Cytomorphological Analysis of Skin Adnexal Tumors

Objectives: To study the cytomorphological features and pitfalls in the cytological diagnosis of various skin adnexal tumors (AT).Methods: This is a two-year cross sectional descriptive study. Cases diagnosed as skin AT on cytology were included in the study. Histological correlation was done on the biopsies which were available. Pitfalls on cytology were evaluated keeping histopathology as the gold standard for diagnosis.Results: A total of 46 cases of skin AT were included in the study. Upper limb was the most common site involved by them (36.96%). Young adults were the most commonly affected age group. Of the 46 aspirates, 26 cases (56.50%) which were typed include pilomatricoma (14 cases), chondroid syringoma (6 cases), skin AT of eccrine origin (5 cases) and sebaceous origin (1 case). Specific typing was not possible in 20 cases in this study. The authors did not diagnose any primary malignant tumor of skin in this study. 21 cases had histopathological correlation. Two cases of pilomatricoma showed discordance on histopathology. Out of the five cases diagnosed as skin AT of eccrine origin, one case was confirmed as eccrine poroma and the other as eccrine spiradenoma on histopathology. Out of the 20 cases, which could not be specified on cytology, five were diagnosed as nodular hidradenoma.Conclusion: FNAC is a useful investigation for diagnosing skin AT but all cases of skin adnexal tumors cannot be typed on cytology

Photography and Its Relevance in Pathology

Pathology is a visual science which holds true of the old adage “seeing is believing.” Photography has become an integral part of this branch of medicine. Its application lies not only in diagnosis and consultation including telepathology, medicolegal documentation and quality assurance but also in learning and scientific purposes. The lower cost and shorter image production time has paved the way for digital imaging. Large archives of such images can be created and stored with an ease of access. Photography techniques in pathology are purely based on observation or experience rather than theory. This article aims to describe the practical aspects of photographic techniques in pathology

Biochemical Changes in Whole Blood - Effect of Storage

Background: Storage of whole blood has deleterious effects on the biochemical parameters of RBCs. Aim: To study the changes in biochemical parameters in whole blood upon storage. Materials and Methods: 30 healthy donors were included in this study and effect of storing whole blood was studied on day 0, 3, 7, 14 and 21. Results: Highly significant changes were noted in the levels of blood pH, sodium, potassium, chloride, bicarbonate, aspartate transaminase and lactate dehydrogenase. Conclusion: There are significant changes in the biochemical parameters during storage. The most significant change is the marked increase in potassium levels. In order to reduce the deleterious effects of stored blood in the recipient, it is advisable to check the clinical details of the patient. Care should be taken to issue fresh blood (not more than 7 days old) particularly to patients with renal disorders.

Analysing Turnaround Time in Laboratory - A Key Performance Indicator

Background: Turnaround time (TAT) is one of the key indicators of performance of a laboratory. Laboratories define it as the time from the receipt of sample/ specimen to the reporting. A fast TAT helps clinicians in making early diagnosis.Aim: To determine the turnaround time (TAT) of the biochemistry laboratory with evaluation of the contribution of pre-analytical and analytical phase to the total TAT.Results: A total of 399 samples were analysed from three outpatient departments. Average pre-analytical turnaround time contribution was found to be higher as compared to the analytical time. Excess workload and delay in pneumatic shoot were the main causes of delay in pre-analytical phase.Conclusion: Improved turnaround time is the key to clinicians’ and patients’ better satisfaction with the laboratory. It can be attained by minimising the bottlenecks within the process

Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India.

INTRODUCTION: Rising burden of cardiovascular disease (CVD) and diabetes is a major challenge to the health system in India. Innovative approaches such as mobile phone technology (mHealth) for electronic decision support in delivering evidence-based and integrated care for hypertension, diabetes and comorbid depression have potential to transform the primary healthcare system. METHODS AND ANALYSIS: mWellcare trial is a multicentre, cluster randomised controlled trial evaluating the clinical and cost-effectiveness of a mHealth system and nurse managed care for people with hypertension and diabetes in rural India. mWellcare system is an Android-based mobile application designed to generate algorithm-based clinical management prompts for treating hypertension and diabetes and also capable of storing health records, sending alerts and reminders for follow-up and adherence to medication. We recruited a total of 3702 participants from 40 Community Health Centres (CHCs), with ≥90 at each of the CHCs in the intervention and control (enhanced care) arms. The primary outcome is the difference in mean change (from baseline to 1 year) in systolic blood pressure and glycated haemoglobin (HbA1c) between the two treatment arms. The secondary outcomes are difference in mean change from baseline to 1 year in fasting plasma glucose, total cholesterol, predicted 10-year risk of CVD, depression, smoking behaviour, body mass index and alcohol use between the two treatment arms and cost-effectiveness. ETHICS AND DISSEMINATION: The study has been approved by the institutional Ethics Committees at Public Health Foundation of India and the London School of Hygiene and Tropical Medicine. Findings will be disseminated widely through peer-reviewed publications, conference presentations and other mechanisms. TRIAL REGISTRATION: mWellcare trial is registered with Clinicaltrial.gov (Registration number NCT02480062; Pre-results) and Clinical Trial Registry of India (Registration number CTRI/2016/02/006641). The current version of the protocol is Version 2 dated 19 October 2015 and the study sponsor is Public Health Foundation of India, Gurgaon, India (www.phfi.org)

Heat stress tolerance in peas (Pisum sativum L.): Current status and way forward

In the era of climate change, the overall productivity of pea (Pisum sativum L.) is being threatened by several abiotic stresses including heat stress (HS). HS causes severe yield losses by adversely affecting several traits in peas. A reduction in pod yield has been reported from 11.1% to 17.5% when mean daily temperature increase from 1.4 to 2.2°C. High-temperature stress (30.5-33°C) especially during reproductive phase is known to drastically reduce both seed yield and germination. HS during germination and early vegetative stage resulted in poor emergence and stunted plant growth along with detrimental effects on physiological functions of the pea plant. To combat HS and continue its life cycle, plants use various defense strategies including heat escape, avoidance or tolerance mechanisms. Ironically, the threshold temperatures for pea plant and its responses are inconsistent and not yet clearly identified. Trait discovery through traditional breeding such as semi leaflessness (afila), upright growing habit, lodging tolerance, lower canopy temperature and small seeded nature has highlighted their utility for greater adaptation under HS in pea. Screening of crop gene pool and landraces for HS tolerance in a targeted environment is a simple approach to identify HS tolerant genotypes. Thus, precise phenotyping using modern phenomics tools could lead to increased breeding efficiency. The NGS (next generation sequencing) data can be associated to find the candidate genes responsible for the HS tolerance in pea. In addition, genomic selection, genome wide association studies (GWAS) and marker assisted selection (MAS) can be used for the development of HS tolerant pea genotypes. Additionally, development of transgenics could be an alternative strategy for the development of HS tolerant pea genotypes. This review comprehensively covers the various aspects of HS tolerance mechanisms in the pea plant, screening protocols, omic advances, and future challenges for the development of HS tolerant genotypes

Drought and salinity stresses induced physio-biochemical changes in sugarcane: an overview of tolerance mechanism and mitigating approaches

Sugarcane productivity is being hampered globally under changing environmental scenarios like drought and salinity. The highly complex nature of the plant responses against these stresses is determined by a variety of factors such as genotype, developmental phase of the plant, progression rate and stress, intensity, and duration. These factors influence plant responses and can determine whether mitigation approaches associated with acclimation are implemented. In this review, we attempt to summarize the effects of drought and salinity on sugarcane growth, specifically on the plant’s responses at various levels, viz., physiological, biochemical, and metabolic responses, to these stresses. Furthermore, mitigation strategies for dealing with these stresses have been discussed. Despite sugarcane’s complex genomes, conventional breeding approaches can be utilized in conjunction with molecular breeding and omics technologies to develop drought- and salinity-tolerant cultivars. The significant role of plant growth-promoting bacteria in sustaining sugarcane productivity under drought and salinity cannot be overlooked

International Review and Advisory Committee

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Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention