Implementation of the Milan System for Reporting Salivary Gland Cytology: A Two-Year Outcome Cytopathology Data of a Tertiary Care Center.

OBJECTIVE: In 2015, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was implemented to eliminate overlapping and disparate morphologies in salivary gland lesions. This approach helps track diagnostic findings, describe the risk of malignancy for each group, and advance therapy based on the results. The research aimed to classify fine-needle aspiration (FNA) smears, analyze malignancy risk, correlate cytology with histological diagnosis, and reduce unnecessary surgeries. METHODOLOGY: We evaluated 217 individuals using FNA, classified their conditions using the Milan System, and followed up on 149 cases through histopathology. Both the risk of malignancy in each cluster and the total risk of malignancy were noted. RESULTS: The most recent studies, as reported by the MSRSGC, found almost universal agreement about this grouping. The FNA cytopathology test demonstrated a sensitivity of 75% for identifying salivary gland abnormalities and a specificity of 93.16%. The findings indicated that the test had an accuracy of 89.66%, with a positive predictive value of 72.41% and a negative predictive value of 93.97%. CONCLUSION: The MSRSGC offers a standardized technique for examining the results and assists the physician in determining the treatment plan that will be most beneficial.

Evaluation of Dakshata, a scale-up WHO SCC and mentoring-based program, for improving quality of intrapartum care in public sector in Rajasthan, India: repeated mixed-methods surveys.

BACKGROUND: The Dakshata program in India aims to improve resources, providers' competence, and accountability in labour wards of public sector secondary care hospitals. Dakshata is based on the WHO Safe Childbirth Checklist coupled with continuous mentoring. In Rajasthan state, an external technical partner trained, mentored and periodically assessed performance; identified local problems, supported solutions and assisted the state in monitoring implementation. We evaluated effectiveness and factors contributing to success and sustainability. METHODS: Using three repeated mixed-methods surveys over an 18-month period, we assessed 24 hospitals that were at different stages of program implementation at evaluation initiation: Group 1, training had started and Group 2, one round of mentoring was complete. Data on recommended evidence-based practices in labour and postnatal wards and in-facility outcomes were collected by directly observing obstetric assessments and childbirth, extracting information from case sheets and registers, and interviewing postnatal women. A theory-driven qualitative assessment covered key domains of efficiency, effectiveness, institutionalization, accountability, sustainability, and scalability. It included in-depth interviews with administrators, mentors, obstetric staff, and officers/mentors from the external partner. RESULTS: Overall, average adherence to evidence-based practices improved: Group 1, 55 to 72%; and Group 2, 69 to 79%, (for both p < 0.001) from baseline to endline. Significant improvement was noted in several practices in the two groups during admission, childbirth, and within 1 hour of birth but less in postpartum pre-discharge care. We noted a dip in several evidence-based practices in 2nd assessment, but they improved later. The stillbirth rate was reduced: Group 1: 1.5/1000 to 0.2; and Group 2: 2.5 to 1.1 (p < 0.001). In-depth interviews revealed that mentoring with periodic assessments was highly acceptable, efficient means of capacity building, and ensured continuity in skills upgradation. Nurses felt empowered, however, the involvement of doctors was low. The state health administration was highly committed and involved in program management; hospital administration supported the program. The competence, consistency, and support from the technical partner were highly appreciated by the service providers. CONCLUSION: The Dakshata program was successful in improving resources and competencies around childbirth. The states with low capacities will require intensive external support for a head start.

Measuring the quality of antenatal care in a context of high utilisation: evidence from Telangana, India.

BACKGROUND: Antenatal care coverage has dramatically increased in many low-and middle-income settings, including in the state of Telangana, India. However, there is increasing evidence of shortfalls in the quality of care women receive during their pregnancies. This study aims to examine dimensions of antenatal care quality in Telangana, India using four primary and secondary data sources. METHODS: Data from two secondary statewide data sources (National Family Health Survey (NFHS-5), 2019-21; Health Management Information System (HMIS), 2019-20) and two primary data sources (a facility survey in 19 primary health centres and sub-centres in selected districts of Telangana; and observations of 36 antenatal care consultations at these facilities) were descriptively analysed. RESULTS: NFHS-5 data showed about 73% of women in Telangana received all six assessed antenatal care components during pregnancy. HMIS data showed high coverage of antenatal care visits but differences in levels of screening, with high coverage of haemoglobin tests for anaemia but low coverage of testing for gestational diabetes and syphilis. The facility survey found missing equipment for several key antenatal care services. Antenatal care observations found blood pressure measurement and physical examinations had high coverage and were generally performed correctly. There were substantial deficiencies in symptom checking and communication between the woman and provider. Women were asked if they had any questions in 22% of consultations. Only one woman was asked about her mental health. Counselling of women on at least one of the ten items relating to birth preparedness and on at least one of six danger signs occurred in 58% and 36% of consultations, respectively. CONCLUSION: Despite high coverage of antenatal care services and some essential maternal and foetal assessments, substantial quality gaps remained, particularly in communication between healthcare providers and pregnant women and in availability of key services. Progress towards achieving high quality in both content and experience of antenatal care requires addressing service gaps and developing better measures to capture and improve women's experiences of care.

Health-Related Lifestyle Among College-Going Youth in Bhubaneswar, Odisha.

Introduction Youth is a period where a number of healthy and unhealthy habits get acquired that last throughout a person's life. Youth health promotion has become a key study focus around the world. Thus this study is undertaken to understand health-related lifestyles affecting college-going youth. Methods A cross-sectional survey was done in the junior colleges in Bhubaneswar, India, which included college-going youth. The sample size was 636. The sampling technique was a two-stage stratified sampling method. Firstly, one college was selected from each of five administrative regions (east, west, north, south, and central zone) in Bhubaneswar randomly by lottery method to provide a representative sample. From each college, 128 students were selected randomly from the list of students. Results In this study, 237 (37.3%) of the participants ate green leafy vegetables on a daily basis, with 39.3% of females and just 31.2% of males. This difference in preference of green leafy vegetables among males and females was found to be statistically significant with a p-value of 0.019. Out of 180 (28.3%) of the participants who consumed milk products daily, 25% were females, while 38.1% were males (p-value of 0.004). In the present study, out of 247 (38.8%) participants who preferred eating fast food, 37.6% were females, while 42.5% were males. Out of 213 (33.5%) of them who preferred sweets (candy/chocolate), 37.2% were females, while only 22.5% were males. This difference in gender in regards to junk food preference was found to be statistically significant with a p-value of 0.001. In the current study, out of 243 (42%) of the participants who spent 30 minutes to one hour on exercise per day, 43.4% were females, while 37.4% were males. Out of 133 (23%) of them who spent one to two hours on exercise per day, 23.6% were females, while only 20.9% were males (p-value of 0.003). Out of 208 (35.9%) of the participants who preferred walking as the main mode of exercise, 40.2% were females, while 22.3% were males (p-value <0.0001). Conclusion The main findings of this study demonstrated that the majority of the youth followed proper meal routines and engaged in regular physical exercise. However, when compared to junk food consumption, participants consumed far fewer green leafy vegetables. This would prove to be harmful to their health. Since the youth of today are the future of tomorrow, they should be provided with proper health education regarding the harmful effects of regular intake of junk food.

Barotrauma and its complications in COVID-19 patients: a retrospective study at tertiary care hospital of Eastern India.

Background: The development of barotrauma in COVID-19 patients who were ventilated and admitted to the intensive treatment unit seemed to have been a problematic issue in the COVID era. This study aimed to explore the possibility of developing the barotrauma-related issues with mechanical ventilation in the cases of individuals suffering from COVID-19. Results: Out of 48 patients who developed barotrauma, 30 (62.5%) presented with pneumothorax, 22 (45.8%) with pneumomediastinum, 10 (20.8%) with subcutaneous emphysema, and 2 (4.1%) with pneumopericardium. Of those that developed barotrauma, 45 (93.7%) patients were in acute respiratory distress syndrome. In patients with and without barotrauma, significant factors were white blood cell count (p = 0.001), neutrophil percentage (p = 0.012), and lymphocyte percentage (p = 0.014). There were no statistically significant differences in CRP, procalcitonin, d-dimer test, LDH, or ferritin. Conclusions: Patients infected with COVID-19 have a high risk of barotrauma when on mechanical ventilation. As a result, the death rate in this patient group is higher.

Seropositivity of Chlamydia trachomatis & Toxoplasma gondii among male partners of infertile couples in Odisha, India: A facility-based exploratory study.

Chlamydia trachomatis (CT) is the most common curable sexually transmitted non-viral infection, which can cause urethritis, prostatitis, orchitis and epididymitis among males. Toxoplasma gondii, a protozoan causes toxoplasmosis among humans. These infections may lead to decreased fertility. Hence, this study was aimed to estimate the seropositivity of CT and T. gondii infection among the male partners of infertile couples in Odisha, India. In this facility-based cross-sectional study, first void urine, seminal fluid and blood sample were collected from 153 males attending infertility clinics including 74 healthy controls. Urine and seminal fluid were tested through polymerase chain reaction (PCR), and enzyme-linked immunosorbent assay was used to detect immunoglobulin (Ig) G, IgA and IgM anti-Chlamydia and IgM anti-Toxoplasma antibodies through serum. The prevalence of CT was 1.26 per cent (95% CI: 0.03-6.85) as estimated from semen samples using PCR. We detected anti-Chlamydia antibodies IgM-four per cent [95% confidence interval (CI): 0.83-11.24]; IgA-28.16 per cent (95% CI: 18.13-40.09) and IgG-12.5 per cent (95% CI: 5.87-22.4) among participants. Anti-Toxoplasma antibodies IgM were observed in 27.63 per cent (95% CI: 17.98-39.08) of participants. None of the control samples were found positive. Overall seropositivity of CT and Toxoplasma infections is comparable, which suggests that greater attention is required for screening these infections at clinics, especially among infertile couples.

Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation.

Quality of intrapartum care is essential for improving pregnancy outcomes; several models for improving performance are tested, globally. Dakshata is one such WHO SCC-based national program-improving resources, providers' competence, and accountability-in public sector secondary care hospitals of India. Andhra Pradesh state devised strategy of mentoring by the handpicked member from within the obstetric team, supported by external technical partner. We evaluated the effectiveness and assessed contextual factors to success of the program. We conducted pre and post mentoring mixed-method surveys to evaluate the change in evidence-based intrapartum and newborn care practices and stillbirth rates, across 23 of 38 eligible hospitals. We directly observed obstetric assessments and childbirth, extracted data from casesheets and registers, interviewed beneficiaries and conducted facility surveys. We in-depth interviewed stakeholders from state, district and facility managers, mentors and obstetric staff, and external managers for theory-driven qualitative assessment. After one year we found, average adherence to practices sustained high during admission (81%, 81%); improved during childbirth (78%, 86%; p = 0.016); moderate within one hour of birth (72%, 71%), and poor postpartum care before discharge (46% to 43%). Stillbirths reduced from 11(95% CI, 9-13) to 4(3-5) per 1000 births (p<0.001). Some practices did not improve even after sustained reinforcement. Commitment from state, engaging district officers, monitoring and feedback by external managers enabled supportive setting. The structured training and mentoring package, and periodic assessments delivered under supervision ensured the standards of mentoring. The mentoring model is acceptable, effective, less costly and scalable; appears sustainable if state commits to institutionalising a long-term mentoring with adequate monitoring. We conclude that the SCC-based mentoring and skill building program showed improvement in practices during childbirth while it sustained high levels of care during admission, but no improvement in postpartum care. The state needs to monitor and ensure continuous mentoring with required infrastructural support.

Immunocytochemistry using Liquid-based Cytology: A Tool in Hormone Receptor Analysis of Breast Cancer.

CONTEXT: Efficacy of immunocytochemistry (ICC) in determining molecular biomarkers like estrogen receptor (ER), progesterone receptors (PRs), and human epidermal growth factor receptor-2 (HER2). AIMS: To evaluate biomarkers using ICC in breast cancer as per American Society of Clinical Oncology/College of American Pathology (ASCO/CAP) guidelines. SETTINGS AND DESIGN: The study was conducted over a period of 2 years from September 2012 to August 2014 and is the first such study in eastern India. MATERIALS AND METHODS: Fine needle aspiration cytology (FNAC) was done for suspected cases of breast cancers and slides were prepared using ThinPrep (TP) technology of liquid-based cytology (LBC) for ICC and corresponding biopsy specimens were processed as formalin fixed paraffin embedded (FFPE) sections for comparison. Both the LBC slides and tissue sections were subjected to immunostaining for ER, PR, and HER2. ICC was evaluated by Allred Scoring and IHC by Quick Scoring. STATISTICAL ANALYSIS USED: Statistical analysis done by Wilconxon Signed rank test on the SPSS program, Chicago, Illinois, USA. The results of ICC and IHC were compared by evaluation of sensitivity, specificity, kappa-value (k-value), positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The comparison of ICC with immunohistochemistry (IHC), ER, and PR showed very good correspondence rate, sensitivity, specificity, NPV, PPV, and agreement with k-value; whereas for HER2 the results were only good. CONCLUSION: ICC using LBC can be a useful tool in assessing biomarkers in advanced cases of breast cancer where surgery is not possible or cases where ASCO/CAP guidelines for management are not followed.

Capsular nevus versus metastatic malignant melanoma - a diagnostic dilemma.

INTRODUCTION: A positive finding of metastatic melanoma in a sentinel lymph node is an ominous sign and a strong predictor of overall survival. In contrast, current data trends have shown that patients with benign nevus cells in the sentinel nodes do not require additional therapy since their prognosis has been shown to be similar to that of patients with negative lymph nodes. Distinguishing between benign capsular nevi and metastatic melanoma often proves to be diagnostically problematic. CASE PRESENTATION: In this case report we present two cases of melanoma in which sentinel lymph node biopsies proved to be difficult in distinguishing metastatic melanocytes from capsular nevus cells. In both cases, further workup was necessary for accurate diagnoses. DISCUSSION: A lack of standardized distinctions of benign nevus cell from melanoma pose a diagnostic pitfall. Assigning a diagnosis of malignant melanoma might seem like the safer approach to avoid a false negative, but the resultant treatment, including the possibility of additional surgical complications, may cause anxiety, discomfort, and financial instability for the patient. Current methods of distinguishing the two based solely on histology may be insufficient due to similar pathologic patterns. CONCLUSION: To avoid misdiagnosing a patient and performing unnecessary therapy, it would be beneficial to get a second opinion by additional histopathologists at a high volume center. Additionally, immunohistochemical staining should be carefully employed due to some overlap in commonly used markers. Using tissue morphology in conjunction with immunohistochemical staining may be the best way to make the most accurate diagnosis.

Sebaceous lymphadenoma of the parotid gland.

Sebaceous lymphadenoma is a rare benign salivary gland tumor of uncertain histogenesis. We report such a case in a 37-year-old female presenting with a parotid swelling. Recognition of key histological features will readily allow differentiation of this neoplasm from its benign and malignant mimics. The prognosis is excellent following excision.

A Rare Malignant Triton Tumor.

Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation, malignant triton tumor, has a rare incidence. We report such a case in a 40-year-old male who presented with a mass over the buttock. He was a previously diagnosed case of neurofibroma in the same area. Histomorphology supported by immunostaining with S-100 protein confirmed the diagnosis. Malignant triton tumor has a poor prognosis owing to its aggressive biological behavior. The fact that the presence of this tumor in the buttock region is extremely rare has prompted the authors to report this case.

Philadelphia chromosome positive chronic myelogenous leukemia in a child: a case report.

Philadelphia chromosome (Ph(1))-positive Chronic Myelogenous Leukemia (CML) in a child below the age of 3 years is extremely rare. We have reported such a case in a 3 year old male child. Peripheral blood smear revealed features of CML and karyotypic study showed (Ph(1)) positivity. Biologic behaviour and prognosis are similar to that of adult-type of CML.

FNAC diagnosis of yolk sac tumor: a case report.

Yolk sac tumor is the second most common germ cell tumor of the ovary. A nine year old female child presenting with a lower abdominal mass diagnosed as a yolk sac tumor on fine needle aspiration cytology (FNAC) is described. Ultrasonographically (USG) guided FNAC of the lesion revealed tight clusters and papillary fronds of cells associated with homogeneous acellular eosinophilic bodies. A preoperative diagnosis of this tumor is helpful in planning further diagnostic and therapeutic steps.

Cytodiagnosis of granular cell tumor: a case report.

A young male aged 28 years presented with a subcutaneous nodule in the left arm. Fine needle aspiration diagnosis was benign granular cell tumor which was confirmed by histopathology. Since it is an uncommon tumor, of controversial histogenesis, it is being reported here.

Endovascular papillary angioendothelioma in an elderly female.

Endovascular papillary angioendothelioma (EPA) is a rare vascular tumor of low grade malignancy, encountered primarily in children. However some cases have also been reported in adults. A sixty year old female with EPA is described here. She presented with a swelling in the neck. Total surgical excision was performed. Histomorphology revealed anastomosing lymphatic channels showing intraluminal papillary fronds with hyaline vascular cores and hobnailing of endothelial cells. A diagnosis of EPA was made based on this picture. This tumor is recurrent and nodal metastasis has been reported in some cases.

Clear cell mesothelioma of the testis with deciduoid areas--a case report.

We report a clear cell type of primary purely epithelial malignant mesothelioma with focal deciduoid features in the para-testis of a 75 year old man. This variant requires ancillary studies like immunohistochemistry for confirmation. Awareness of this variant is required to avoid misdiagnosis and treatment as either metastasis from a renal cell carcinoma or as a germ cell tumor. A diagnosis of mesothelioma must be ruled out in elderly patients with epithelial-looking tumor especially if the serum germ cell tumor markers are within normal range.