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Introduction: Integrated teaching helps the students to understand the concepts well and conceptualise the subject well. Clinical cases introduced in the first year are interesting and stimulative for the student but may overwhelm and confuse the student. Aim: To know the perception and acceptance of integrated teaching among the first year Bachelor of Medicine and Medicine of Surgery (MBBS) students which include multiple case scenarios. Materials and Methods: This educational research is a crosssectional observational study involving first year medical students in Ramaiah Medical College, Bangalore. Study was conducted for a period of one year (August 2018 to June 2019). Horizontal integration of a system in the first year MBBS subjects were done. This was followed by an interactive session conducted by a Clinician basically comprising of multiple case scenarios on the particular system. The sessions focussed on integration of basic medical science subjects and their application in the case scenarios. Six organ-systems were similarly covered. The integrated sessions involved in class discussions of the clinical cases and were designed, implemented and moderated by two faculties (clinicians and basic science faculty). Collected data were entered into MS Excel, and analysis was done using Statistical Package for the Social Science (SPSS) software. The students’ feedback regarding the perception of integrated teaching was collected on the Five point likerts scale using a validated questionnaire and analysed. Results: The number of students included in the study was 140. About 135 (96.43%) of the students felt that integrated teaching using multiple case scenarios motivates them to learn in a better way. About 133 (95%) of students felt that integrated teaching helps them to understand concepts well, stimulates the critical thinking. About 136 (97.14%) of students felt that integrated teaching helped them to understand the topic in a holistic way. Conclusion: The students felt that the integrated teaching using multiple case scenarios enhanced their perception and comprehension of the diseases and helped them to understand the relevance of application of pre-clinical knowledge in clinical practise.

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in the United States. NHL comprises a heterogeneous group of over 40 histological subtypes, each of which has distinct genetic, morphologic and clinical features. While NHL epidemiology as a single entity has been well-characterized using population-based cancer registry data, the epidemiology of NHL subtypes is not well understood and even less data are available for rarer subtypes. We aimed to determine geodemographic correlates for NHL subtypes in North Carolina to provide rarely reported epidemiologic characterization of each distinct malignancy. Methods: Demographic data were obtained on all NHL subtypes reported in persons >18 years of age from 2009-2019 from the North Carolina Central Cancer Registry (NCCCR). NHL subtypes were determined based on World Health Organization International Classification of Diseases for Oncology,Third Edition (ICD-O-3) Morphology codes provided by NCCCR. Crude incidence and mortality rates were estimated per 100,000 persons for the 10-year period using 2019 population data from the U.S Census Bureau. Urban and rural residence designations were based on zip code using rural-urban commuting codes developed by the Rural Health Research Center. County tier designations were used as markers of economic prosperity, with 3 being most prosperous, and provided by the North Carolina Department of Commerce. Data are being mapped using ESRI ArcMap 10.8.1. Results: A total of 25,627 incident cases of NHL and 9,930 associated deaths were reported between 2009 and 2019 in North Carolina. Therefore, the standard NHL incidence and mortality rates are 24.1 and 9.3 per 100,000 persons. For incident NHL cases, median age at diagnosis was 68 years (range 19-103), 55% were male and 45% female. Most (83%) identified as white, 14% as black, and 3% as other. Median age at death was 70 years (range 19-106). Twenty-eight NHL subtypes were identified with the four most common NHL subtypes being Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL), Diffuse Large B Cell Lymphoma (DLBCL), Follicular Lymphoma (FL), and Marginal Zone Lymphoma with 6.54, 6.42, 3.55, and 2.0 cases (per 100,000 persons), respectively. Least common subtypes included Intravascular Large B Cell Lymphoma, Primary Effusion Lymphoma, Primary Cutaneous Gamma Delta T-cell Lymphoma (PCGD-TCL) and Subcutaneous Panniculitis-Like T-cell Lymphoma, all with 0.01 cases per 100,000 persons (or 15, 14, 9 and 6 cases respectively). The distribution of NHL subtypes varied according to demographics with several notable findings. DLBCL had the highest crude mortality rate of 2.98 deaths/100,000 persons, followed by CLL (2.12 deaths/100,000 persons), FL (0.98 deaths/100,000 persons) and Lymphoma NOS (0.51 deaths/100,00 persons). Mediastinal Large B-cell Lymphoma (MLBCL) was diagnosed in the youngest individuals with median age of 36 (range 20-74), whereas PCGD-TCL occurred in the oldest with median age of 74 (range 31-99). Primary Effusion Lymphoma had the highest male predominance (93%) and MLBCL had the highest female predominance (73%). Mantle Cell Lymphoma had the highest predominance of persons who identify as white (90%), Anaplastic Large Cell Lymphoma (ALK+/-) with those who identify as black (66%), and Primary Effusion Lymphoma with those who identify as other (14%). Predominance of rurality and county tier designations varied by NHL subtype. Conclusions: A registry-based assessment of NHL subtypes illustrates the heterogeneous nature of this group of malignancies and highlights significant variation in the geodemographic features of each subtype. Evaluating geodemographic correlates deepens our understanding of NHL subtypes and can inform populations at risk for each unique NHL subtype. Figure 1 Figure 1. Disclosures Dittus: BeiGene: Other: Advisory Board; Seattle Genetics: Research Funding; AstraZeneca: Research Funding; Genentech: Research Funding.

Background: Malaria is most important parasitic disease affecting humans. The literature relating to malaria and the blood groups are sparse and have mixed response. Objectives: The study was undertaken to assess the distribution of ABO blood group and their relationship with malaria species and parasite load. Methods: In 200 malaria positive patients blood group analysis was done. Malaria parasite detection and load estimation was done using quantitative buffy coat (QBC) methodology using a fluorescent microscopy. ABO blood group was determined by agglutination test using antisera. Results: A total of 200 were included in the study of which 121 cases were positive for plasmodium vivax, 32 cases were positive for plasmodium falciparum and 47 patients had mixed infection. The results of blood groups showed, 63 malaria infected patients with A blood group, 50 with B blood group, 80 with O blood group and 7 with AB blood group. Maximum parasite load was noted in blood group O, followed by group A and B. The most common blood group infected with plasmodium vivax is blood group O, similarly with 3+and 4+ parasite load is blood group O. Conclusion: This study suggests significantly higher proportion of O blood group malaria patients infected with plasmodium vivax with higher parasite load.

Background:The pre-donation haemoglobin (Hb) estimation is the only laboratory test done on blood donors to determine an individual's eligibility to donate blood with an intention to prevent bleeding an anaemic donor. With availability of wide range of screening methods, no single technique has emerged as the most appropriate and ideal for screening blood donors. The primary objective of the study was to compare results of copper sulphate method and haemoglobin meter with the gold standard Cyanmeth hemoglobin (CyanHb) method. Materials and methods : Prospective observational study done in 238 blood donors. Sample analyses were done using Copper sulphate solution, haemoglobin meter and Cyanmeth haemoglobin method. Results : Mean values of three methods Cyanmeth haemoglobin, and Haemoglobin meter methods are 12.5±2.2, and 13.08±1.61 respectively. Haemoglobin values obtained by haemoglobin meter and copper sulphate methods were comparable, with sensitivity of 94.25% and 94.47% respectively. Conclusion : CuSo4 method and haemoglobin meter can be used alternatively based on resources available. The higher values obtained by CyanHb method could be due to turbidity factor of the lipids in the blood sample.

Objectives : The objectives of the study were to study the relation of total body adiposity and abdominal adiposity markers with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in adolescents in Bengaluru. Methods : 125 healthy children from a school and 70 asthmatics from Ramaiah hospital between 10 and 15 years were included in the study. Anthropometry including weight, body mass index (BMI), waist and hip circumference, and abdominal height was done in all study adolescents. The subjects were categorized according to BMI. Pulmonary function tests (PFTs) were done by Knudson method and FEV1, FVC, and peak expiratory flow (PEF) were measured. The patients were classified by their asthma severity according to GINA guidelines. Results : BMI, weight, waist and hip circumference correlated with abdominal height in male asthmatics and controls where they revealed significant correlations with FEV1/FVC% ratio. In females, abdominal height correlated with BMI, weight, waist and hip circumference in both the groups. PEF correlated with BMI, weight, waist circumference, and abdominal height in healthy females. FEV1/FVC correlated with BMI, abdominal height in female asthmatics, with weight in healthy females. Independent predictors of FEV1/FVC% ratio were hip circumference in males and abdominal height, and waist circumference in females. Conclusion : Increase in obesity is associated with reduced lung volumes and flows. The abdominal adiposity markers (waist and hip circumference, and abdominal height) are significant and effective predictors of obesity and the variations of PFT’s than total adiposity markers (BMI and weight).

Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months) the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services.

Introduction: In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94%. Aim: The aim of this study was to explore the barriers for seeking psychiatric help by qualitative analysis of stake holders of male victims of child abuse. Materials and Methods: All the statements made by the stakeholders regarding psychiatric assessment and treatment were recorded in each referral made to the psychiatrist. Semistructured interviews and in-depth interviews were conducted to explore the topic of understanding the need for psychiatric treatment to the victims. Results: Collaborative child response unit, a multidisciplinary team, to tackle child sexual abuse in a general hospital received three referrals of male child abuse among the 27 referrals in 20 months. The main theme of the barrier that was generated by interviewing the stakeholders of male child victims of abuse was the misconception of superiority of a male victim due to gender (patriarchy) an expectation that he will outgrow the experience. In-depth interviews of three cases of homosexual abuse explored the theme. Conclusion: Patriarchy is oppressing male children and acts as a barrier to seek psychiatric help in collaborative child response unit.

Background Population-based cancer registries collect information on first course of treatment that may be utilized in research on cancer care quality, yet few studies have investigated the validity of this information. We examined the accuracy and completeness of registry-based treatment information in a cohort of adolescent and young adult women. Methods Women diagnosed with breast cancer, lymphoma, thyroid cancer, cervical/uterine cancer or ovarian cancer at ages 15–39 during 2003–2014 were identified using data from the North Carolina Central Cancer Registry (CCR) (N = 2342). CCR data were linked to Medicaid and private insurance claims data, and claims were reviewed for the 12 months following diagnosis to identify cancer treatments received. Using claims data as the gold standard, we calculated the sensitivity and positive predictive value (PPV) of CCR data for receipt of chemotherapy, radiation and hormone therapy. We also compared dates of treatment initiation between the two data sources. Results For all cancer types combined, the sensitivity of the CCR data was high for chemotherapy (86%) and moderate for radiation (74%). PPVs were 82% and 83% for chemotherapy and radiation, respectively. Both the sensitivity (67%) and PPV (70%) were lower for hormone therapy for breast cancer. For all three treatment types, dates of initiation in the registry and the claims differed by ≤30 days for most women. Conclusions In this cohort of young women, population-based cancer registry data on chemotherapy receipt was reasonably accurate and complete in comparison with insurance claims. Radiation and hormone therapy appeared to be less complete.

Triple-negative breast cancer (TNBC) is an aggressive subgroup of breast cancer which lacks effective target therapy. Expression of biomarkers is one of the important deciding factors for treatment strategies. The aim of this study was to evaluate expression of E cadherin and Ki 67 in relation to clinicopathological features. This prospective observational study included 141 cases of TNBC. Immunohistochemical staining was employed to analyze two biomarkers: E cadherin and Ki 67 on formalin-fixed paraffin-embedded tumor samples obtained from patients defined as TNBC. The age of the patients ranged from 26 to 84 years. Positive lymph nodes were found in 82 (58.1%). The tumor was grade 3 in 105 (74.4%). The E cadherin receptor was positive in 83 (58.8%). The Ki Index was > 10% in 89 (63.12%). The Ki 67 expression was significantly associated with a high nuclear grade (p = 0.000). The significant association noted between loss of E cadherin expression and positive lymph node (p = 0.0296). According to the results, TNBCs are frequently associated with the younger age groups, and the majority is poorly differentiated. The majorities of these have high expression of the Ki 67 and significantly associated with the higher nuclear grade. Loss of E cadherin was significantly associated with positive lymph nodes. Hence, evaluating the expression of E cadherin and Ki 67 routinely would be helpful for evaluating prognostic implications.

Objective: To assess the role of procalcitonin (PCT) in the diagnosis and prognosis in children with sepsis. Design: Prospective, observational study. Setting: Tertiary care center in South India. Participants: Children, 1 month to 15 years of age, admitted with the diagnosis of sepsis excluding children with chronic systemic/inflammatory disease, degenerative neurologic disease, primary/ acquired immune deficiency, on steroids and children who had trauma/burns. Intervention: None. Main Outcome Measures: Serum PCT levels, grades of sepsis and mortality. Results: Respiratory tract infection was the most common source of sepsis (71%). Of the 53 patients studied, PCT was >2 ng/ml in 42 (79.2%) patients. Mean PCT values were 9.63, 17.72, and 84.68 ng/ml in sepsis, severe sepsis, and septic shock, respectively. PCT was found to be 86.36% sensitive, 55.56% specific with a positive predictive value (PPV) of 90.48, and negative predictive value of 45.45. 79.2% of patients in the study were discharged and 18.9% died. PCT levels were high in children who died subsequently. Conclusions: There is a positive association between PCT levels and the severity of sepsis as reflected by high sensitivity and PPV. High PCT levels also indicate increased chances of mortality. Key words: Procalcitonin, Sepsis, Septic shock, Severe sepsis, Systemic inflammatory response syndrome

Glomangiopericytoma belongs to a spectrum of lesions which include myofibromatosis, myofibroma, and subset of sinonasal hemangiopericytomas. [1, 2] Stout and Murray in 1942 initially reported GPC as hemangiopericytoma, the tumors displaying a characteristic well developed ‘staghorn’ branching vascular pattern [2] Over the years this definition has been questioned and hemangiopericytoma was better considered as a diagnosis of exclusion, as it appeared that this growth pattern was non-specific, shared by numerous, unrelated benign and malignant lesions and that GPC and SFT belongs to category of lesions which are individualised within the heterogeneous group of hemangiopericytoma – like neoplasms. [2] GPC characteristically has a component of cells with glomus type features including cuboidal cells, distinct cell borders, clear to eosinophilic cytoplasm and central round nuclei. Glomus tumors involving, internal organs are very rare and most often situated in GIT. In GIT, tumors usually involve the stomach but tumor developing in the omentum have not been reported. [3] We report a case of GPC of omentum and challenges we faced in immunohistochemistry interpretation based on literature review.

Objectives: To study the clinical characteristics and laboratory profile of systemic lupus erythematosus (SLE) in children in a tertiary care center. Methods: Children presenting to our tertiary care center with suspected SLE, fulfilling at least 4 out of 11 American College of Rheumatology (ACR) criteria for the diagnosis of SLE were reviewed retrospectively. The study period was from June 2012 to May 2015. The clinical presentation and laboratory parameters were analyzed. Results: A total of 14 patients fulfilled the ACR criteria; there were 12 girls and 2 boys with a sex ratio of 1:6 favoring girls. The mean age on presentation was 9.8 years with a range of 3-15 years. At presentation, 70% of the children had features not suggestive of SLE. The most common symptom was fever seen in 100% of the patients, followed by hematological abnormalities in 78%, and renal involvement in 57% patients. Arthritis, skin lesions, and pulmonary involvement were seen in 42% of the patients. The gastrointestinal presentation was seen in 21% of the patients. Conclusion: SLE has a varied clinical presentation depending on the predominant organ involved. A high index of suspicion is required for the early diagnosis of SLE in children. Key words: Anemia, American College of Rheumatology, Antinuclear antibodies, Arthralgia, Lupus nephritis, Systemic lupus erythematosus

Background: Sleep is an integral part of any healthy individual and sleep problems can affect the intellectual abilities including the performance at school. Objectives: We studied the sleep problems among school going children in the age group of 6-16 years and the association of the sleep problems with scholastic performance in them. Materials and Methods: The study was a cross-sectional study carried out in students attending a private school. The children were given a questionnaire based on the “BEARS” screening tool for sleep problems in children to be filled by children and parents. Accordingly, the age and academic grades of students were recorded. The prevalence of sleep problems and their relation to school grades were studied. Results: Out of 229 students, 25.33% (58) students were found to have sleep problems after applying the “BEARS” criteria. Of these 58 children, 31 scored A grade, 25 scored B grade, and 2 scored C grade. 23% (31 out of 135) of A graders were found to have sleeping problems, 28% (25 out of 89) of B graders, and 40% (2 out of 5) of C graders had sleeping problems. Conclusion: Sleep problems were common in school going children. It was observed that as scholastic grades decreased, the prevalence of sleeping problems increased. Sleep problems might be one of the contributors for poor scholastic achievements in children.

Importance Children with birth defects have a greater risk of developing cancer, but this association has not yet been evaluated in children conceived with in vitro fertilization (IVF). Objective To assess whether the association between birth defects and cancer is greater in children conceived via IVF compared with children conceived naturally. Design, setting, and participants This cohort study of live births, birth defects, and cancer from Massachusetts, New York, North Carolina, and Texas included 1 000 639 children born to fertile women and 52 776 children conceived via IVF (using autologous oocytes and fresh embryos) during 2004-2016 in Massachusetts and North Carolina, 2004-2015 in New York, and 2004-2013 in Texas. Children were followed up for an average of 5.7 years (6 008 985 total person-years of exposure). Data analysis was conducted from April 1 to August 31, 2020. Exposures Conception by IVF for state residents who gave birth to liveborn singletons during the study period. Birth defect diagnoses recorded by statewide registries. Main outcomes and measures Cancer diagnosis as recorded by state cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for birth defect-cancer associations separately in fertile and IVF groups. Results A total of 1 000 639 children (51.3% boys; 69.7% White; and 38.3% born between 2009-2012) were in the fertile group and 52 776 were in the IVF group (51.3% boys; 81.3% White; and 39.6% born between 2009-2012). Compared with children without birth defects, cancer risks were higher among children with a major birth defect in the fertile group (hazard ratio [HR], 3.15; 95% CI, 2.40-4.14) and IVF group (HR, 6.90; 95% CI, 3.73-12.74). The HR of cancer among children with a major nonchromosomal defect was 2.07 (95% CI, 1.47-2.91) among children in the fertile group and 4.04 (95% CI, 1.86-8.77) among children in the IVF group. The HR of cancer among children with a chromosomal defect was 15.45 (95% CI, 10.00-23.86) in the fertile group and 38.91 (95% CI, 15.56-97.33) in the IVF group. Conclusions and relevance This study found that among children with birth defects, those conceived via IVF were at greater risk of developing cancer compared with children conceived naturally.

Background Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis. Methods The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage. Results For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall. Conclusions For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.

Background: ABO and Rh blood groups are most important blood groups in human beings. The frequency of four main blood group systems varies in population throughout the world and even in different parts of country. Objective if this study was to identify distribution of ABO and Rh blood group system. Materials and methods: The study was conducted in rural tertiary care hospital from January 2008 to December 2012. Data were collected from Blood Bank grouping records. All blood samples processed during period of observation were included in study. Results: During the period of observation total 43,103 numbers of blood groups were performed. Patient's samples were 28,305 and donor's samples were 14,798. The frequency of blood group O in our population was 42.0% (40.1% O Rh positive and 1.8% O Rh negative). The frequency of blood group B in our population was 27.3% (25.6% B Rh positive and 1.62% B Rh negative) followed by blood group A was 25.8% (24.3% A Rh positive and 1.4% A Rh negative) and blood group AB was 4.8% (4.4% AB Rh positive and 1.4% AB Rh negative) and a two Bombay blood group donors (0.0046%). Rh positive were 94.64% and Rh negative were 5.35%. Discussion: O positive blood group is significantly high in our population. Every transfusion centre should have a record of frequency of blood group system in their population. It helps in inventory management. Knowledge of blood group distribution is important for clinical studies, for reliable geographical information and for forensic studies in the population.

Subclinical hypothyroidism (SCH) can negatively affect cognitive functioning. This study aimed at correlating serum T3, T4, TSH with adolescent’s performance on a learning disability scale. Methods: A cross-sectional study was conducted on 100 schoolchildren, (10 - 15 years). Thyroid hormones were estimated and classified into two groups: euthyroid and subclinical hypothyroid. NIMHANS index for Specific Learning Disabilities was used to assess the learning ability and cognitive functions. Results: Subclinical hypothyroid group made more mistakes than euthyroid group. In SCH male group, T3 correlated with language and T4 levels correlated in all areas except in language. In the females, there is no significant correlation between T3 and ability parameters except in partial correlation coeffeicient among euthyroid children in arithmetic, visual-motor skills and memory. T4 results did not correlate in language skills. There was a statistical significance between T4 and ability skills in girls except in language. TSH and language skills correlated in females. Conclusion: T3 and T4 levels have correlation with cognitive skills other than TSH. It is necessary to measure both T3 and T4 in addition to TSH in adolescents.

Dirofilariasis is a zoonotic filarial parasitic infestation. Its prevalence has increased in recent times. Hence, it is described as an emerging zoonosis. However, not many cases of subcutaneous manifestation of the disease have been reported in the literature. Here, we are presenting two cases of dirofilariasis manifesting as a breast mass causing a diagnostic dilemma in treating clinician. We present two cases of dirofilariasis in the breast tissue mimicking a tumor initially, and on histopathology, it was diagnosed as a Dirofilaria infestation. The increased incidence of Dirofilaria infestation in the Southern part of the country has created a need for increased awareness among the population living in endemic areas to reduce the load of the parasite. Hence it is an ideal time to initiate the primary preventive measures to reduce the incidence of Dirofilaria infestation.

Autoimmune hemolytic anaemia (AIHA) is rare clinical disorder and requires efficient immunohematological and transfusion support. We report two cases of Immune hemolytic anaemia. A case of AIHA in congestive cardiac failure and second a known case of Giant cell arteritis with cold antibodies. Both the cases we encountered problems during cross matching.

Fibrous dysplasia (FD) is a benign disorder affecting one or more bones seen in all age groups and shows no geographical, racial and sex predilection. Fibrocartilaginous dysplasia (FCD) is a type of fibrous dysplasia where there is extensive cartilaginous differentiation. Our patient was a young girl with a 2 year history of pain in the right forearm and hip. Imaging studies showed multiple lucent lesions in the femur, humerus and radius. Microscopic examination of the curetted fragments from the lesion showed predominant cartilaginous components with focal fibro-osseous areas and areas of enchondral ossification. We present this case due to its rarity and the importance of distinguishing FCD from other benign and malignant cartilaginous tumors as it mimics these in clinical and histological features.

Context: The data on histological and receptor status in breast cancer in an Indian population is limited as receptor status is not routinely carried out for these patients. In the present study, receptor status was analyzed and it was correlated with morphological prognostic parameters. Objective: To analyze the morphological prognostic parameters and its correlation with receptor status in Indian women. Design: The sample consisted of 126 specimens of invasive breast cancer received in department of pathology of our institution with teaching hospital attached to it, situated in South Canara district of, Karnataka, South India between year 2009 and 2011. Result: Sixty-seven percent of patients were 50 years or younger. Histological types were invasive ductal carcinoma, not otherwise specified (58.7%), and overall (15.9%) were grade 3. Estrogen receptor was positive in 36.5%, HER/neu was overexpressed in only three cases; 50.0% were "triple" negative (estrogen receptor, progesterone receptor, HER/neu negative). Estrogen receptor (ER) and progesterone receptor (PR) positivity decreased with increase in tumor grade. There was significant association between tumor size and ER positivity. Conclusions: Breast carcinoma in our population presents at younger age than Western population. Our results showed very high proportion of triple-negative breast cancers. The tumor size and grade is related to expression of only ER. The findings suggest that women in our population more often have histologically aggressive breast carcinoma at young age, likely to be less susceptible to conventional hormonal and targeted antibody treatment. Detecting and treating this increasing important cause of mortality will be an enormous challenge.

Data on initial treatment of 8232 cases of localized prostate cancer diagnosed in 2004 were obtained by medical record abstraction (including hospital and outpatient locations) from seven state cancer registries participating in the Centers for Disease Control and Prevention's Breast and Prostate Cancer Data Quality and Patterns of Care Study. Distinction was made between men receiving no therapy with no monitoring plan (no therapy/no plan [NT/NP]) and those receiving active surveillance (AS). Overall, 8.6% received NT/NP and 4.7% received AS. Older age at diagnosis, lower clinical risk group, and certain registry locations were significant predictors of use of both AS and NT/NP. AS was also related to having more severe comorbidities, whereas nonwhite race was predicted receiving NT/NP. Men receiving AS lived in areas with a higher number of urologists per 100 000 men than those receiving NT/NP. In summary, physician and clinical factors were stronger predictors of AS, whereas demographic and regional factors were related to receiving NT/NP. Physicians appear reluctant to recommend AS for younger patients with no comorbidities.

The thiazolidinediones (TZDs) are a class of oral antidiabetic drugs that improve insulin sensitivity in patients with type 2 diabetes. Although the mechanism by which the TZDs lower insulin resistance is unclear, they are known to target the peroxisome proliferator-activated receptor γ (PPARγ), a nuclear hormone receptor. Ligands for PPARγ regulate adipocyte production and secretion of fatty acids as well as glucose metabolism, resulting in increased insulin sensitivity in adipose tissue, liver, and skeletal muscle. However, TZDs have several adverse effects, including weight gain and liver toxicity. Herein we report identification of non-TZD PPARγ agonists which exhibit beneficial effects similar to that of TZDs in animal models, but without the associated adverse effects.

Introduction Diallyl disulphide is an organo-sulphur compound which is present in garlic and responsible for the characteristic odor of garlic. It is known for its anticancer and invitro membrane stabilizing properties. Aim The main aim was to evaluate the haematopoietic, antioxidant and membrane stabilizing property of diallyl disulfide in irradiated mice. Materials and methods Mice were grouped into 6 groups as control, drug control, radiation control and drug pre-treatment groups (i.e. drug administration + radiation group) The mice were fed orally for 15 consecutive days and on the 15(th) day, one hour after drug administration, the mice were irradiated with 6Gy electron beam radiation. The changes in blood cell count, total antioxidant levels, malondialdehyde and reduced glutathione levels were determined. The immunomodulatory response of DADS to the radiological effects was determined by the estimation of IL-6 levels. Results A significant improvement in pre-drug treatment group when compared to control groups in the haemoglobin, red blood cell count, white blood cell count, haematocrit and platelet counts was observed. There is an increased level of interleukin-6 in the drug treated groups compared to the radiation control. An increase in the malondialdehyde levels and decrease in the glutathione levels in the irradiated group indicate increased lipid peroxidation and oxidative stress, whereas, there is a significant reduction in the malondialdehyde levels and increased glutathione levels in the drug pre-treatment groups showing membrane stabilization. Conclusion Thus DADS proves to be an effective haematopoietic and antioxidative agent to counter radiation induced haematopoietic suppression and oxidative stress.

Objective Cervical cancer causes over 4000 deaths yearly in the United States, although highly preventable through vaccination, screening, and early treatment. We aimed to determine demographic correlates for cervical cancer in North Carolina to identify target populations for interventions and to create a framework for state-level analyses. Method Data on all reported invasive cervical cancer cases from 1998 to 2007 were obtained from the North Carolina Central Cancer Registry. Age-adjusted incidence and mortality rates were estimated using population data from the National Center for Health Statistics. Results Cervical cancer incidence and mortality rates varied greatly by county and were inversely associated with county prosperity. Hispanic women had the highest incidence rate, black women the highest mortality rate, although white women accounted for most cases. Incidence rates remained fairly steady above age 35 and mortality rates steadily increased with age. A later stage at diagnosis was more common for older women and for women without private insurance. Conclusion Registry-based assessment illustrates the economic, racial, and age disparities associated with cervical cancer. This localized focus on demographic correlates is an important step toward eliminating this preventable disease and offers a template for cervical cancer prevention programs in other states.

Background: To date, no study has reported on the cost of treating breast cancer among Medicaid beneficiaries younger than 65 years of age. This information is essential for assessing the funding required for treatment programs established by the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Objective: This study assesses the incremental cost of breast cancer treatment among Medicaid beneficiaries aged below 65 years. Research Design: Administrative data from the North Carolina Medicaid program linked with cancer registry data were analyzed to derive monthly Medicaid costs for cancer patients and the incremental costs of breast cancer treatment at 6, 12, and 24 months from diagnosis. We compared 848 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 1696 comparison cases matched on age. Results: With the exception of in situ cancers, the cost of cancer care continued to increase beyond the initial 6-month period. The incremental costs at 6 months after diagnosis are $ 14,341, $ 24,002, and $ 34,469 for those with local, regional, and distant breast cancers, respectively; and these costs increased to $ 22,343, $ 41,005, and $ 117,033 at 24 months. Conclusions: The extended period of health care utilization, beyond the immediate 6-month period after diagnosis, indicates that Medicaid coverage may be required for many months after diagnosis to complete treatment. Continuous Medicaid coverage should be provided for an adequate time period to ensure that complete and comprehensive treatment is provided.

Background To date, no study has reported on the cost of treating cervical cancer among Medicaid beneficiaries younger than 65 years of age. This information is essential for assessing the cost effectiveness of screening interventions for low-income women and the funding required for treatment programs established by the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Methods Administrative data from the North Carolina Medicaid program linked with cancer registry data were used to analyze total Medicaid costs for these patients and the incremental costs of cervical cancer care at 6 and 12 months from diagnosis. We compared 207 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 414 controls. Findings Total Medicaid costs at 6 months after diagnosis were $3,807, $23,187, $35,853, and $45,028 for in situ, local, regional, and distant cancers, respectively. The incremental cost of cancer treatment for local and regional cancers was $13,935 and $26,174 and by 12 months increased to $15,868 and $30,917, respectively. Conclusion Medicaid coverage may be required for many months after diagnosis to ensure the provision of comprehensive care, especially for women with late-stage cancers. Given the great differences in cost of early versus late-stage cancers, interventions aimed at increasing screening among low-income women are likely to be cost effective.

Langerhans cell histiocytosis most commonly occurring in children, demonstrates a broad spectrum of clinical and radiologic features that may mimic those of infection as well as benign and malignant tumors. Osseous involvement is the most common manifestation. Recognition of the skeletal alterations is important so that the disease is considered as differential diagnosis. This disease is of unknown aetiology, non-specific clinical and imaging findings with diagnosis possible only on histopathological examination, will always pose a diagnostic challenge to the orthopaedic surgeon. Here by we are reporting two cases of eosinophilic granuloma that has presented with lytic lesion in the tibia and scapula. The clinico-radiological suspicion was either infection or tumour of the affected bones. Hence, core biopsy was done confirmed as eosinophilic granuloma on histopathology and immunohistochemistry.

Objectives: To describe the epidemiology and clinical profile of cases of HFMD in an outbreak. Design: Descriptive epidemiological study. Setting: Tertiary care center in North Bangalore. Methods: Patients attending to M.S.Ramaiah medical college hospital with features suggestive of HFMD were included in the study. The patient's demographic data, clinical features and examination findings were entered in to a predesigned format. The epidemiol- ogy and clinical features were analyzed using appropriate statistical methods. Results: A total of 71 children were diagnosed as HFMD disease, 47 (66.2%) were boys and 24 (33.8%) were girls, fever was seen in 62 (87.3 %) of the affected children, anorexia and sore throat was seen in 47 (66.2 %) and 35 (49.3%) children respectively. Typical rashes were seen on hands in 67 (94.4%), 64 (90.1%) had rashes on feet, 58 (81.7%) had mouth ulcers, and 37 (52.1%) had rashes on buttocks. There was history of exposure to a HFMD in 46 (64.8%) of the children mostly at home in 19 (26.8%), at day care centers in 14 (19.7%) and in 13 (18.3%) at school. The disease lasted between 2 days to 8 days. There were no complications noted. Conclusion: HFMD affected mainly children in the age group of 1-10 years, affected more boys than girls, complete recovery without any major complications was seen in the present outbreak. The characteristic clinical features will be helpful in early diagnosis of HFMD and will help in looking for any complications occurring in HFMD.

Imerslund Grasbeck syndrome (IGS) is a rare autosomal recessive childhood disorder characterized by selective Vitamin (vit) B 12 malabsorption with asymptomatic proteinuria without any structural renal pathology. The patients stay healthy for decades with life-long parenteral vit B12. We report a case of young female who presented with pancytopenia and proteinuria, evaluated in local hospitals as chronic hemolytic anemia (autoimmune cause), finally diagnosed as IGS on complete evaluation. She was treated with injectable vit B12 (1000 μg cyanocobalalmin) and showed drastic recovery. IGS should be considered in patients with megaloblastic anemia not responding to oral vit B12 and associated proteinuria.

Background and Purpose: Triple Negative Breast Cancer (TNBC) is defined by a lack of expression of the steroid hormone receptors (oestrogen and progesterone), and the human epidermal growth factor receptor-2 (HER-2). It is characterized by distinct molecular, histological and clinical features. It is a high risk breast cancer that lacks the benefit of a specific therapy. Our study was aimed at pathologically illustrating triple-negative breast carcinoma and at evaluating the expression of the Epidermal Growth Factor Receptor (EGFR) ,cytokeratin 5/6 (CK 5/6) and Ki-67 among triple-negative breast cancer cases. Further, we aimed to probe whether triple–negative phenotype could be a surrogate marker for the basal phenotype and to correlate the expression of the basal markers (CK 5/6 and EGFR) with the clinico-pathological prognostic parameters. Methods: The expression of EGFR, CK 5/6 and Ki-67 were studied by immunohistochemistry (IHC) in 50 triple-negative breast cancer cases. Statistical Analysis: A statistical analysis was implemented by using the SPSS version 20.0. The Chi-square test was conducted to assess the relationship between the immunohistochemical markers and other variables. The Fischer exact test was used when the expected cell counts were less than 5. Results: The women with triple-negative breast cancer were younger, with the adverse pathological characteristics of a high tumour grade, tumour necrosis, frequent nodal metastases and high proliferation. 37 (74%) of the 50 triple-negative breast carcinomas showed the expression of the basal markers (EGFR and /or CK 5/6). We observed a statistically significant association between the basal marker expression and the presence of tumour necrosis. Conclusion: The triple-negative breast cancers in our population harbour adverse pathobiological features and a five marker immunohistochemical panel can be reliably used to define the basal-like cancers. The “Triple-negative” status cannot be used as a surrogate for the “basal marker expression”.

Introduction: Plasmodium vivax infection-associated hematological changes including severe anemia can cause significant morbidity and indirect mortality. Objective: The objective of the study is to analyze hematological changes in P. vivax malaria patients and to review pathogenesis and cause of death in P. vivax infection. Materials and Methods: During a 1-year period, patients who were screened and confirmed as P. vivax by quantitative buffy coat and peripheral smear were included in the study. The demographic details and hematological profile (hemoglobin, total white blood cell count, and platelet count) were correlated. The severity of anemia was graded based on hemoglobin and correlated with parasitemia. Results: Two hundred patients were included. Twelve of them in addition showed Plasmodium falciparum. Thrombocytopenia (74.5%) was a significant feature compared to anemia (4.5%) and leukopenia (20.5%). Only three patients had hemoglobin level

Metastatic tumors of the intestinal tract from extra-abdominal sites are rare. In cervical cancer, the liver, lung, and the bones are the most common distant sites of metastases. Metastasis to the small intestine is very rare. We report a rare case of metastasis of cervical squamous cell carcinoma to jejunum after a few months of chemoradiotherapy.

Dermatofibrosarcoma protruberans(DFSP) is rare, morphologically distinct dermal/ subcutaneous neoplasm [1]. It typically presents during early or mid adult life. It is most common in the trunk and extremities and it accounts for approximately 0.1 % of all cutaneous malignancies and 6 % of all soft tissue sarcomas [2–4]. DFSP is highly aggressive, invades locally and rarely metastasizes [4]. Surgical scars, old burns, contractures and sites of vaccinations have all been reported as DFSP sites [5, 6]. DFSP occurring in the breast is very unusual. A review of literature reveals very few cases of DFSP breast. DFSP in the breast is usually characterized by smooth mobile raised reddish mass with brownish plaque like cutaneous thickening [6]. Treatment is primarily surgical, with chemotherapy and radiation therapy sometimes being used [6, 7].

Chronic illness can lead to anxiety and depression in both parents and their adolescents. The identification of predictor variables would greatly assist pediatricians and parents in identifying children at risk for prolonged depression. Findings indicate that age and gender of the adolescent and duration of illness did not affect the depression score, but type of illness affected the score significantly. This article illustrates the fact that pediatricians can use the Beck Depression Inventory to identify depression and guide parents and adolescents to adequate medical care.

Adenocarcinoma is the most frequently diagnosed histological subtype of bronchogenic carcinoma in women and nonsmokers [1]. Extrathoracic metastasis is found at autopsy in over 80% of patients with adenocarcinoma. Metastasis to bones is common occurrence in patients with advanced carcinomas, particularly in those with lung, breast or prostate [2]. Metastasis to bone marrow from prostate, breast, pancreas, gastric adenocarcinoma and small cell carcinoma lung have been frequently reported. Bone marrow involvement in pulmonary adenocarcinoma is rare [1]. Here we are reporting a case of adenocarcinoma lung with bone marrow involvement as its first manifestation.

Cervical region teratoma is a rare disease, accounting for 3-5% of all teratomas in the children. Teratomas of the head and neck due to their obscure origin, unpredictable behavior, and often manifest as a clinical surprise. Airway obstruction is the most serious postnatal complication of cervical teratoma. Prenatal diagnosis is crucial for early recognition of the neck masses that could obstruct the airway. We present a case of 4-month-old female child at age of 4 th month with right submandibular region swelling. Computed tomography neck showed ill-defined, multiloculated cystic lesion with enhancing thick septations in the right side of the neck. Excision biopsy revealed Grade I--immature teratoma--cervical region. On 1-year of close follow-up, no evidence of local recurrence or metastasis was seen. Unlike adults, teratomas in children are often congenital and very rarely turn malignant. The treating consultant should be aware of their natural history, clinical features, pathology, and principles of management.

A nine-month-old infant presented with fever and loss of milestones. Examination revealed intermittent rigidity and dystonic movements. Magnetic resonance imaging (MRI) shows decreased signal intensity in globus pallidus and substantia nigra, indicative of iron deposition, suggesting Hallervorden Spatz Disease. The dopamine-neuromelanine system has been postulated to be the possible pathogenesis. Gene mapping has located the defect to be in the coding sequence of a gene called PANK-2. Prenatal diagnosis is possible. The case is reported because of its rarity and early presentation.