recommended Dose of Nitrogen) recorded as 2.46 (Kharif) and 1.43 (rabi). The outcome might be utilised to optimise the row configuration of intercropping design, explain the mechanism of intercropping on light utilisation, and improve radiation use efficiency