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Ninety-five renal transplant recipients from an endemic area of tuberculosis were investigated to find out the prevalence and course of tuberculosis in pre- and post-transplant periods. Eleven patients had tuberculosis in the pre-transplant period - pulmonary (2), pleural (2), miliary (1), abdominal (2), lymph node (5) and pericardial (1). They were transplanted after antituberculous therapy of 3 to 6 months with satisfactory results. The anti-tuberculous treatment was usually continued for 2 years. Only one of the above 11 patients had evidence of tuberculosis in the post-transplant period. Nine patients developed tuberculosis for the first time in the post-transplant period - pulmonary (4), pleural (1), miliary (1), lymph node (4) and pericardial (1). There was no mortality due to tuberculosis. Thorough search for tuberculosis is mandatory both during pre-transplant assessment and post-transplant follow-up in areas of endemic tuberculosis. [ABSTRACT FROM PUBLISHER]

A retrospective review of 143 cases of carcinoma of the gall bladder is presented. The disease was more common in females in the 5th and 6th decades. Pain, anorexia, weight loss and jaundice were the common presenting symptoms, and hepatomegaly and palpable gall bladder the common signs. Laboratory and radiological investigations were merely confirmatory as the diagnosis in a majority of the cases was clinically obvious. Aspiration cytology and laparoscopic biopsy were of help in obtaining histological diagnosis. Only 47 patients were considered fit enough to undergo laparotomy. In a majority of these patients biopsy alone was possible while palliative procedures were performed in the others. The operative mortality was 18% even in this selected group of patients, due to the poor general condition and the advanced stage of the disease at the time of diagnosis. Curative resection may be possible and long term survival is expected in incidentally found carcinoma at cholecystectomy. The only hope lies in prevention by prompt treatment of patients with benign biliary disease. [ABSTRACT FROM PUBLISHER]

Angiomyolipomata of the kidney are unusual lesions composed of abnormal thick walled blood vessels, smooth muscle and adipose elements. These are asymptomatic and occasionally present with flank pain, a palpable mass or gross hematuria. They may be associated with tuberous sclerosis. The risk of bleeding is increased with size, and lesions greater than 4 cm have more than 50% chance of significant bleeding. An unusual case of multifocal renal angiomyolipoma associated with tuberous sclerosis and presenting as massive intra abdominal hemorrhage is reported.

This paper reports a case of a 42 year old female patient who presented with a large multi septate, predominantly cystic ovarian mass with elevated CA-125 levels. A diagnosis of malignant ovarian tumour was made on grounds of pre operative investigations and radical surgery was planned. Histopathological examination however revealed an ovarian fibroma with cystic change reinforcing the non specificity of CA-125 as a marker of ovarian malignancy and establishing the importance of a proper histopathological examination even in the most obvious of cases.

In April 2006, a 55-year-old female presented with a thyroid mass and multiple skin nodules on scalp, forehead and neck. Fine needle aspiration cytology of thyroid mass and multiple skin nodules show tumor cells clusters in a repetitive microfollicular pattern on May-Grunwald-Giemsa stain suggestive of follicular thyroid carcinoma with metastasis to skin. Although follicular carcinoma have a propensity for vascular invasion and hematogenous dissemination, skin is not commonly involved. Only a few cases of cutaneous metastasis from follicular thyroid carcinoma are reported in the English language literature.

Objectives: Both superficial and deep serratus anterior plane (SAP) blocks are effective for anterior chest wall surgeries, but there is little clarity on which is more effective. Hence, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the comparative efficacy of the 2 approaches for SAP block after anterior chest wall surgery., Materials and Methods: A systematic literature search was performed using PubMed, Embase, Scopus, and Cochrane Central Registers of Controlled Trials for eligible RCTs from inception until August 2023. The primary outcome was opioid consumption during the first 24 hours of the postoperative period. The secondary outcomes included pain scores at various intervals, intraoperative opioid consumption, time to first analgesic request, block-related complications, opioid-related side effects, and patient satisfaction scores. Statistical analysis of the pooled data was performed using Review Manager Version 5.3., Results: We identified 7 RCTs published between 2020 and 2022, enrolling 371 patients (186 in the superficial SAP block and 187 in the deep SAP block). Moderate certainty of evidence suggests that both the approaches (deep and superficial) of SAP block were comparable for 24-hour oral morphine equivalent consumption with a mean difference (MD) of 3.78 mg (95% CI: -1.70 to 9.29; P = 0.18; I2 = 87%). The results of other secondary outcomes were comparable, including resting pain scores with an MD of 0.08 (95% CI: -0.27 to 0.43; P = 0.67; I2 = 87%) for early pain and MD of 0.63 (95% CI: -1.28 to 0.01; P = 0.05; I2 = 95%) for late pain scores, time to first analgesic request with MD of -0.41 hour (95% CI: -1.40 to 0.59; P = 0.42; I2 = 90%), and incidence of postoperative nausea and vomiting (odds ratio: 1.45 (95% CI: 0.72 to 2.90; P = 0.30; I2 = 0%)., Conclusion: Current evidence does not support the preference for one approach of SAP block over the other for postoperative pain. Based on the available data, we recommend further future trials to determine any differences between these interventions., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Context: The aim of the study was to identify and monitor the circulating strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the samples received at our center and update the existing national and international genomic surveillance data., Introduction: SARS-CoV-2 is no exception to the basic nature of the viruses ability to change and evolve. Since its first report in December 2019 from Wuhan, China, multiple variants of the virus have emerged and been reported. Five variants of concern have been recognized and reported by the Centers for Disease Control and Prevention, which are associated with variable degrees of transmissibility and mortality., Materials and Methods: Nasopharyngeal and oropharyngeal swabs received in viral transport medium at the Viral Research Diagnostic Laboratory were processed for reverse transcription-polymerase chain reaction for SARS-CoV-2. Whole genome sequencing (WGS) was performed for selective positive samples using Oxford Nanopore sequencing technology, using MinKNOW software for data acquisition., Statistical Analysis: The clades were assigned using Nextclade v2.4.1 software. The statistical analysis was calculated using OpenEpi version 3, an open-source calculator, and two by two., Results: Variants reported over the study period included Alpha, Kappa, Delta, and Omicron. Delta dominated in the year 2021, while Omicron was the dominant variant in 2022. In both the dominant variants, asymptomatics contributed to around 30-40% of positives. Intensive care unit admissions and mortality were higher in the Delta variant, while vaccination history and travel history were higher in the patients with Omicron variant., Conclusion: The trend tracking of these variants has been important in view of public health, enabling early interventions to control the spread of the disease and foresight in preparation for the situation., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

This case describes an atypical cutaneous presentation of metastatic gastric carcinoma in a patient initially presenting with dysphagia and a sclerotic red plaque overlying the anterior neck and chest. Skin biopsy revealed metastatic adenocarcinoma from the upper gastrointestinal tract. Esophagogastroduodenoscopy revealed stage IV metastatic gastric adenocarcinoma. Treatment with chemotherapy was initiated., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Follicular lymphoma (FL) is a common form of non-Hodgkin lymphoma. Although extranodal involvement of the gastrointestinal (GI) tract is common in lymphomas, primary GI-FL confined to the GI tract is relatively rare. The disease process is typically indolent in nature and usually incidentally found. Among this subset of patients, the duodenum and terminal ileum tend to be the most common site of origin. Here, we present a rare case of primary multifocal GI-FL that found incidentally during routine colonoscopy with subsequent esophagogastroduodenoscopy and video capsule endoscopy revealing duodenal, jejunal, and sigmoid colon involvement., (© 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Airway management is a core skill essential for anaesthesiologists and health care providers involved in resuscitation and acute care of patients. Advancements in airway management are continuously evolving. This narrative review highlights the recent advancements with respect to innovations, tools, techniques, guidelines, and research in both technical and non-technical aspects of airway management. These include nasal endoscopy, virtual endoscopy, airway ultrasound, video endoscopes, supraglottic airways with enhanced protection against aspiration, hybrid devices, and the use of artificial intelligence and telemedicine, the utility of which has increased in recent times, thereby improving success with airway management and enhancing patient safety. There has been an increasing emphasis on peri-intubation oxygenation strategies to reduce complications in patients with a physiologically difficult airway. Recent guidelines for difficult airway management and preventing unrecognised oesophageal intubation are available. Large multicentre airway data collection helps us examine airway incidents, aetiology, and complications to expand our knowledge and give us insights for change in practice., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Anaesthesia.)

Objectives: To study the biochemical, metabolic and hormonal profile among children presenting with acne and to determine the correlation of these parameters with acne grading., Methods: The observational cross-sectional study was conducted for a duration of 18 months on a total of 50 children between 1 and 12 years of age with clinical features of acne. The detailed information regarding the type of acne, biochemical profile (lipid profile, blood sugar levels), hormonal profile and associated illnesses were recorded. Spearman's rank correlation coefficient was used to find out the correlation of acne grading with hormonal and metabolic changes., Results: The mean age of the children was 11.4 years. Among the various lesions, comedones were seen in 98% cases, papules in 94.00% cases, a scar in 14.00% and pustule in 4.00% cases. As compared to children of age 1-7 years, those in age group 8-12 years had significantly more comedones (48 vs 1, P = 0.04), significantly fewer pustules (0.00% vs 100.00%, P = 0.001), and a comparable number of papules and scars. Most of the children (88.00%) had acne vulgaris grade 1. There was a significant negative correlation of Blood sugar-fasting (r = -0.312, P = 0.0275) and a significant positive correlation of HDL (r = 0.28, P = 0.0491) with acne grading., Conclusion: Comedones and papules are the commonest and the earliest forms of pediatric acne. Severe forms of acne are rarely seen below 12 years, age group. Preadolescent acne is commoner than mid-childhood acne, with no difference between male and females. Blood sugar levels and lipid profile derangements have a weak correlation with acne grading., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Dermatology.)

Background and Aims: The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution., Methods: A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols., Results: The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4-4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6-1.83) among anaesthesiologists and by 4.3 (CI: 5.3-3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination., Conclusion: Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Anaesthesia.)

Background: Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures. We assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent GIB., Aim: To evaluate for an association between endoscopic intervention and subsequent GIB. Secondary aims were to assess the frequency of GIB in our cohort, describe GIB presentations and sources identified, and determine risk factors for recurrent GIB., Methods: We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011 - December 2018 and assessed all hospital encounters for GIB through December 2019. We performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures performed. We performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent GIB., Results: In the cohort of 295 patients, 97 (32.9%) had at least one GIB hospital encounter. There were 238 hospital encounters, with 55.4% (132/238) within the first year of LVAD implantation. GIB resolved on its own by discharge in 69.8% (164/235) encounters. Recurrent GIB occurred in 55.5% (54/97) of patients, accounting for 59.2% (141/238) of all encounters. Of the 85.7% (204/238) of encounters that included at least one endoscopic evaluation, an endoscopic intervention was performed in 34.8% (71/204). The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant (odds ratio 1.18, P = 0.58)., Conclusion: Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic procedures. In this retrospective cohort study, adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus suggesting the uniqueness of the LVAD population. A prospective study is needed to identify patients with LVAD at risk of recurrent GIB and determine more effective management strategies., Competing Interests: Conflict-of-interest statement: Birati EY is recipient of research grants through the University from Impulse Dynamics and Medtronic. No relevant conflicts of interest to this manuscript; Fisher L site principle investigator for a Medtronic trial regarding video capsule endoscopy, but not related to LVADs. No relevant conflicts of interest to this manuscript; No disclosures or COI for the other authors., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

The association of Hemophilia A and ruptured aneurysm of sinus of valsalva (RSOV) has never been reported to the best of our knowledge. We report the case of a 29-year-old male patient with Hemophilia type A who presented with a RSOV into right atrium (RA). The patient underwent device closure off the RSOV and received Factor VIII infusions to decrease blood loss. The peri-procedural management is being presented in this case report., Competing Interests: None

Background: Malignant peripheral nerve sheath tumors are malignant tumors arising from a peripheral nerve or displaying nerve sheath differentiation. Gastrointestinal malignant peripheral nerve sheath tumors are rare and malignant peripheral nerve sheath tumor of the colon is even rarer. To date, only five cases have been reported as malignant peripheral nerve sheath tumor arising in the colon. This is probably the first case report of malignant peripheral nerve sheath tumor of the transverse colon associated with peritoneal metastasis., Case Presentation: A 25-year-old Indian man presented with a large abdominal mass. A computed tomography scan revealed a large 18 cm-sized mass in his transverse colon, suggestive of gastrointestinal stromal tumor. A wide local excision was performed. Histopathology showed sheets and fascicles of elongated to spindle-shaped tumor cells showing a moderate degree of pleomorphism and atypia. Based on morphology and immunohistochemistry, a final diagnosis of malignant peripheral nerve sheath tumor of the transverse colon was given. A peritoneal metastatic tumor deposit was identified grossly and confirmed on histopathology., Conclusion: This is a rare case report discussing the detailed diagnostic approach along with an extensive review of the literature for malignant peripheral nerve sheath tumor arising in the colon.

Background: Tricuspid annular plane systolic excursion (TAPSE) has become a popular tool for assessing right ventricular (RV) systolic function because of its ease of application. TAPSE using transesophageal echocardiography (TEE) is limited by alignment with the lateral wall of the RV. Modified TAPSE (m-TAPSE) is a novel method for measuring TAPSE. m-TAPSE is the difference in the 'apical to lateral tricuspid annulus distance' during diastole and systole. The aim of the present study was to compare prospectively m-TAPSE with the most commonly used parameter TAPSE and near-gold standard 2D echocardiographic parameter RV fractional area change (RV FAC)., Methods: We conducted a prospective observational study of 125 consecutive patients undergoing coronary artery bypass graft surgery in a single tertiary care center. Post-anesthetic induction TAPSE was recorded using transthoracic echocardiography (TTE). m-TAPSE was recorded using TEE in the mid-esophageal four-chamber view. RV FAC was also assessed using TEE. m-TAPSE < 16 mm, TAPSE < 16 mm and RV FAC < 35% were taken as cut-offs for RV systolic dysfunction. Correlations were assessed using the Pearson correlation coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using 2 × 2 cross table., Results: m-TAPSE was significantly correlated with TAPSE (r = 0.797, p < 0.001). Similarly, a significant correlation was observed between m-TAPSE and RV FAC (r = 0.602, p < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of m-TAPSE were 100%, 98.3%, 80%, 100% and 98.4%, respectively., Conclusions: m-TAPSE correlated well with both RV FAC and TAPSE. Therefore, m-TAPSE can be considered an easily measurable alternative parameter for evaluating RV systolic function in a busy intraoperative setting., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2019 Korean Society of Echocardiography.)

Esophageal high-resolution manometry (HRM) has advanced the understanding of esophageal motor function and the ability to diagnose and manage disorders of esophageal motility. In this review, we describe the indications for and the technical performance of HRM. The Chicago classification of esophageal motor function, now in its third iteration, streamlines and standardizes the nomenclature and basic interpretation of HRM data depicted as Clouse topographic plots. In clinical practice, HRM is an important diagnostic test for patients with dysphagia as well as patients with suspected gastroesophageal reflux disease (GERD), particularly in those patients with a suboptimal symptomatic response to antisecretory therapy. HRM can support diagnoses such as achalasia, as well as provide evidence for behavioral disorders such as rumination syndrome or supragastric belching with the assistance of postprandial HRM with impedance. Further, the GERD classification of motor function introduces a three-part hierarchical evaluation of esophageal motor function in GERD, highlighting the value of assessment of esophageal contractile reserve through provocative maneuvers during HRM such as multiple rapid swallows.

Malignant fibrous histiocytoma (MFH) is one of the most common types of soft tissue sarcomas in adults. Distant metastases are developed in 30-40% of patients with MFH, with the most common site being the lung. However, metachronous MFH has not been reported previously in literature. This report describes a case of a 30-year-old man, who had two metachronous thigh tumors, both of which were confirmed to be MFH on histopathology and immunohistochemistry evaluations. A contemporary multidisciplinary approach to therapy including surgery, radiation and chemotherapy was advocated. Two primary sites of MFH raised the possibility of a genetic abnormality that could predispose such a patient to develop multiple primary sites of the same tumor.

Pseudocarcinomatous hyperplasia of the fallopian tube is a rare, reactive response to an underlying inflammatory or neoplastic process. Only a few cases have been reported in literature. It is a benign condition that mimics a malignant neoplasm clinically and radiologically. Thus, a preoperative diagnosis of this entity is important to avoid radical surgical treatment. We report a case of pseudocarcinomatous hyperplasia of the fallopian tube in a 27-year-old female, which was clinically and radiologically thought to be a tubal neoplasm. The approach to such a case and the differentiating features from adenocarcinoma have also been discussed., Competing Interests: There are no conflicts of interest.

Xanthogranulomatous inflammation of female genital tract is uncommon and is usually seen in endometrium. Only a few cases involving the ovary have been reported. Its clinical manifestations, imaging modalities, and gross features can mimic ovarian malignancy. Thus, a preoperative diagnosis of this entity is important to avoid radical surgical treatment. We report a case of xanthogranulomatous oophoritis in a 24 years female, which was clinically and radiologically misdiagnosed as ovarian neoplasm. The approach to such a case and the differential diagnosis has also been discussed., Competing Interests: There are no conflicts of interest.

Background: The mechanism of development of atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) has not been clearly defined, and the involvement of multiple factors such as advanced age, withdrawal of β-blockers, inadequate atrial protection, and electrolyte imbalance, particularly hypomagnesemia has been documented by several authors. Despite all the available pharmacologic prophylaxis, incidence of AF still remains high in this group of patients. This unexplained cause could be genetic inheritance of endothelin-1 (ET-1) gene which is thought to have a pro-arrhythmogenic effect., Aim: This study aims to investigate the relationship between plasma ET-1 concentrations, ET-1 gene polymorphisms in loci -1370 T/G, -134 (3A/4A) Ins/del, Lys198Asn (G/T), and occurrence of AF in patients undergoing CABG., Methodology: Ninety-eight nonrelated, nondiabetic patients over a period of 4 years undergoing routine CABG were selected for the present study. All patients were genotyped for three single nucleotide polymorphisms (SNPs) in loci -1370 T/G, -134 (3A/4A) Ins/del, and Lys198Asn (G/T) in the ET-1 gene by gene sequencing. The plasma ET-1 concentrations were measured using an ET immunoassay., Results: Plasma ET-1 concentrations were higher in AF+ group (P = 0.001) as compared to AF- group. The allele frequencies between AF+ and AF- group were significantly different only with respect to the Lys198Asn (G/T) SNP of the ET-1 gene., Conclusion: The study described the possible correlation of polymorphism of ET gene in CABG population from India. The ET-1 gene might play a disease-modifying role in atrial fibrillation.

We report a rare case of sinus of Valsalva aneurysm of both right and left coronary sinus (LCS), with perforation of the LCS opening into the left ventricle. The LCS aneurysm with its perforation was undiagnosed on transthoracic echocardiography emphasizing the role of transesophageal echocardiography in delineating the anatomy.

Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to 'treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and 'just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors., (Copyright © 2016. Published by Elsevier Editora Ltda.)

Background: Cyclooxygenase-2 (Cox-2) is frequently overexpressed in cervical carcinoma, but little is known about its altered serum concentration. Hence, this study evaluates clinical utility of cellular and serum level of Cox-2 enzyme in cervical cancer., Methods: The expression of Cox-2 was evaluated in cervical tissues and serum samples collected from normal controls (n = 100; n = 68), cervical intraepithelial neoplasia patients (CIN, n = 67; n = 12), and invasive squamous cell carcinoma patients (SCCs; n = 153; n = 127) by immunohistochemical and enzyme-linked immunosorbent assay (ELISA) analyses., Results: The significant cytoplasmic overexpression of Cox-2 was noted in 50.7% of CIN and 69.9% of SCCs as compared with normal (P = 0.0001). Serum level of Cox-2 was also found to be elevated both in CIN (median 4.35 ng/ml) and in SCCs (median 19.39 ng/ml) with respect to normal (median 0.44 ng/ml; P = 0.0001), respectively. The ROC analysis revealed the potential of serum Cox-2 over its cellular expression to distinguish CIN and SCCs from normal., Conclusion: Augmented Cox-2 activity is implicated in the pathogenesis of cervical cancer, and its serum level could serve a potential to distinguish this malignancy. Therefore, it is suggested that serum Cox-2 may be useful in monitoring the diagnosis and treatment outcome of patients., (© 2016 Wiley Periodicals, Inc.)

Literature search is a key step in performing good authentic research. It helps in formulating a research question and planning the study. The available published data are enormous; therefore, choosing the appropriate articles relevant to your study in question is an art. It can be time-consuming, tiring and can lead to disinterest or even abandonment of search in between if not carried out in a step-wise manner. Various databases are available for performing literature search. This article primarily stresses on how to formulate a research question, the various types and sources for literature search, which will help make your search specific and time-saving.

Introduction: Oral squamous cell carcinoma (OSCC) comprises one of the largest subsets of cancers with a tendency for regional metastasis. Nodal status is a key prognostic indicator in patients with OSCC, particularly with N0 neck. Occult metastasis in the form of micrometastasis (MM) and isolated tumor cells (ITCs), often goes undetected by routine hematoxylin and eosin (H&E) examination using 1-2 sections for analysis. This limitation could be overcome by combining serial sectioning (SS) with immunohistochemistry (IHC) for the detection of MM and ITC. Pan-cytokeratin (pan-CK) (AE1/AE3) is particularly a useful marker to detect these deposits as their presence has resulted in varied interpretations and different applications of the tumor-node-metastasis system., Objectives: The objective of the study was to identify a suitable method for detecting MM and ITC in lymph nodes (LNs) of OSCC by combining SS and IHC and to compare it with conventional H&E staining., Materials and Methods: This laboratory-based, prospective study was conducted on 133 LNs harnessed from ten patients treated with radical neck dissection for primary OSCC. The LNs were subjected to SS at 100 μm intervals. The sections were stained with routine H&E staining, pan-CK and analyzed for MM and ITC according to criteria laid by Hermanek et al ., Statistical Analysis: The obtained data were subjected to statistical analysis using Chi-square test., Results: The application of combination of SS and IHC using pan-CK (AE1/AE3) in our study revealed the presence of MM and ITC in 2.25% of the LNs diagnosed as negative on routine H&E examination. The detection of these occult metastatic deposits resulted in upstaging of 33.33% of the patients., Conclusion: In the view of crucial role of occult LN metastasis in prognosis and survival of OSCC patients with N0 neck, diagnostic tools such as IHC staining, particularly with pan-CK (AE1/AE3), combined with SS should be preferred over conventional methods as they result in upstaging, thus sparing the low-risk patients the morbidity of unnecessary treatment.