Immunohistochemical Analysis of p53, CD10 and Ki67 Expression as Prognostic Biomarkers in Urinary Bladder Carcinomas Correlating with Age, Histomorphology, Grade and Stage: An Institutional Study of One and Half Year.

Background: Bladder carcinoma ranks tenth among all cancers worldwide predominantly affecting elderly males. Common risk factors being cigarette smoke and aniline dyes. Immunohistochemical markers play a pivotal role for its diagnosis and prognosis. Aim: To analyze the immunohistochemical expression of p53, CD10, Ki-67 in bladder cancers correlating with demographic features, pathological grade, and stage and to establish as prognostic biomarkers. Materials and Methods: Surgical samples of total of 70 cases of bladder tumor were collected, processed, stained in routine hematoxylin and eosin followed by immunohistochemistry of p53, CD10, and Ki67 markers performed on randomly selected 30 cases only. Results: Out of 70 cases 69 cases (98.6%) were carcinomas; urothelial carcinoma being 71.4% (n = 50) with male: female ratio = 7.7:1 and mean age = 61.81 ± 12.83 years. Out of 30 cases, p53 was positive in 50% of cases, 30% - negative and 20% - equivocal. p53 positive expression pattern was more in high grade (HG) than low grade (LG). Significant difference was observed in the mean p53 scoring (%) and different stages (P = 0.043). CD10 expression was negative in 56.6%, (1+) in 16.6%, and (2+) in 26.6% of cases and significant difference in CD 10 expression was observed between the high and LG (P = 0.001). Ki-67 labeling index was appreciably higher in HG than the LG tumor (32.49% ± 24.35%; 6.86% ± 8.1%). Majority of Ki-67 expression was observed in stage pT2, followed by the pT1 stage. Conclusion: Cocktail of p53, CD10, and Ki67 is useful as potential prognostic markers in bladder cancers.

An event of Evans even in HIV.

Autoimmune cytopenias may be the initial presentation in patients with HIV infection or can develop while on treatment with antiretroviral therapy (ART). These cytopenias usually resolve after initiation of ART. We report a rare case of HIV who presented with Evans syndrome on ART, being refractory to steroids and rituximab but with response to splenectomy.

Masquerading of mismatched blood transfusion by underlying autoimmune hemolytic anemia.

Mismatched blood transfusion due to immunohematological discrepancy is relatively uncommon and in most instances occurs due to Type IV blood group discrepancy which is the discrepancies between forward and reverse groupings. Here, we present a case of a 15-year-old girl with preexisting autoimmune hemolytic anemia (AIHA) who inadvertently received 3 units of wrongly matched packed red blood cell (PRBC), followed by severe intravascular hemolysis. On detailed immunohematological investigation, the patient was found to be autoimmunized and diagnosed with "mixed AIHA" and the patient's blood group was confirmed as "A" positive. Three units of group-specific "best match" PRBC was transfused under close observation without any adverse effect. This highlights the importance of carrying out both forward and reverse blood groupings to avoid mismatched blood transfusion.

Thrombocytosis in children: Clinico-hematological profile from a single centre in Eastern India.

BACKGROUND AND OBJECTIVE: Thrombocytosis is not an uncommon finding in hemograms of children with an incidence of 6%-15% among hospitalized children. This study aims to determine the etiology of thrombocytosis and analyze various platelet parameters in children attending our hospital. MATERIALS AND METHODS: A prospective observational study was carried out in a tertiary care center in Odisha, in eastern part of India, for 6 months from July 2016 to December 2016. All children of age group 1-14 years of age attending pediatrics and other pediatric super specialty outdoors and/or admitted to indoors and whose complete blood counts (CBC) were done were included in the study. The CBC parameters such as hemoglobin, red blood cell indices, and platelet indices (platelet distribution width [PDW], mean platelet volume [MPV], platelet large cell ratio [P-LCR]) were noted. RESULTS: Out of 2500 hemograms done in pediatrics age group, 272 (10.8%) patients showed thrombocytosis. About 99.6% of cases were of secondary thrombocytosis. Only one case of primary thrombocytosis was encountered. The most common cause of secondary thrombocytosis was infection (39.5%) alone followed by iron deficiency anemia (14.1%). With increasing platelet counts, a decrease in MPV, P-LCR, and PDW was noted which was statistically significant (P < 0.05). CONCLUSION: Thrombocytosis is not rare (10.8%) in children. Secondary thrombocytosis is common and predominatly attributed to infection.

Utilization of Antenatal Care Services in Dalit Communities in Gorkha, Nepal: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Antenatal care (ANC) is one of the main components of maternal health. Utilization of safe motherhood is deprived in women who belong to low-caste groups like Dalit of Nepal. Low socioeconomic status, poor knowledge and awareness on obstetric complications, lack of decision-making autonomy, and limited health care options lead to underutilization of existing maternal health care service. The aim of this study was to ascertain the utilization of antenatal care services in terms of ANC visits with health personnel, receiving recommended period of iron tablets, consumption of antihelminthes and number of Tetanus Toxoid (TT) vaccines taken among child bearing women in Dalit community. MATERIALS AND METHODS: Descriptive cross-sectional research design was used to conduct the study of 150 child bearing women of reproductive age (15-49 years) having at least one child up to three years of age in a Dalit community of Gorkha from March 2015 to March 2016. The data was collected from each mother by conducting face to face interview with each household by using a questionnaire. RESULT: The study revealed that mean age at marriage of respondents was 17.7 years and mean age at first pregnancy was 18 years. 44.6% of respondents experienced complication during last pregnancy, labour, and postpartum period in their last pregnancy. 59.3% of respondents stated that neighbors, relatives, and traditional healers were the best first contact person during health problem of women. 76.0% of respondents had attended antepartum visit during their last pregnancy whereas 24.0% of respondents did not attend any antepartum clinic. 68.3% of the mothers had consumed Iron/Folates within 45 days after delivery. Only 30.0% of respondents received antihelminthes (albendazole) while 70.0% of respondents had received TT Vaccines during their last pregnancy. Age, type of family, and education of the mothers were significantly associated with utilization of antenatal care services. CONCLUSION: Even though there is reasonable good utilization rate of antenatal service, the study revealed that low education and awareness among mothers, low socioeconomic condition, early marriage and pregnancy, inappropriate antenatal health check-up, and cultural taboos were significant factors affecting the satisfactory utilization of services among the Dalit community. Hence, there is a need to emphasize on raising awareness of Dalit mothers for receiving available prenatal services.