Efficacy and safety analysis of intravitreal bio-similar products of bevacizumab in patients with macular edema because of retinal diseases.

Purpose: The purpose of this study was to evaluate retrospectively the efficacy and safety profile of intravitreal injection of bevacizumab bio-similar product Zybev(Z) for macular edema because of retinal diseases. Methods: A retrospective analysis was conducted on patients with macular edema because of retinal diseases, who had been administered intravitreal injections of bio-similar bevacizumab at a tertiary eye care center. Changes in the retinal thickness and visual acuity were evaluated to judge the efficacy, and adverse events were noted for the safety profile over a period of 6 weeks. Results: A total of 104 patients were included in the study. The mean age of the patients was 53 ± 13.5 years. The mean pre-injection best corrected visual acuity (BCVA) was 1.32 ± 0.70 log minimum angle of resolution (logMAR) with a central subfield thickness (CST) of 429.26 ± 204.30 µm, and the post-injection BCVA at 6 weeks was 1.13 ± 0.71 logMAR with a CST of 302.26 ± 104.50 µm; this change was statistically significant (P < 0.05) for all groups. The mean average cube thickness (µm) decreased from 11.85 ± 1.96 pre-injection to 10.52 ± 1.75 post-injection, and the mean average cube volume (mm3) decreased from 329.30 ± 54.35 to 302.23 ± 49.56 (P < 0.05). During the follow-up period after injection, no patient had inflammation, endophthalmitis, an increase in intra-ocular pressure, or systemic side effects. Conclusion: This short-term retrospective analysis provides evidence regarding the efficacy and safety of intravitreal injection of bio-similar products of bevacizumab for the treatment of macular edema because of retinal diseases.

Learning Preference of Medical Undergraduate Students: A Multi-Institutional Survey.

This cross-sectional multi-institutional study was conducted to analyze learning preference among medical undergraduate students (n=1659) in four colleges in Haryana. VARK questionnaire (v8.01) was administered through designated study leaders of the respective institutes. The most preferred learning modality was kinesthetic (21.7%), which favors experiential form of learning, most suited for teaching-learning of skills in medical curriculum. More information on the learning preference of medical students is needed to optimize learning outcomes.

Evaluation of Salivary Alpha-Amylase Levels for Determining Stress Variations in Patients Undergoing Spinal Anesthesia for Infra-Umbilical Surgery.

AIMS AND OBJECTIVES: To evaluate salivary alpha-amylase (sAA) levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery. MATERIALS AND METHODS: One hundred and twenty subjects (age 18-65 years) planned for infra-umbilical surgery under spinal anesthesia were included and allocated to Groups A and B ensuring age and sex matching. In both groups, sAA levels (S1 to S4) were assessed sequentially at different times (E1 to E4). S1 and S2 were collected on the evening before surgery (E1) and in the preoperative room on the day of surgery (E2), respectively. Thereafter, in Group A, S3 and S4 were collected before (E3) and 15 min after spinal anesthesia (E4), following which intravenous Midazolam was given. In Group B, intravenous Midazolam was administered first, S3 was collected 5 min later (E3), spinal anesthesia was administered and S4 was collected after15 min (E4). RESULTS: In both groups, sAA levels showed a mild increase from E1 to E2 (not significant). Thereafter from E2 to E3 and E3 to E4, a significant sharp rise in sAA levels in Group A and a significantly acute decline in Group B was noted. Mean sAA levels in Group A were higher as compared to group B (P < 0.005) in E3 and E4. CONCLUSION: Sequential documentation of increase in sAA levels in our study, starting with the baseline levels, presents a comprehensive report of the stress that the patients experience during preoperative period and reinforces the need of anxiolytic before spinal anesthesia.

A pilot study of the implementation and evaluation of a leadership program for medical undergraduate students: Lessons learned.

BACKGROUND: Most Indian medical schools lack formal leadership training though students are expected to evolve into leaders. The Student Leadership Program (SLP) was designed and evaluated with an objective to incorporate and strengthen leadership skills in undergraduates and to initiate change in organizational practice through the development of a Student Leadership Society. METHODS: The SLP was designed using best evidence guidelines in medical education. Competencies and learning outcomes were identified in four domains: reflective writing, self-management, team management, and experiential learning. A stepwise program was implemented over 6 months in which participants wrote reflections at the end of each program session. So as to gain objective evidence of behavioral change in participants in relation to the leadership training, their reflections were qualitatively analyzed and corresponding codes and themes were derived. RESULTS: We describe the content and stepwise process of implementation of our pilot leadership program, which included 24 final-year students. Results of qualitative analysis are presented in relation to the domains of self-management, team management, and evaluation of experimental learning. Among the findings were: students viewed assertive skills training as the most powerful learning experience within self-management, and in team management, the session on "Myers-Briggs Type Indicator for understanding one's own leadership style" was seen as the most powerful learning tool, while the session on conflict management was the most difficult in this domain. A Student Leadership Society was instituted. DISCUSSION: In this study, students' reflections helped us better understand factors (the "how" and "why") that make leadership training more effective. The SLP, with a strong evidence base, achieved the intended learning outcomes. A Student Leadership Society was constituted as a networking platform to explore the long-term effects of leadership training on organizational practice. The content and process of our pilot leadership program and lessons learned through understanding of students' perspectives should be applicable to subsequent iterations of student leadership development programs here and in other settings.

Cytodiagnosis of chondroid syringoma-Series of three cases.

Chondroid syringoma is a rare, benign, appendegeal neoplasm. It was initially termed as mixed tumor as it comprises both epithelial cells and chondromyxoid stroma. It usually presents as a slow growing, solitary, painless, subcutaneous, or intracutaneous mass, frequently in the head and neck region. Cytological features usually include the presence of both components, similar to histology but aspiration of only one component or atypical features can pose challenges in diagnosis. According to literature, only a few single case reports describing the cytological features of chondroid syringoma has been published. We report three cases of chondroid syringoma and its differential diagnosis on cytology.

Pyrenochaeta romeroi causing subcutaneous phaeohyphomycotic cyst in a diabetic female.

Opportunistic subcutaneous fungal infections are increasing in present times due to increasing incidence of many medical conditions causing immunosupression like diabetes, AIDS, organ transplant recipients and anticancer therapy. Pyrenochaeta romeroi, a fungus from the dematiaceae group, first described by Borelli in 1959, is saprophyte to soil and plants.We present a rare case of subcutaneous phaeohyphomycotic cyst in a diabetic female caused by P. romeroi.

Inflammatory Septal Nasal Polyp.

INTRODUCTION: Nasal polyps are benign prolapsed mucosal lesions which commonly arise from the paranasal sinuses and lateral walls of the nose especially the contact areas of osteomeatal complex. Though nasal polyps arising from the nasal septum have been reported, those arising from its anterior part are extremely rare and present a diagnostic dilemma. Aetiology is multifactorial and is mainly a result of the inflammatory response of the lining mucosa. CASE REPORT: The case of a 28-year-old male, with a history of progressively increasing nasal complaints since 4 months and with a nasal mass arising from the anterior nasal septum on examination, is reported. Diagnosis of an inflammatory nasal polyp was made on histopathological examination after surgical excision of the mass. CONCLUSION: The diagnosis of an inflammatory nasal polyp was not only unusual in terms of its location but also in its appearance on anterior rhinoscopy and tomographic scanning images. The definitive diagnosis in such cases can only be achieved through surgical resection and detailed histopathological examination.

Evaluation profile of thyroid nodule by fnac in the rural population of khanpur kalan, sonepat, haryana.

BACKGROUND: Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its visible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteoporosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodinization phase is largely unknown. AIM: The main objective of this study was to generate valuable epidemiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. MATERIALS AND METHODS: The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. RESULTS: The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%).The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary carcinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. CONCLUSION: The increased prevalence of goiter in this post iodinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Leukaemic pleural effusion as a manifestation of acute myeloid leukaemia: a case report and review of literature.

Haematologic malignancies such as acute and chronic leukaemias rarely present with or develop pleural effusion during their clinical course. We present a case of a young female who presented with unilateral pleural effusion and was diagnosed with haematologic malignancy on pleural fluid cytology. On further workup, a diagnosis of acute myeloid leukaemia was established. The patient was put on chemotherapy thereafter. This case clearly highlights the importance of cytopathology aids in making a diagnosis of rare and unusual presentation in haematologic malignancies.

Variable clinical presentations of histoplasmosis: a report of six cases.

Histoplasma is a dimorphic fungus that primarily involves the lungs and the environmental reservoir is soil. It has emerged as an important opportunistic fungal infection in immunocompromised patients. Six cases of histoplasmosis with variable clinical presentations diagnosed either on cytology or histopathology are discussed - three were HIV-positive. The possibility of histoplasmosis should always be borne in mind, especially in immunocompromised patients, as it can have variable clinical presentations.

Rosai-Dorfman disease: A case report with extranodal thyroid involvement.

Rosai-Dorfman Disease (RDD) or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a rare disorder typically manifesting as enlarged lymph nodes with or without systemic involvement. These cases are often clinically misdiagnosed as lymphoma. Recognising this entity to distinguish it from lymphoma and other causes of histiocytosis is important because of different treatment modalities for these disorders. Extranodal involvement is also common, often with a particular predilection for the head and neck region. We report a rare case of Rosai-Dorfman Disease with both nodal and extranodal involvement in a 33-year-old woman. The patient had bilateral cervical lymphadenopathy and diffuse thyroid enlargement. Thyroid gland involvement in RDD diagnosed on fine needle aspiration cytology (FNAC) has rarely been reported in literature. FNAC is a useful and reliable tool for the diagnosis of RDD and the biopsy can be avoided in these patients, thus reducing inconvenience to patients.

Giant pericardial cyst in a 5-year-old child: A rare anomaly.

Pericardial cysts are uncommon congenital abnormalities that occur in the middle mediastinum. Most of these are found incidentally on chest x-rays. The occurrence of pericardial cyst in children is quite rare. It needs to be differentiated from other cystic mediastinal masses. A rare case of pericardial cyst in a 5 year old male child is reported. The child presented with chest pain, cough and fever. The preoperative diagnosis of pericardial cyst was suggestive on echocardiography and CT scan. It was confirmed on histopathology after successful surgical excision. The rarity of this benign mediastinal lesion in children prompted us to report this case.

Comparative evaluation of beneficiary effects of priming agents (2% hydroquinone and 0.025% retinoic acid) in the treatment of melasma with glycolic acid peels.

BACKGROUND: Chemical peels have become a popular modality in the treatment of melasma. The most disturbing side effect of this procedure is postinflammatory hyperpigmentation. This may be minimized with the help of priming agents. Because there is a paucity of such studies, this study was taken up to evaluate the beneficial effects of hydroquinone versus tretinoin as priming agents in treatment of melasma with glycolic acid peels. METHODS: Sixty patients of melasma were randomly assigned in three groups of 20 patients each in a single-blind study. Group I received only glycolic acid peels while Groups II and III were primed with 0.025% tretinoin and 2% hydroquinone, respectively, for 2 weeks before peeling. The patients received serial glycolic acid peels fortnightly for the first 3 months and then monthly for the next 3 months and were then followed up for the next 3 months when peeling was stopped. Clinical and photographic evaluation was done at 3, 6, and 9 months, and subjective improvement was noted. RESULTS: There was an overall decrease in MASI from baseline to 6 months in all three groups but it was highly significant between Groups I and III (p<.001) at 6 and 9 months and significant between Groups II and III (p<.01) at 9 months. CONCLUSIONS: Results are better with hydroquinone as priming agent compared to tretinoin in enhancing the results with glycolic acid peels in melasma and in decreasing postpeel postinflammatory hyperpigmentation.