Role of Hematological Parameters in the Early Diagnosis of Neonatal Sepsis.

The major cause of neonatal mortality and morbidity is bacterial sepsis. Blood culture is the most reliable method in neonatal sepsis. This study was conducted to study the usefulness of hematological parameters in the early diagnosis of neonatal sepsis and to assess the most sensitive and specific variables in diagnosing neonatal sepsis. This prospective study was conducted in a tertiary care hospital from January 2017 to January 2018. Peripheral blood smears were prepared from patients with clinical suspicion of sepsis or predisposing perinatal factors for sepsis and stained with Field's stain and examined. The hematological findings were analyzed according to the hematologic scoring system of Rodwell. It was found that immature PMN count, I: M ratio, and I: T ratio had the highest sensitivity (92.06%, 87.30%, and 74.60%, respectively) while I: M ratio, I: T ratio, and degenerative changes in PMN had the highest specificity (97.50%, 96.50%, and 94.0%, respectively) in the prediction of sepsis.

Isolated Papillary Thyroid Carcinoma of the Pyramidal Lobe: A Case Report and Review of Literature.

The pyramidal lobe (PL) represents an embryological remnant of the thyroglossal duct. A solitary focus of papillary thyroid carcinoma (PTC) of the PL of thyroid gland is a rare entity. We present a case of a 33-year-old woman with PTC of the PL with lymph nodal involvement and further discuss the lines of surgical management for primary PTC arising from the PL of thyroid gland.

Pattern of suspicious deaths of married females brought for medico-legal autopsy at teaching institute of India.

Background: Death is unnatural and suspicious when it is caused by external causation like injury or poisoning or other than natural course. In such deaths of married females, the inquest is carried out, and a medico-legal autopsy is conducted to ascertain the cause of death and manner of death. Materials and Methods: This record-based, retrospective study was carried out at RVRS Medical College, Rajasthan in the year 2021 (1st January, 2021 to 31st December, 2021) to know the pattern of the suspicious death of married females brought for medico-legal autopsy. The inquest report, medico-legal autopsy report, histopathological examination report, and chemical analysis report findings were tabulated and analyzed. Results: The maximum number (31.62%) of female deaths belonged to the age group of 18-22 years of age. A total of 33.82% of females died during a marriage duration of less than 5 years of married life. A total of 22.79% of female deaths were related to dowry and 60.2% of females belonged to rural areas. A total of 59.56% of females were died due to poisoning and 75% of female deaths considered suicidal. Conclusion: Suspicious deaths of married women brought for medico-legal autopsy must be dealt with due to precaution to determine the cause and manner of death. One must be vigilant that the suspicious death of a married female may be associated with dowry in the Indian scenario.

Assessment of the Number of Phlebotomists in a Newly Established Sample Collection Center.

INTRODUCTION: Phlebotomy, i.e., the collection of blood samples, is one of the most commonly performed procedures in almost all hospital settings. The phlebotomy center is the first point of contact for patient samples with the laboratory services. The patient load visiting the phlebotomy center of a rapidly developing hospital is very variable and unpredictable. This leads to staffing issues related to a number of phlebotomists. The actual phlebotomy procedure requires only a few minutes, but the total time includes the patient's arrival to departure from the phlebotomy center. In this study, we have attempted to assess the adequacy of the number of phlebotomists in our sample collection center and to determine how many patients can be attended to comfortably by each phlebotomist. As the sample load increases, the burden on phlebotomists also increases, and they may or may not express the strain of it. We attempted to determine the cut-off patient numbers above which request for additional personnel has to be put into the hospital administration. MATERIALS AND METHODS: This was a prospective, hospital-based, observational study carried out in the outpatient sample collection center section at the All India Institute of Medical Sciences, Bibinagar, Telangana, over a period of one month, i.e., December 2022. The movement of 1200 patients was observed for the phlebotomy procedure. Patient details, the time taken for registration, waiting time, and phlebotomy time were noted, along with the hindering factors in the phlebotomy center. OBSERVATIONS AND RESULTS: There were 680 males and 520 females. The mean time for patient arrival to departure from the phlebotomy center and the mean waiting time was 9.8 minutes and 6.5 minutes, respectively. Various reasons for increased phlebotomy time were pediatric patients, anxious patients, postprandial sample patients, difficulty in finding veins, etc. Though the estimated capacity of the phlebotomy center is apparently satisfactory with four personnel, many hidden causes for time loss were observed.  Conclusion: An adequate number of trained and effective phlebotomists is the first step in ensuring the success of any laboratory service, and while deciding on this "adequate number," not only the direct effort, but also the indirect effort, operational needs and emergencies have to be kept in mind. Each phlebotomist in a six-hour shift can comfortably attend 30 to 35 outpatients for phlebotomy. When this number exceeds it, additional staff has to be added. Adopting measures to reduce the waiting time for phlebotomy procedures will improve the phlebotomy center's service. The study provides a basis for the modification of a number of phlebotomists in order to ensure optimal patient service.

Evaluation of Citrated Plasma After Thawing for Routine Coagulation Testing.

OBJECTIVE: We aim to find the time in which a thawed citrate plasma sample that was preserved can be analyzed for routine coagulation testing without losing precision. METHODS: Whole blood samples from 30 healthy volunteers were collected in 3.2% sodium citrate vacutainer and centrifuged to separate platelet-poor plasma. Each sample was then aliquoted, one aliquot was used immediately for prothrombin time (PT)-international normalized ratio (INR) and activated partial thromboplastin time (APTT), four were stored at -20°C, and four were stored at -80°C for 24 hours. After 24 hours, the aliquots were taken out and thawed at 37°C in water bath and analyzed after 15, 30, 60, and 120 minutes. STATISTICAL ANALYSIS: Data were presented as mean with standard deviation (SD). Repeated measures ANOVA with Tukey post-hoc test was performed for multiple comparisons. All analysis was done using GraphPAD Prism 8.0 software (GraphPad Software, San Diego, California, USA).  Results: In the case of PT and INR, no statistically significant difference was found between the mean values after thawing for 120 minutes when compared with the mean baseline value. However, the APTT showed a statistically significant difference (p = 0.0232) after 30 minutes of thawing when the sample was stored at -20°C. Furthermore, a statistically significance difference (p = 0.0001) was found after 60 minutes of thawing when the samples were stored at -80°C. CONCLUSION: Plasma samples for the PT and INR may be accepted for assessment up to 120 minutes, when stored at -20°C and -80°C for 24 hours. In the case of APTT, the plasma sample can be used for assessment up to 30 minutes after thawing when stored at -20°C and up to 60 minutes when stored at -80°C.

Correlation of Robinson's Cytological Grading with Elston and Ellis' Nottingham Modification of Bloom Richardson Score of Histopathology for Breast Carcinoma.

Introduction: Invasive carcinoma of the breast is one of the leading causes of death in women. In developing countries, fine needle aspiration cytology (FNAC) of the breast is used for preoperative diagnosis of breast cancer due to low cost. The grading system of breast carcinoma on FNAC is widely accepted. In the era of neoadjuvant therapy, if grading of breast carcinoma is incorporated in FNAC reports for prognostication, it will be of great help especially in patients with locally advanced disease, older patients with accompanying chronic disease and patients who reject surgery. Hence, there is much to be gained by grading a tumor on FNAC. Materials and methods: The present study was conducted on 40 cases of cytologically diagnosed breast carcinomas. Fine needle aspiration cytology smears were graded by Robinson cytological grading system. All surgical specimens were processed and the histological grading of the resulting slides was done by the Nottingham modification of Bloom Richardson score. Then, the cytological grade was compared with the histological grade and statistical analysis was done. Results:Based on Robinson grading method, cases were classified into grade I (15%), grade II (55%) and grade III (30%). Based on the Nottingham modification of Bloom Richardson (SBR) grading method, the cases were classified as grade I (5%) and grade II and III (47.5%) each. A total concordance rate between both the grading systems was seen in 65% of cases. A positive correlation was found and there was a significant association between Robinson cytological grading and SBR histological grading. Conclusions:Grading breast carcinoma on cytology allows its prognostic evaluation along with diagnostic value without any additional morbidity or expense to the patient. Thus, it is recommended to grade breast carcinomas on FNAC. It helps in deciding the proper line of treatment, so that patients can have a better prognosis.

Cytology of micropapillary mucinous carcinoma: A case report of a clinically and genetically distinct breast carcinoma variant.

Micropapillary mucinous carcinoma (MPMC) is an uncommon histopathological variant of breast cancer accounting for approximately one-fifth of all mucinous breast carcinomas. In contrast to pure mucinous carcinoma, MPMC tends to affect younger women and is associated with decreased progression-free survival, higher nuclear grade, lymphovascular invasion, lymph node metastasis, and positive HER2 status. Typically MPMC histology shows micropapillary architecture with "hobnailing" of cells and reverse polarity. Very few publications document the cytomorphological findings of MPMC. We report a case of MPMC that was suspected in fine needle aspiration cytology (FNAC) and confirmed at histopathology.

Correlation of Tumor Budding With Known Clinicopathological, Histomorphological and Hormonal Receptor Status in Patients With Invasive Breast Carcinoma.

Introduction: Tumor blossoming may be a predictive indicator for a variety of cancers. At the invasive origin of the tumor, cells get detached from the original tumor mass. Aims & objectives: Studying breast cancer tumor budding, as well as its link to other prognostic indicators, such as clinicopathological features and hormone receptor status, will be the focus of this study. Materials & methods: Over six years, 110 cases of invasive breast cancer were examined. Ten high-power fields were used to analyze H&E-stained slices for tumor sprouting. It was determined that the tumor buds were divided into low and high grades. Tumor budding and other prognostic factors were compared using the chi-square test. It was considered significant if the p-value was less than or equal to 0.05. Results: There were 110 cases of invasive ductal carcinoma, which accounts for more than half of the total cases (88.18%). A total of 144 tumors were present, of which 74 displayed strong budding and 36 displayed poor budding. A correlation between tumor budding and tumor size, lymph node metastasis, and tumor stage is statistically significant (P = 0.0099). Conclusion: Tumor budding in breast cancer is an easily visible in microscopy, novel prognostic indicator. A new prognostic element may be added to the reporting process.

Development and Evaluation of the POPBL (Patient-Oriented Problem-Based Learning) Module in Pathology: A Comparative Analysis of Performance and Perception Among Second-Year Pathology Students.

Background and objective Employing the POPBL (Patient-Oriented Problem-Based Learning) method to teach students offers a fresh take on the classroom experience. It helps to enhance the motivation of the students, improves knowledge, self-learning behavior, and clinical reasoning, and also helps to promote long-lasting memory. In our medical college, we adopted a newer technology-oriented method with the use of case history, laboratory findings, a gross specimen of the same case, microscopic live sessions via Deca and Penta head microscopes, television, and microscopic camera. In light of this, in this study, we aimed to develop a patient- and technology-oriented new Problem-Based Learning (PBL) method and compare its effectiveness with the traditional tutorial method. Materials and methods A total of 149 second-year MBBS students were enrolled in the study. Consent was taken from all students. A total of eight systems of systemic pathology from the second-year MBBS curriculum were selected. Of the eight systems, four were covered under POPBL with gross and microscopic features associated with the help of newer-generation audiovisual aids, and the other four systems were covered under the traditional tutorial/lecture method. The evaluation was performed using prevalidated objective types of questions after exposure of about one week. The objective was to evaluate and compare the outcomes and students' performance between these two sets of pathology systems. Results Students gave excellent responses. Performance (87.92% of students had scores >75%) and attendance (94.14%) parameters with respect to POPBL gross and microscopic features associated with the help of newer-generation audiovisual aids like Deca and Penta head microscopes were superior compared to the traditional tutorial/lecture method, where 53.02% of students scored more than 75% and the attendance was 76.12%. The difference in attendance was also statistically significant (p=0.05). Conclusion Using POPBL instead of standard tutorial/lecture methods leads to better outcomes. Students also found POPBL more appealing than standard lectures. It is a student-centered method that provides a significant level of motivation and encourages active participation among students. The efficacy of this new way of teaching and demonstrating will attract more students to this method.

Utility of inquest and medico-legal autopsy in community deaths at tertiary care hospital of India.

Background: In India, inquest is carried out by police or magistrate depending upon the type of death and medico-legal autopsy is carried out by doctor. In some cases, inquest is sufficient to make out necessary information related to death and medico-legal autopsy can be avoided in such death, but medico-legal autopsy has its own value. Materials and Methods: A retrospective record-based study was carried out at RVRS Medical College, Bhilwara, Rajasthan, regarding the correlation of inquest and medico-legal autopsy findings in community deaths which were brought dead to hospital in the year 2020. Results: A total of 467 cases of community deaths were brought dead for medico-legal autopsy in the year 2020. As per inquest, 7.28% died due to hanging, 3.85% died due to burns, 3.43% died due to electrocution, 16.27% died due to poisoning, and the same was established via medico-legal autopsy without any difference from inquest report. After inquest, in 3% of cases, the cause of death remained undetermined, while after the medico-legal autopsy, it was only 0.86%. The manner of death was undetermined in 3% of cases after inquest, while after the medico-legal autopsy, only in 0.86% of cases. Conclusion: We recommend proper training of the investigating officers who conduct inquest to overcome the discrepancies observed between the investigating officer and the doctor in ascertaining the cause of death and manner of death in all unnatural deaths in India. If well-trained person will conduct in depth inquest, then medico-legal autopsies can be avoided in certain types of death.

Fine needle aspiration cytology of swellings of head and neck region.

UNLABELLED: Head and neck mass lesions are frequently found in clinical practice. A spectrum of pathological lesions ranging from simple benign lesion to highly malignant manifestation is observed. OBJECTIVES: To make clinicopathological correlation of head and neck lesions and to assess the frequency of incidences of different sites, age groups, sex, and distribution among inflammation and neoplastic lesion. MATERIALS AND METHODS: A retrospective study was conducted from January 2011 to April 2012. Fine-needle aspiration diagnosis was correlated with details of relevant clinical findings and investigations. Patients aged between 1 and 70 years were included in the study. A total of 200 patients with the swellings of head and neck underwent fine-needle aspiration cytology (FNAC). RESULTS: Out of 200 fine-needle aspiration procedures, 52% were of thyroid, 28.50% were of lymph node, 11% from salivary gland, and 4% from soft tissue and miscellaneous swellings. There were 4.5% cases in which diagnosis was not possible. In inflammatory swelling (33%), tuberculous lymph node (42.12%) involvement is common than all other sites with male preponderance (55%). CONCLUSION: FNAC is a simple, quick, inexpensive, and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.