Background: Mild microcytic hypochromic anemias due to Iron deficiency (IDA) and beta thalassemia trait(𝛽-TT) continue to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to evaluate the validity of 12 different discrimination indices to distinguish 𝛽-TT from IDA. Methods: A total of 225 patients diagnosed with mild microcytic hypochromic anemia on complete blood count and peripheral blood film were included in the study. HB, RBC count, MCV, MCH and RDW obtained from the electronic cell counter were used to calculate 12 discrimination indices by various mathematical formulae. Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and Youden’s index(YI) were calculated. Result: The Shine & Lal and Ricerca et al indices exhibited the highest sensitivity of 100% each while the England & Fraser index demonstrated the lowest sensitivity of 61.1%. The England & Fraser and Mentzer indices demonstrated the highest specificities of 90.2% and 86.9% respectively. The highest and the lowest PPV were found for Mentzer index (77.3%) and MCHD (32.71%) respectively. The Ricerca et al. and Shine & Lal indices demonstrated the highest NPV of 100% each and the lowest NPV was exhibited by MCHD (69.8%). The highest and the lowest values for Youden’s index were shown by Mentzer index (81.3%) and MCHD (2.36%) respectively. Conclusion: Though HBA2 estimation is the gold standard for diagnosing 𝛽-TT, in developing countries, Mentzer index followed by Ehsani et al. index can be used to screen mild microcytic hypochromic anemia cases to eliminate as many false positive cases as possible to reduce the financial cost.
A 26-year-old female presented with abdominal pain and distension in 2003. Clinical evaluation and imaging were suggestive of bilateral benign renal solid masses. Fine needle aspiration showed tubular cells only. Patient was kept under periodic follow up. She reported 4 years later with increase in pain and size of masses, and underwent bilateral staged nephron sparing surgery. The histopathology was reported as bilateral oncocytoma. Two years after surgery, she developed epidural spinal cord compression and liver metastasis. A decompression laminectomy and biopsy revealed conventional renal cell carcinoma (RCC). To our knowledge this is the first case report of sporadic bilateral synchronous hybrid RCC and oncocytoma in a young woman, with spinal epidural metastasis.
Background: Untreated geriatric anemia is important to diagnose early as it is associated with greater morbidity and mortality in comparison to the anemia in younger adults. Objectives: To determine the prevalence, patterns of anaemia, and to assess haemopoietic nutrient status of geriatric population attending a hospital. Material and methods: 2540 subjects aged 60 years and above, attending our geriatric clinic were screened for presence of anemia. 100 anemic subjects were randomly selected for further characterization. Tests carried out were, pattern of anemia, full blood count, serum ferritin and stool for occult blood. Vitamin B12, folate and other additional investigations were carried out in selected patients as per study protocol. Main outcome measure: Prevalence, pattern and underlying etiologies of anemia. Results: The prevalence of anemia was 71%. Normocytic blood picture was most common. Eleven cases had absolute iron deficiency. 5 and 2 cases had low vitamin B12 and folate levels respectively. Nine out of 11 (82%) patients with depleted iron stores had positive stool occult blood. Conclusions: Screening for anemia is important in all geriatric patients seeking medical care, irrespective of the presenting illness. Also a dedicated search for micronutrient deficiency and stool occult blood should be a routine component
Background: Breast carcinoma is the most common malignancy in women in the world. This study evaluated the expression of ER, PR and p53 in breast carcinoma and its correlation with age, size, lymph node status and other parameters. Methods: 103 histologically proven Breast carcinoma cases were subjected to IHC for ER,PR and p53. Result: Total cases of breast cancer were 103. All the cases were between 21-60 years with tumour size varying from 0.5->5cm. Maximum cases were of grade III. Metastatic carcinomatous deposits in lymph nodes were seen in 53 cases. Tumors were separated into 4 categories depending on ER/PR expression with ER-ve/PR-ve category having maximum number of cases. As the tumour grade increased lesser was the ER PR expression. P53 positivity was noted in 60 cases comprising of 58.3%. Significant correlation was noted while comparing p53 with lympho vascular invasion (p=0.042) but not with age, tumour size, tumour grade and lymph node status. Significant correlation was also noted while correlating p53 and ER/PR expression with tumour size (p = 0.036) but not with tumour grade, lympho vascular invasion and lymph node status. Conclusion: In the present study it was observed that ER PR status is inversely proportional to p53 expression. It is concluded that p53 has direct relationship with tumour grade, tumour size, lymphovascular invasion. Thus p53 helps to provide prognostic information and better treatment options
INTRODUCTION: Carcinoma cervix is one of the leading causes of morbidity and mortality worldwide but has a benefit of being identified at a precancerous stage before the invasion starts and hence is amenable to early detection and treatment. HPV infection as the etiological agent of carcinoma cervix and its precursor lesions is well established. High risk HPV (16,18) is most commonly associated with invasive cervical carcinomas worldwide. The aim of this study is to find the prevalence of genital HPV infection in women of reproductive age group in a north Indian city that were screened for cervical cancer by Pap smears. METHODS: The was a prospective study conducted from Jan 2014 to June 2016 on women in reproductive age group (< 49 years) who were screened for cervical cancer by Pap smears and HPV testing was done by PCR (sample was sent to higher center for testing). HPV was classified into high risk HPV DNA and low risk HPV DNA. Proper informed consent was taking from the participating women. RESULTS: A total of 1549 tests were received during the above period.1068 (69%) were CPS and 481 (31%) were LBC. HPV testing was carried out in 169 cases of which 20 cases were found to be positive for HPV DNA (11.8%). High risk DNA was found in 17 cases (85%) and low risk DNA in 03 cases (15%). The annual rate of HPV detection showed a gradual slight increase from 10.3% in 2014 to 12.8% in 2016. Abnormal cytological findings were detected only in 5/20 cases (25%), which were subjected to HPV DNA testing pressing home the advantage of HPV testing in the reproductive age group. CONCLUSION: The study still establishes the important role of HPV as an etiological agent in carcinoma cervix and the need to get HPV testing included in the cervical cancer-screening program so as to diagnose the precursor lesions at an early stage leading to early treatment and reduction in morbidity and mortality from a world wide prevalent and preventable cancer.
Background: Fine Needle Aspiration Cytology (FNAC) has many advantages and utilities in cervical region. Most of the studies documented in the literature regarding head and neck masses, either describe spectrum of lesions or etiological causes. The studies in the past have also tried to associate the FNAC procedure with statistic parameters such as sensitivity, specificity and predictive values / diagnostic accuracy. However, in the present study an attempt was made to correlate the etiological (diagnostic) and site-specific need of doing a FNAC procedure with epidemiological parameters such as age specific sub groups and sex parameters.
Materials and Methods: 1708 cases of head and neck swellings reporting for FNAC to the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India over a period of three years (January 2012 - December 2014) were included in the study. The final diagnosis with other epidemiological, anatomical and clinical history was obtained from the requisition forms and the final reports filed in the archives of the department. Statistics employed included central distribution parameters such as mean, median and averages. Chi-Square (?2) test and Fischer’s exact test were employed to analyze and investigate for significance of the cytological diagnosis with epidemiological and anatomical parameters.
Results: The most common age group varied from 20-50 years with M:F ratio being 0.7:1. Overall reactive lymphadenitis and lymph nodes were the commonest cause and site for patients to undergo FNAC for swellings of head and neck region. Thyroid, skin and soft tissue lesions were the next commonest sites (36.29% and 19.33% respectively). Across the board, inflammatory pathologies were the commonest lesion reported (66.56%). Statistically it was found that there was significant difference between type of lesion according to the anatomical site (p value= 0.001) and the difference was not attributable to
Introduction: Fine needle aspiration cytology (FNAC) is an established tool in the diagnosis of palpable lesions. FNAC is a sensitive and rapid method in differentiating benign breast lesions from malignant ones. But there exist some gray areas in which this differentiation becomes difficult. Problem arises in categories C3 and C4 in which there exists significant interobserver variation in the diagnosis. The study was done to evaluate the usefulness of FNAC in diagnosis of C3 and C4 categories and correlate it with histopathological diagnosis. Methods: This Study was conducted on 512 cases of breast FNAC in from January 2014 to December 2014. FNAC diagnosis of C3 and C4 categories were selected. The cytological diagnosis was compared with histopathological diagnosis in the cases where biopsy was done subsequent to FNAC diagnosis. Results: C3 and C4 categories constituted 28 (5.46%) and 48 (9.3%) cases respectively. Histopathology was available in 13 cases of C3 (46.4%) and 30 cases of C4 (62.5%). Among C3 category, 10/13 cases showed benign lesions (77%) and 3/13 cases were malignant (23%). Among C4 category, 4/30 cases showed benign lesion (13.3%) and 26/30 cases were malignant (86.7%). There was a significant statistical difference between benign and malignant diagnosis of C3 & C4 categories (p< 0.001). Conclusion : Clinicians and pathologists should understand the limitations of FNAC. C3 and C4 categories should still be continued with, as there was a statistically significant difference in benign & malignant diagnosis for these categories in our study.
Septic arthritis is a severe condition with notable morbidity and mortality. Limited knowledge exists regarding factors influencing the readmission of septic arthritis in real-world scenarios.
Objectives:
To explore 30-day readmission in patients with septic arthritis and identifying independent predictors associated with readmission using National Readmission Database (NRD).
Methods:
In this retrospective study, the 2019 data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database were utilized. The primary focus was on determining the rate of readmission for all causes within 30 days post-discharge. Secondary objectives included assessing hospital-level metrics such as length of stay, total hospitalization charges, and costs. The identification of independent risk factors for readmission was carried out through Cox regression analysis.
Results:
Of the 22,911 total index admissions, 851 resulted in readmissions. Males constituted the majority of index admissions at 64.8%, with a slightly higher readmission rate of 67.09%. The average age for index admissions was 58.1 years, decreasing to 54.1 years in readmitted patients. Insurance distribution showed a decline in readmissions among Medicare-insured patients (from 47.18% to 41.5%) and an increase among Medicaid-insured individuals (from 20.17% to 25.9%). Co-morbidities, such as chronic kidney disease (CKD), Hypertension, and Osteoarthritis, Alcohol Use, Liver Diseases, Thyroid Diseases, HIV, Other Connective Tissue disorders including RA, SLE, Sjogren's Syndrome were prevalent in both cohorts. On identifying most common diagnosis for Septic Arthritis readmissions, top prevalent were Pyogenic Arthritis (M00.9) and Staphylococcal Arthritis (M00.062). Total Length of Stay for all readmissions in the year 2019 was 6683.75 days with total charges of $57,100,000$ ± $4,881,148. Independent Predictors for Readmissions includes age ([aOR] 0.986, p<0.0001), Medicaid insurance (aOR 1.46, p<0.001), rehab transfer (aOR 3.39, p<0.0001), smoking (aOR 1.46, p<0.0001), and connective tissue combined disorders (aOR 0.73, p<0.05).
Conclusion:
Septic arthritis imposes a significant strain on hospital outcomes due to recurrent readmissions, leading to substantial healthcare utilization in the year 2019 alone. It is crucial to carefully examine independent predictors of readmissions associated in regards to septic Arthritis. Although it was a limitation that only 2019 data was used, but still smoking was a risk factor for recurrent admissions and readmissions was least in patients who had highest income bracket.
En la vértebra atlas, los puentes posteriores, los puentes laterales y los túneles postero-laterales son las protrusiones óseas que pueden causar presión externa en la arteria vertebral cuando pasa del foramen transverso de la vértebra cervical al foramen magnum del cráneo. Ejemplares que muestran dichas protrusiones fueron clasificadas según tengan puentes del atlas completos o incompletos que pueden predisponer a la insuficiencia vertebrobasilar y al síndrome cervicogénico especialmente durante los movimientos de cuello. El objetivo del estudio es saber la incidencia, ontogenia y filogenia de los puentes del atlas junto con las implicaciones clínicas. Este canal de la arteria vertebral del atlas y la morfología de los puentes fueron estudiados en un total de 60 (120 lados) vértebras atlas humanas completas y secas obtenidas de la colección de esqueletos del Departamento de Anatomía del Government Medical College de Amritsar en Punjab. La incidencia de la impresión de la arteria vertebral (44), la impresión profunda de la arteria vertebral (42) era 71,66%, el puente parcial fue 13,33% y el puente lateral parcial fue 3,33% en el lado derecho y 5% en lado izquierdo. También se observaron doce anillos completos y un túnel 1.66% postero-lateral. La ocurrencia de estos puentes óseos abrazando la arteria vertebral es de suma importancia clínica, pueden causar efecto de comprensión en la arteria vertebral durante la rotación extrema de la cabeza y movimientos de cuello manifestándose en mareos, desmayos, diplopía temporal, vértigo y desórdenes neurológicos. El conocimiento de esta variación es importante para médicos, otorrinolaringólogos, neurólogos y ortopedistas que en la práctica diaria están en contacto con estas enfermedades de la columna vertebral y sus consecuencias. In atlas vertebrae, the posterior bridges, lateral bridges and postero-lateral tunnels are the bony outgrowths which may cause external pressure on the vertebral artery when it passes from foramen transversarium of the cervical vertebra to foramen magnum of the skull. Specimens exhibiting such outgrowths were classified as having incomplete or complete atlas bridges that may predispose to vertebro-basilar insufficiency and cervicogenic syndrome especially in neck movements. The objective of the study is to know the incidence, ontogeny and phylogeny of atlas bridges along with its clinical implications. The groove of the vertebral artery of the atlas and the morphology of the bridges were studied in a total of 60 (120 sides) complete and dry human atlas vertebrae obtained from the skeletal collection of Department of Anatomy,GovernmentMedicalCollege,Amritsar,Punjab. The incidence of impression of vertebral artery (44), deep impression of vertebral artery (42) was 71.66%, Partial ponticuli were 13.33% and Partial lateral ponticuli were 3.33% on right side and 5% on left side. Twelve complete rings and one 1.66% postero-latetal tunnel was also observed. Occurrence of these bony bridges embracing the vertebral artery is of great clinical importance, may cause compression effect on the vertebral artery during extreme rotation of head and neck movements presenting with dizziness, fainting, transient diplopia, vertigo and neurological disturbances. The knowledge of this variation is important for physicians, otolaryngologists, neurologists and orthopaedicians who in every day practice are in contact with the diseases of spine and their consequences.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
