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Abstract Background Medical undergraduate students are often unaware of the managerial aspects of operating a healthcare facility. This leads to confusion and a sense of being lost when they assume administrative roles, highlighting the need for hospital management and leadership training. This prompted us to evaluate the needs of medical undergraduates concerning these crucial aspects. Methods An exploratory study was conducted on 240 medical undergraduate students to assess the medical undergraduates’ need to learn about hospital management and leadership training, their views about the importance and their self-perceived knowledge of the various elements of hospital management and leadership training. A meticulously validated questionnaire, comprising three essential parts, based on the Likert scale was effectively employed in the study. Part A asked students to evaluate the importance of 15 selected elements of hospital management and leadership training, ranging from not important to very important, in their role as a doctor. Part B required the students to assess their self-perceived knowledge levels on a scale from no knowledge to very adequate for the same 15 elements. Part C inquired about the students’ opinions on including these topics in their curriculum and, if so, the appropriate timing. Results Nearly 75% of the students felt that time management, stress management, and patient safety issues were very important for their role as doctor. Closely following these were communication/ public relation skills, hospital information system & record keeping, quality improvement/assurance, law, ethics & code of conduct. Only 25% of the students reported their self-perceived knowledge as very adequate for almost all the elements. For inclusion in the curriculum, the majority wanted to learn about these elements and throughout the course was the preferred timing. Conclusion The students felt that hospital management and leadership training were pivotal for their roles as doctors. They expressed a lack of sufficient knowledge in these areas and the need for these important aspects to be included in their curriculum as a longitudinal course.

Background: Diabetes mellitus encompasses metabolic disorders marked by chronic hyperglycemia, leading to various complications. It is considered a prothrombotic state associated with increased platelet reactivity. Parameters such as mean platelet volume (MPV) and platelet distribution width (PDW), which are indicative of platelet size, enzymatic activity, and prothrombotic risk, can be readily assessed during routine hematological analysis, facilitating early detection of this prothrombotic state. Aims and Objectives: The study aimed to investigate the varied alterations in platelet parameters in type 2 diabetes mellitus (T2DM) patients and tried to elucidate these parameters’ predictive role in diabetes complications. Materials and Methods: This prospective cross-sectional study was conducted between February 2022 and February 2024, involving 100 patients with T2DM and 100 healthy non-diabetic individuals. MPV, PDW, fasting blood glucose (FBS), and glycated hemoglobin (HbA1c) levels were measured and analyzed. Statistical analysis was carried out using the Student’s t-test, Mann–Whitney U-test, Chi-square test, and Spearman’s correlation tests in the Statistical Package for the Social Sciences software (version 21.0). Results: Most of the patients were in the age group of 40–70 years with male predominance. In comparing the 100 diabetics and 100 non-diabetics groups, MPV and PDW levels were notably higher in diabetics (11.46±1.75 vs. 9.40±1.02 fl, 21±2.57 vs. 16.72±1.48%) with statistical significance (P

Ovarian cancer presenting as an isolated pancreatic metastasis after years of treatment is extremely rare. Most such patients are easily misdiagnosed as a case of primary pancreatic cancer. We herein describe a unique case of posttreatment high-grade serous papillary ovarian carcinoma metastasizing to the pancreas that mimicked primary pancreatic cancer and caused a diagnostic dilemma. The approach to such a case, pathogenesis, differential diagnosis, management, and a brief literature review is also presented.

The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.

College students with more emotional support experience lower levels of anxiety and other psychosocial and behavioral problems. During the COVID-19 pandemic, the emotional well-being of college students was additionally challenged by an abrupt shift to distance learning followed by a return to face-to-face classes. In this exploratory study, we compared the levels of perceived emotional support and anxiety among incoming first-year undergraduate students, prior to starting classes, which included different learning modes in five semesters of instruction from 2021-2023 (three distance semesters and two face-to-face semesters). Data from 8659 undergraduate students were extracted from a Mexican state university database, corresponding to students' responses collected during new student orientation week. Participants were students in the arts and humanities (9.7%), social and legal sciences (38%), life and health sciences (28.9%), and engineering and architecture (23.4%). Anxiety levels were measured with the GAD-7 scale, and emotional support was measured using a subscale of the PERACT-R (To go through with resilience) inventory. Comparisons of emotional support and anxiety scores among semesters revealed highly significant differences with small effect sizes. Anxiety levels increased significantly with mean average of 6.65 SD(5.52) during the baseline measure to the highest in 2022-2 to 7.53 SD(5.3) and Emotional Support decreased systematically each semester from baseline mean = 8.03 SD(2.0) to the lowest 7.52 SD(1.8) in 2022-2. The results show that a return to face-to-face classes was associated with increased anxiety levels, whereas levels of emotional support systematically decreased across the five semesters. MANOVA analysis revealed significant differences in anxiety and emotional support scores between semesters, with peaks during the learning mode semester that students returned to face-to-face classes after distance learning even after adjusting for gender. Given that the effect of emotional support on anxiety may be related to success in future educational and professional activities, it is important to develop interventions to restore and increase college students' emotional support levels and develop anxiety management strategies.

The single-valued neutrosophic (SVNS) set is a beneficial and significant tool to deal with uncertainty with the neutrality of truth. This article introduces a non-conventional asymmetric measure of comparison in the single-valued neutrosophic framework. Such a measure is applied to the problems where the conventional symmetric measures of comparison do not produce valid computational results and require a directed closeness or discrimination between two abstractions represented by neutrosophic sets. We prove some properties of the proposed neutrosophic comparison measure and empirically justify its utilization in a problem of strategic decision-making, pattern recognition and medical diagnosis. The assessment of the performance of the proposed measure using “Degree of Confidence” shows the advantage of the proposed measure.

Federated ML (FL) provides an alternative to train accurate and generalizable ML models, by only sharing numerical model updates. Here, the authors present the largest FL study to-date to generate an automatic tumor boundary detector for glioblastoma.

Obesity has become an unprecedented epidemic worldwide owing to a prolonged imbalance between energy intake and expenditure. Available therapies primarily suppress energy intake but often fail to produce sustained fat loss, necessitating a more efficacious strategy to combat obesity. In this study, a polyherbal formulation, Divya-WeightGo (DWG) has been investigated for its anti-obesity activity using in-vitro and in-vivo assays. Ultra-high performance liquid chromatography (UHPLC) analysis revealed the presence of phytocompounds including gallic acid, methyl gallate, corilagin, ellagic acid, pentagalloyl glucose, withaferin A and hydroxycitric acid, proven to aid in weight loss. The exposure of 3T3-L1 cells to DWG at cytosafe concentrations inhibited lipid and triglyceride accumulation and downregulated the expression of several adipogenic and lipogenic markers like PPARy, C/EBPα, C/EBPβ, SREBP-1c, FASN and DGAT1. DWG reduced LPS-induced pro-inflammatory cytokine release and NF-κB activity in THP-1 cells. The in-vivo anti-obesity activity of DWG, both alone and in combination with moderate aerobic exercise, was assessed in a high fat diet-induced obese mouse model. DWG mitigated the obesity associated increased body weight gain, feed efficiency ratio, glucose intolerance, diminished insulin sensitivity, dyslipidemia, altered liver function profile, lipid accumulation and adiposopathy in obese mice, alone as well as in combination intervention, with better efficacy in the combination approach. Thus, the findings of this study suggest that DWG could be a promising therapeutic avenue to treat obesity through attenuation of lipid and fat accumulation in liver and adipose tissues and could be utilized as an adjunct with lifestyle interventions to combat obesity and associated complications.

Background: Exacum lawii C.B. Clarke (Gentianaceae) bitter medicinal herb, has been extensively applied for the treatment of kidney diseases and ailments by Indigenous medical practitioners and local communities in Maharashtra and Karnataka states of India. The pharmacognostical and phytochemical standardization has been performed, but its therapeutic mechanism is still unknown. Swertiamerin, a secoiridoid glycoside established as marker component. The aim of the current research is to investigate the cytoprotective ability and examine targets of action of Exacum lawii standardised extract against cisplatin exposed Human embryonic kidney cell line (HEK-293). Methods: Swertiamerin was isolated from standardised extract using column chromatography and characterized by various analytical techniques. In-vitro cellular assay (MTT cytotoxicity assay, iNOS expression, proinflammatory cytokine level, ROS estimation and cell cycle progression, DNA fragmentation assay and morphology of cells) were employed to understand the efficacy and mechanism of action of standardised extract and swertiamerin against cisplatin induced toxicity in HEK-293 cells. Results: Extract and swertiamerin summed up to be nontoxic to HEK-293 cells and the IC50 for cisplatin was 2.261 µg/ml. Molecular docking study showed the binding capacity of swertiamerin for iNOS enzyme (responsible for the nitrosative stress in cells). Various Scientific techniques validates the potential of extract and swertiamerin to reduce the nitrosative stress, oxidative stress, and inflammation in HEK-293 cells significantly (P

Introduction: Resources for oral health care remain limited in in rural and backward areas where an inherent need to exists to explore inexpensive cleaning aids at ease. Aim: To assess the efficiency of Miswak stick as an oral hygiene aid among madrasa-going 12–14 years old children, by comparing it with toothbrush and toothpaste in Nuh district of Haryana, India. Materials and Methods: The study population comprised of 540 madrasa-going children. 400 cases were Miswak users, whereas 140 toothbrush and toothpaste users were in the control group. Their oral hygiene status was assessed using the Gingival Index (GI), Oral hygiene index- simplified (OHI-S) and Plaque Index (PI). Decayed, Missing, Filled Teeth (DMFT) index was used to measure the dental caries incidence. The data were recorded, tabulated, and statistically analyzed. Results and Discussion: The results showed that Miswak users had significantly less mean GI score and OHI-S index scores (P = 0.001) but no statistically significant difference in PI score as compared to toothbrush and toothpaste users. Second, DMFT score was more in toothbrush and toothpaste users as compared to Miswak users. Conclusion: This study concluded that the oral hygiene status of Miswak users in the madrasa-going children of Nuh district was better than that of toothbrush and toothpaste users.

The odontogenic tissue surrounding an impacted tooth is a harbinger of a wide variety of odontogenic cysts and tumors. As these hamartomatous and neoplastic aberrations can occur at any stage of odontogenesis, therefore combined features of odontogenic tumors with epithelial and mesenchymal components can develop within the odontogenic cysts. One of the odontogenic cysts is the dentigerous cyst (DC) which is not only the most common developmental odontogenic cyst arising from the pericoronal tissue but is of great clinical significance owing to its neoplastic potential and association with other rare odontogenic tumors. We herein describe an unusual case of adenomatoid odontogenic tumor which developed secondary to a DC in a 22-year-old female and created a diagnostic conundrum. The approach to such a case, differential diagnosis, and review of the literature is also presented.

Radiotherapy is a common treatment modality in the management of head and neck malignancies. In select clinical scenarios of well-lateralized tumors, radiotherapy can be delivered to the primary tumor or tumor bed and the ipsilateral nodal regions, while intentional irradiation of the contralateral neck is omitted. Proton beam therapy is an advanced radiotherapy modality that allows for the elimination of exit-dose through nontarget tissues such as the oral cavity. This dosimetric advantage is apt for unilateral treatments. By eliminating excess dose to midline and contralateral organs at risk and conforming dose around complex anatomy, proton beam therapy can reduce the risk of iatrogenic toxicities. Currently, there is no level I evidence comparing proton beam therapy to conventional photon radiation modalities for unilateral head and neck cancers. However, a growing body of retrospective and prospective evidence is now available describing the dosimetric and clinical advantages of proton beam therapy. Subsequently, the intent of this clinical review is to summarize the current evidence supporting the use of proton beam therapy in unilateral irradiation of head and neck cancers, including evaluation of disease site-specific evidence, unique challenging clinical scenarios, and ongoing clinical trials.

Background: Dental trauma is relatively common, with its incidence and prevalence varying not only within countries and states but also within different socioeconomic groups. A primary goal in oral health care is to prevent dental trauma. Objectives: The aim of the present study was to determine the prevalence of anterior tooth trauma (ATT) and to analyze factors associated with ATT among schoolchildren aged 10—19 years in Mewat district, an underdeveloped and underprivileged area in Haryana state, India. Methods: A cross-sectional study was conducted among 3043 schoolchildren residing in Mewat district. They were divided into the following age groups: 10—13, 14—16, and 17—19 years. Dental injuries to anterior teeth were recorded according to Ellis and Davey’s classification. Data were collected using a specifically designed questionnaire. The data were analyzed using IBM Statistical Package for Social Sciences for Windows (version 20.0). Categorical variables are presented as proportions (%), and Pearson’s χ2 test was used to analyze these variables. Tests were conducted at the significance level of 5%. Results: Of the 3043 schoolchildren (males, n = 2178; females, n = 865) examined in the study, 362 schoolchildren had experienced dental trauma, giving a prevalence rate of 11.89%. Males were more prone to ATT (13.36%), and an Ellis Class I fracture was the most frequent type of ATT (78%). The most common causes of ATT were falls (49.44%), followed by road traffic accidents. In addition, children with partial lip coverage and an overjet of more than 3 mm had an increased risk of ATT. Conclusion: The prevalence of ATT among schoolchildren in Mewat district was 11.89%, and the major etiological factor was a fall. There is an increased need for awareness of dental trauma in school-aged children.

Abstract Objective Although the prognostic role of human papilloma virus (HPV) status in oropharyngeal head and neck squamous cell carcinoma (SCC) is well established, growing evidence shows that there may be a prognostic role for HPV status in hypopharyngeal SCC. The objective of this study was to determine the prognostic role of HPV status in hypopharyngeal SCC. Methods We performed a retrospective, population‐based analysis of 1934 adult patients with HNSCC diagnosed between 2010‐2016 and treated with a combination of surgery and/or radiotherapy, with or without chemotherapy, and a subset of 641 patients with hypopharyngeal SCC and known HPV status included in the Surveillance, Epidemiology, and End Results (SEER) Head and Neck with HPV Status Database. Patient data were used to determine the adjusted 2‐year cancer‐specific survival (CSS) and overall survival (OS) for the entire cohort and the specific subgroup of hypopharyngeal cancer patients with known HPV status. Results Of the 1934 hypopharynx SCC cases, HPV status was unknown in 1294 (66.9%), and 167 (8.6%) were HPV positive; among hypopharynx cases with known HPV status, 21.6% were HPV positive. In models adjusting for sex, age, race/ethnicity, marital status and stage, patients with HPV‐positive hypopharyngeal tumors had improved CSS compared with patients with HPV‐negative tumors (CSS: HR: .57, 95% CI = .38 to .86, P = .008; OS: HR: .49, 95% CI = .34 to .71, P =

A single-valued neutrosophic set (SVNS) is a subcategory of neutrosophic set that is used to represent uncertainty and fuzziness in three tiers, namely truthfulness, indeterminacy, and falsity. The measure of entropy of a SVNS plays an important role to determine the ambiguity in a variety of situations. The knowledge measure is a dual form of entropy and is helpful in certain counterintuitive situations. In this paper, we introduce a knowledge measure for the SVNS and contrast the same with existing measures. The comparative study reveals that the proposed knowledge measure is more effective in modeling the structured linguistic variables. We provide the relations of the proposed knowledge measure with single valued neutrosophic similarity and distance measures. We also investigate the application of the proposed measure in multi-attribute group decision making (MAGDM). The proposed MAGDM model is helpful when the decision makers in the group have varied background and the hiring organization is unable to assign the level of importance or weight to a decision-maker.

Purpose: Substantial research exists on the physical toxicities from radiation therapy (RT) for oropharyngeal cancers, but emotional quality of life is understudied. The purpose of this study is to map the effects and time course of radiation-related changes in mood and anxiety and to investigate the physical factors that drive these changes. Methods and materials: We prospectively collected University of Washington Quality of Life questionnaires and identified patients with oropharyngeal cancer who were treated with curative-intent RT between 2013 and 2016 and had completed questionnaires within 12 months after RT (n = 69). We analyzed swallow, saliva, taste, chewing, speech, pain, mood, and anxiety scores, using a scale from 0 to 100. We conducted a multivariate regression analysis to identify physical functioning predictors of worse emotional scores. Results: Physical functioning scores declined from before RT to 3 months after RT and then began improving but did not rebound to baseline levels within 12 months. Patient mood slightly declined, but anxiety improved immediately after RT, with both generally improving such that scores were higher at the 12-month follow-up than at initial consult. Analysis showed that longer duration of treatment is associated with a higher likelihood of worse mood scores at 12 months (odds ratio [OR], 1.446; P

Primary retroperitoneal teratomas are uncommon extragonadal nonseminomatous germ cell tumors that are composed of well differentiated parenchymal tissues which are derived from more than one of the three embryonic germ cell layers. Here we report an unusual and first of its kind, a case of primary mature cystic retroperitoneal teratoma mimicking as adrenal tumor in a 7-month-old female in which the tumor was predominantly composed of neurogenic tissue histologically which is unlike the usual pattern seen in the teratomas.

Background and Objective: Liquid-based cytology (LBC) is an emerging pathological method for better establishment of the diagnosis in almost all the organs of the body. It is currently used both for the gynecological and non-gynecological (fine-needle aspirates (FNAs)/fluid) specimens in most of the developed and few developing countries. The current study aimed at assessing and illustrating the cytological morphology on SurePath® LBC technique when used on FNAs from head and neck lesions, compared to the conventional smears (CS). Methods: In the current prospective study, a total of 1000 FNAs obtained from swellings of head and neck region were simultaneously processed both by the standard conventional and SurePath® LBC techniques. Both of these preparations were studied, compared witha semi-quantitative scoring system, and statistically analyzed. Pvalue Results: LBC smears were better, compared to CS ones, due to the presence of evenly dispersed cells (P ≤0.001), clearance of obscuring elements / background debris (P≤0.001), and better cellular details (P≤0.001). However, these abilities of LBC often became its own nemesis and made the interpretation difficult. Conclusion: LBC, though costly, is an acceptable, simple, and valuable technique. However, CS still cannot be considered inferior to it, and it is recommended that in most of the cases LBC, along with CS, should be reported before reaching a final diagnosis. This is beneficial especially in the developing countries such as India where most of the centers are devoid of LBC technique and hence, are not familiar with many cytomorphological features and potential diagnostic pitfalls unique to it.

Background: Gastrointestinal tract endoscopy along with biopsy is an established procedure for investigating a wide range of gastrointestinal conditions especially inflammatory and malignant diseases. The aim was to study and categorizing the morphological lesions of non-malignant origin at various sites of gastrointestinal tract and to compare with its endoscopic findings.Materials and Methods: This study was conducted on 280 benign GI biopsies received in the Department of Pathology of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.Results: Maximum cases (39%) were observed in the age group of 41-60 years. Male patients outnumbered the females (male to female ratio was 1.4:1). There were total 33 esophageal biopsies amongst which the most common lesion was non-specific esophagitis with least common being Barrett’s esophagus. Correlating the results of endoscopic and histopathological features of acute and chronic gastritis a positive predictive value of 80% with sensitivity of 44.4% was seen. Total 83 duodenal biopsies were analyzed with non-specific duodenitis being the most commonly diagnosed lesion followed by celiac disease. Correlation of endoscopic and histopathological findings in celiac disease revealed a sensitivity of 50% and positive predictive value of 42.86%. In both sigmoid colon and rectum, non-specific colitis was the commonest diagnosis followed by ulcerative colitis. Endoscopic findings were correlated with the histopathological features in ulcerative colitis, revealing a sensitivity of 57.14% along with the positive predictive value of 80%. Conclusion: Histopathology remains the gold standard for diagnosing a case along with endoscopic findings and endoscopic findings alone cannot make the final diagnosis.

Giant polyp is an unusual female genital tract pathology, commonly arising from the cervix than the endometrium. It is a great masquerader of cervical or endometrial malignancy and can lead to a diagnostic dilemma and unnecessary aggressive interventions. Experience in one such case of an extremely rare protruding giant endometrial polyp in a 58-year-old postmenopausal female is being described herewith so as to create awareness among the dealing clinicians. The approach to such a case, differential diagnosis, and review of the literature is also presented.

Tuberculosis (TB) is a great mimicker of innumerable diseases and is often overlooked causing diagnostic dilemmas, especially when it occurs at extrapulmonary sites. Spermatic cord TB is a very rare form of genital TB with only a handful of cases documented in the world literature. Here, in this report, an unsuspected case of a spermatic cord TB in a 60-year-old male is described which not only disguised as a tumor but also led to an unneeded surgery as its treatment.

Background: In recent years, p53 has emerged as an important tool for not only diagnosis and predicting prognosis in head and neck squamous cell carcinoma. The aim of this study was to find the role of p53 staining intensity in determining prognosis. Materials and Methods: Fifty histopathologically proven cases of squamous cell carcinoma of head and neck were studied. The findings of the study were analyzed particularly in reference to p53 expression and their correlation with age, sex, anatomical site, tumor size, histological grading, vascular, peri-neural, muscle invasion, lymph node metastasis and staining intensity.Results: Immunopositivity rate of p53 was 64% with percentage positive cells varying from 5-76% with mild, moderate and strong staining intensity. A positive correlation of p53 independently was seen with oral cavity, grade, lymph node metastasis and pathological staging.Conclusion: p53 immunoexpression is an important independent variable of prognostication.

Objective: Environmental pollutants are responsible for inducing a number of biochemical and physical changes in the various organs of an organism. The most potent pollutants is7,12-dimethylbenz(α)anthracene (DMBA) (a genotoxic carcinogen), a polyaromatic hydrocarbon. It is known to induce a number of genetic changes including the formation of DNA adducts. These genotypic changes in turn are responsible for inducing microstructural changes in the vital organs viz. kidneys, stomach and lungs of an organism. These changes in turn cause biochemical alterations in an animal and hence alter the normal functioning. Synthetic drugs provide a sigh of relief but a large number of side effects in addition to the growing resistance has made it necessary to find an efficient alternative. Plant secondary metabolites, especially glucosinolate hydrolytic products, are known for their high bioprotective activity. The current study was therefore designed to analyze the bioprotective role of erucin against DMBA-induced microstructural changes in kidneys, lungs and stomach of male Wistar rats using histological analysis. Material and Method: The bioprotective efficacy of erucin was evaluated in male Wistar rats against DMBA induced microstructural changes. The rats were divided into five groups where group I was untreated control, group II was DMBA treated and group III-V were treatment (DMBA + erucin) groups. Results: Erucin was able to protect the rats against DMBA-induced histopathological changes in the lungs and stomach. No changes were observed in the kidney following treatment with DMBA or erucin. Conclusion: Erucin has bioprotective activity against genotoxic carcinogen.

Background: The data available about the knowledge of tooth avulsion in Indian school children is minimal. There is a tremendous need to evaluate awareness regarding appropriate emergency measures to be followed after avulsion by them. Therefore, this study was planned. Aim: To assess the knowledge regarding tooth avulsion in athletically active high school children of Chandigarh. Materials and Methods: The sample consisted of 997 (750 boys, 247 girls) school players in the age range of 10–17 years. The participants were interviewed through a standardized questionnaire. Statistical analysis was done by Chi-square test. Results: In cases of participants who knew about tooth avulsion (37.3%), only 38.4% of them were in the opinion to replant the tooth in its socket. More number of males would try to replant the avulsed tooth and in older age group. Almost half of the players would transport the avulsed tooth in paper, plastic or cotton, 28.6% would transport in hand and only 11.9% in tap water. Milk was considered the ideal storage medium by only 4.8% of the participants. Conclusion: More emphasis should be made on organizing educational campaigns which provide education to teachers, parents, and school children regarding appropriate emergency measures to be followed after tooth avulsion.

Background: Prostate carcinoma is the second leading cause of cancer-related deaths in males worldwide. The burden is expected to grow 1.7 million new cases and 499,000 new deaths by 2030. In developing countries such as India, prostate carcinoma will show an increase by 140% in the next few years. Although the diagnosis of prostate carcinoma can usually be made on histological features, now a days many immunohistochemical (IHC) markers are used to distinguish it from benign mimickers as well as in predicting prognosis and treatment. Out of these markers, Ets-related gene (ERG product) is a proto-oncogene which participates in chromosomal translocations and is frequently over expressed in prostate carcinoma which harbors ERG-transmembrane protease, serine 2 fusion. Materials and Methods: Fifty cases of carcinoma prostate diagnosed in needle biopsies and prostatic chips, in the Department of Pathology of a tertiary care teaching hospital in Punjab, India, were included in the present study. The slides were observed under the light microscope, and Gleason scoring was done using the 2005 International Society of Urological Pathology modified Gleason system. IHC study for ERG expression was done on all the cases, for which anti-ERG monoclonal rabbit clone antibody EP111 (Dako, Denmark) was used. Lymphocytes and endothelial cells were taken as in built positive controls for staining. The intensity of ERG positivity was scored as no staining (0), weak staining (+1), moderate staining (+2) and intense staining (+3). The H score was then calculated by multiplying the intensity of the stain with the percentage (0-100) of the cells showing that staining intensity. The H-score has a range of 0-300. The relationship between IHC expression and clinico-pathological parameters was compared and analyzed using Chi-square test. P < 0.05 was considered statistically significant. Results: Majority of patients included in the study were in the age group of 61-80 (84% of the total). When ERG expression was studied with age-specific rates, it was not found to be statistically significant. The most common pattern noted in the present study was 4 + 3, constituting 36% of total, followed by 3 + 4 constituting 32%. Calculating the score, the majority of patients had a Gleason score of 5-8, constituting 76% of total. Out of the total fifty cases of prostate carcinoma, ERG was positive in 29 cases (58%) and negative in 21 cases (42%). Fourteen out of 21 (48%) of the ERG positive cases had an intensity score of 3. When the ERG intensity was correlated with the Gleason score group, it was seen that patients having Gleason score 7-8 showed ERG positivity in 19 out of 38 cases (50%), with 11/19 (57%) cases showing an ERG intensity score of 3. The Gleason score group 9-10 showed ERG positivity in 83% (10/12) cases, 20% (2/10) cases showing intensity score of 3. This correlation was found to be statistically significant. Conclusion: ERG immunostaining was performed in a small Indian cohort of prostate cancer patients, diagnosed in trucut biopsy specimens and prostatic chips. ERG expression was found in 58% patients. An increase in the ERG expression was observed with an increase in Gleason score. The intensity of ERG expression, however, decreased with an increasing Gleason score.

Filariasis is a global health problem which is endemic in tropical and subtropical regions of Asia, Central and South America and Pacific Island nations. The most common parasite causing lymphatic filariasis in India is Wuchereria bancrofti, the microfilariae of which has been detected incidentally in fine needle aspirates and aspirated body fluids. However, its presence in the bone marrow aspirates is quite uncommon and that too in co-existence with a haematological malignancy. We report one such extremely rare case of Wuchereria bancrofti microfilaraemia in a multiple myeloma patient, which is the second case to be documented in the world literature to the best of our knowledge.

Intraparotid hemangioma of the children is a rare neoplasm, posing diagnostic dilemma to the diagnosticians as well as treating clinicians. A 2-month-old male infant presented with a diffuse swelling in the parotid region since birth that was gradually increasing in size. The ultrasonography (USG) report was suggestive of a right intraparotid mass of uncertain etiology; whereas magnetic resonance imaging (MRI) report inclined toward a mass associated with chronic inflammatory pathology. Fine-needle aspiration cytology (FNAC) suggested two differentials - a vascular neoplasm of the parotid gland and a spindle cell neoplasm with increased vascularity. The lesion was reaspirated and a cell button was constructed from the aspirated material to reach a conclusive diagnosis by histopathological evaluation and immunohistochemistry (IHC) before attempting any intervention to treat the infant. The final diagnosis after histopathological and IHC studies was given as deep cellular intraparotid hemangioma. Subsequently, the patient was treated with single sitting bleomycin sclerotherapy. A simple technique of cell button resulted in sparing of hospitalization and surgical procedure in the infant.

Introduction: Oral Squamous Cell Carcinoma (OSCC) is characterized by diversity in their biological behaviour which in turn forms the basis of deciding management options. It usually arises from Premalignant/Potentially Malignant Lesions (PMLs) of the oral cavity such as leukoplakias, erythroplakias, oral submucous fibrosis, lichen planus etc. Multiple summative genetic alterations occur in these lesions which result in a progression from epithelial dysplasia through in situ carcinoma to an invasive cancer. Aim: To assess the expression of p53, Ki-67 and Bcl-2 in patients having oral leukoplakia versus patients having OSCC and to correlate their immunoexpression with other clinicopathological parameters. The goal was also to determine if these biomarkers have potential as early indicators of malignancy. Materials and Methods: This was a retrospective study which was conducted at the Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, between the period of June 2016 to September 2016. The study comprised of two groups. Group 1 included 30 histologically proven cases of oral leukoplakia and Group 2 included 30 histologically proven cases of OSCC. The OSCC cases were classified and graded on histomorphology. Both the groups were immunohistochemically analyzed for the expression of p53, Ki-67 and Bcl-2 and their expression were correlated with age, sex, anatomical site, histological grading and staining intensity. The results were tabulated and statistically analyzed. A p-value less than 0.05 was considered significant. Results: A statistically significant increase for Ki-67 expression was seen in OSCC cases than in leukoplakias while the expression of p53 was also similar, but it was statistically insignificant. A significantly high p53 and Ki-67 expression were seen in moderately to poorly differentiated OSCC cases. A statistically significant co-relation was also found between low immunostaining and p53 expression in the cases of leukoplakia and vice-versa in OSCC cases. No statistical significant relation was found between Bcl-2 expression and other parameters in both the groups. Conclusion: The present study highlights that the immunohistochemical expression of Ki-67 and p53 should be assessed in all the cases of PMLs as these can act as predictive markers for poor prognosis in such cases. These biomarkers also allow identification of tumours with a higher rate of cell growth, thereby permitting the development of prognostic factors which effects the patient’s treatment and the survival time.

Tumors of thymus gland are rare and account for 0.2% to 1.5% of all the neoplasms. They constitute a heterogeneous group that has an unknown etiology and a complex as well as varied biology. This has led to difficulty in their histological classification and in predicting their prognostic and survival markers. Among them, thymic carcinoma is the most aggressive thymic epithelial tumor exhibiting cytological malignant features and a diversity of clinicopathological characteristics that can cause diagnostic dilemmas, misdiagnosis, and therapeutic challenge. We herein describe a case of a 60-year-old man who while undergoing evaluation for the cause of pancytopenia was discovered having bone marrow metastasis from an asymptomatic thymic carcinoma. Bone marrow metastasis is an extremely rare initial presentation of thymic carcinoma with only few cases reported in the literature.

Background: To achieve the standardization of the thyroid FNA reporting, the National Cancer Institute (NCI) hosted the “NCI Thyroid Fine Needle Aspiration State of the Science Conference”, which led to the formation of ‘The Bethesda System for Reporting Thyroid Cytopathology’ (TBSRTC). Materials and Methods: The present study was undertaken by 2 experts in thyroid FNA, who in a double blinded fashion, examined and re-classified 80 random FNA cases according to the 6 levels of TBSRTC for an inter-observer review, to study and assess the new terminology for ease of reproducibility and to note the rate of disagreement overall or in any particular category. The FNAs were reclassified in a double blinded fashion according to the 6 levels of TBSRTC which are: non diagnostic (ND); benign; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), Hurthle cell type/suspicious for a follicular neoplasm, Hurthle cell type (FNHCT/SFNHCT); suspicious (SUS), and malignant. Results: In the present study, the maximum number of cases was reclassified under the benign category (61.25% cases), followed by the FN/ SFN category and the AUS/FLUS category (11.25% and 10.00% respectively). An agreement was reached in 66 cases (82.5%); the experts disagreed in 14 cases-17.5% (where 1 expert did not agree with the other). Individually; a 93.87% agreement was noted for the lesions in the benign category, for 50% lesions in the AUS/FLUS category, for 66.66% lesions in the FN/SFN and the SUS categories, for 71.42% lesions in the FNHCT/ SFNHCT categories and for 100% lesions in the ND and the malignant categories. Thus, the maximum disagreement was noted in the AUS/FLUS category. Conclusion: The implementation of TBSTRC which stands for a unique, international and a universal terminology for reporting the thyroid cytology; should be encouraged in our country, because of its relative ease of reproducibility. Although there was a great deal of agreement in implementing TBSTRC in the present study; disagreements were seen in the categories of AUS/FLUS and FN/SFN in the study which was conducted at our centre. This corroborated with the findings of the studies which were done elsewhere.

Bone Marrow Necrosis (BMN) is regarded as a rare entity in the aspirates and the trephine biopsies which are obtained from living patients and it is a rare antemortem diagnosis. Usually, BMN is associated with a poor prognosis and it has a 90% association with malignancies (mainly haematological). Its other causes include infections, drugs and other non malignant haematological causes. BMN which occurs due to unknown causes (idiopathic), is very rare. The present case report describes a case of BMN in a 14 year old male child from rural background, who came to the medicine outpatient department of a tertiary care centre in north India, with the complaints of generalized weakness, severe bone pains, especially in the ribcage area and fatigue. His peripheral blood film revealed pancytopaenia. His bone marrow aspiration yielded a watery, sero-sanguinous fluid from 2 different sites. Microscopy revealed “ghost like” haematopoietic cells lying in eosinophilic, proteinaceous material. Bone marrow biopsies from both the sites revealed extensive foci of gelatinous transformation and necrosis. A diagnosis of BMN was rendered. No underlying neoplastic / non neoplastic cause was identified, even after a thorough systematic investigation (haematological/biochemical/ radiological and immunological). Thus, a final diagnosis of BMN due to an idiopathic cause, was finally given. The patient was given supportive treatment, after which he was referred to a higher centre. BMN which arises idiopathically is usually very rare and often precedes the aetiological diagnosis and obscures the diagnosis. Traditionally, the prognoses of the patients with BMN were considered as poor, but with better treatment aids (chemotherapy and supportive treatment), the prognoses of these patients have been found to improve. Vigorous supportive care, along with a disease specific treatment, is the key to its management. This case was worth reporting, as no cause of BMN was elicited in it and we have summarized the signs and symptoms, the associations, haematological and other lab investigations and the role of radiology, which helped in its diagnosis.

Background: Thrombocytopenia (platelet counts less than 150,000/μl) is commonly encountered in various hematological disorders including myelodysplastic syndromes as well as various non-myelodysplastic hematological conditions. Aim: The present study was undertaken to calculate the prevalence of various conditions associated with thrombocytopenia and to record the megakaryocytic alterations in various cases of thrombocytopenia. Apart from this by means of statistical analysis it was tried to analyze whether a significant difference existed in megakaryocytic alteration noted in myelodysplastic versus non- myelodysplastic conditions. Materials and Methods: A prospective series of 60 bone marrow aspirations along with concomitant bone marrow biopsies was conducted in a tertiary care centre catering to both urban as well as rural population in north India. Statistical Analysis: The distribution of morphological changes in cases of non myelodysplastic conditions and myelodysplastic were compared using Chi-Square test. A p-value less than 0.05 was considered significant. Results: The commonest cause of thrombocytopenia for which bone marrow examination was sought was dimorphic anaemia (18 cases, 30%), followed by myelodysplastic syndrome (06 cases, 10%) which was followed equally by acute lymphocytic leukemia and blast crisis of chronic myeloid leukemia (CML). Of all the non-MDS conditions apart from dimorphic anaemia, idiopathic thrombocytopenic purpura and chronic myeloid leukemia (blast crisis); megakaryocytic dysplastic forms were not noted in any other condition. In cases of myelodysplasia; dysplastic forms, bare megakaryocytic nuclei, hypogranular forms and micromegakaryocytes were seen. Comparison between frequencies of normal, high and low number of nuclear lobes among MDS (n=9) and non MDS (n=68) conditions were found to be statistically significant. Conclusion: Further studies on the evaluation of megakaryocytic alteration and their contribution to thrombocytopenia can provide growing knowledge to the pathogenesis of numerous hematopoietic disorders that may identify broader clinical applications of the newer strategies to regulate platelet count and functioning.

can present extraordinarily as a non-resoluting inflammatory pathology or can even mimic as malignancy especially sarcomatous or metastatic deposits. It sometimes can be diagnostically challenging for both the treating clinician and pathologist. The present case report documents a 47-yearold male agricultural worker who was immunocompetent and showed no signs and symptoms of pulmonary tuberculosis. His intradermal tuberculin sensitivity test was also negative. He presented with non-union of right tibia shaft fracture. A modified technique was employed i.e. of doing Fine needle aspiration cytology (FNAC) with Sahli’s bone marrow aspiration needle from the non-united ends of the tibia shaft. This led to the documentation of caseating granulomas and later on positive Ziehl-Neelsen (ZN) staining confirmed the diagnosis of EPTB. The case is worth reporting because of the unusual presentation of EPTB as non union with involvement of marrow and how a systemic approach with cytology and microbiology can lead to a quick and confirmative diagnosis, thus avoiding open biopsies which are not only expensive for the patient but are also associated with a share of morbidity.

Pyogenic granuloma (PG) is a kind of inflammatory hyperplasia in response to chronic irritation. Here, we report a case of 64 year old male patient with PG on midline of the dorsum of the posterior third of the tongue. Its differential diagnosis, the importance of biopsy findings in establishing definitive diagnosis and about the new approaches for its treatment is discussed.

Brain metastases traditionally carried a poor prognosis with an overall survival of weeks to months in the absence of treatment. Radiation therapy modalities include whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS). WBRT delivers a relatively low dose of radiation, has neurocognitive sequelae, and has not been investigated for its immunostimulatory effects. Furthermore, WBRT exposes the entire intracranial tumor immune microenvironment to radiation. SRS delivers a high dose of conformal radiation with image guidance to minimize dose to surrounding normal brain tissue, and appears to promote anti-tumor immunity. In parallel with many of these discoveries, immune checkpoint inhibitors (ICIs) have demonstrated a survival advantage in multiple malignancies commonly associated with brain metastases (e.g., melanoma). Combination SRS and ICI are theorized to be synergistic in anti-tumor immunity directed to brain metastases. The purpose of this review is to explore the synergy of SRS and ICIs, including pre-clinical data, existing clinical data, and ongoing prospective trials.

Aim: Enteric duplication cysts are rare and uncommon congenital malformations formed during the embryonic period of the development of human digestive system and are mainly encountered during infancy or early childhood, but seldom in adults. The clinical presentation is extremely variable depending upon its size, location and type. We present six cases of enteric duplication cysts with diverse clinico-pathological features. Materials and Methods: This study was carried out in the Department of Pathology and Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India for a period of 2 years (January 2013 - December 2014). We retrospectively analyzed six patients of enteric duplication cysts based on data obtained, which consisted of patient’s age, sex, clinical presentation, radiological features, operative findings and histopathology report. The data collected was analyzed by descriptive statistics. Results: Six children between age range of 3 days to 10 years had enteric duplication cysts. Two had ileal and one each were of pyloroduodenal, colonic and rectal duplication cyst. In one patient a presumptive diagnosis of enteric duplication cyst was made. Radiology played an important contributory role in diagnosis of these cysts in all the patients but histopathology proved to be gold standard for its confirmation. All these patients were managed by surgical excision. The postoperative and follow up period in all the cases was uneventful. Conclusion: It is important to be aware and make a definitive diagnosis of this rare congenital anomaly as they can present in various clinical forms and can cause significant morbidity and even mortality if left untreated by causing life threatening complications.

Pancreatic endocrine tumours are rare in occurrence. They may present with a baffling range of symptoms which pose a diagnostic dilemma. Two cases of pancreatic insulinoma are presented herewith. Both presented with neuro-psychiatric complaints and were treated symptomatically for depression, anxiety, seizures etc. The diagnosis in these patients was missed for years. Insulinoma being a great diagnostic challenge, requires reasonably high clinical suspicion, accurate biochemical diagnosis and radiological localization to avoid extensive surgery. The aim is to highlight the occurrence of this rare tumour at a tertiary care hospital.

An institutional study was carried out in 102 patients to investigate the site specific effect of addictions, that is, tobacco smoking and tobacco chewing (smokeless), both independently and synergistically in development of malignancies in upper aerodigestive tract through retrograde questionnaire. The histopathologically proven cases were interviewed regarding different forms of addictions followed by clinical examination and investigations for grading (according to Modified Broadmann’s method) and TNM staging (according to UICC) according to the tumor site. Statistical analysis was done by Pearson test. Out of all proven cases of cancers, 29.4% were only tobacco chewers (smokeless), 25.5% were only smokers, 42.2% were having both types of tobacco addictions (smoke and smokeless), and only 2.9% were having no addiction. Out of only tobacco chewers (smokeless), 83.3% were of oral cavity cancers, 6.7% were of oro- and hypopharynx and the rest were of others. Among only smokers, 69.2% cases were of laryngeal and oro- and hypopharynx as compared to 11.5% of oral cavity cancers (nearly 6 times). Tobacco (smokeless) chewing is associated with oral cancers whereas tobacco smoking is associated with laryngeal and hypopharyngeal carcinoma. Both smoking and smokeless tobacco act in synergy with each other.

Objective. The objectives of the present study were to investigate the prevalence and characteristics of supernumerary teeth in a patient sample of Nepalese children. Study Design. A survey was performed on 2684 patients (1829 females and 1035 males) ranging in age from 6 to 14 for the presence of supernumerary teeth. For each patient with supernumerary teeth the demographic variables (age and sex), number, location, eruption status, and morphology were recorded. Descriptive statistics were performed. Results. Supernumerary teeth were detected in 46 subjects (1.6%), of which 26 were males and 20 were females with a male : female ratio of 1.3 : 1. The most commonly found supernumerary tooth was mesiodens followed by maxillary premolars, maxillary lateral incisor, and mandibular lateral incisor. Of the 55 supernumerary teeth examined, 58.18% (n=32) had conical morphology, followed by tuberculate (30.90%, n=17) and supplemental (10.90%, n=6) forms. The majority of the supernumerary teeth were erupted (56.36%, n=31). Conclusion. The prevalence of supernumerary teeth in Nepalese children was found to be 1.6%, the most frequent type being mesiodens. Conical morphology was found to be the most common form of supernumerary tooth.