scholarly journals Clinicopathological Analysis of Whipple’s Pancreaticoduodenectomy Specimens in a Tertiary Care Hospital with Special Emphasis on Grossing

2021 ◽  
Author(s):  
Ashima Nagesh Amin ◽  
Christol Blanch Moras ◽  
T Umashankar
Keyword(s):  
Lymph Node ◽  
Perineural Invasion ◽  
Tertiary Care ◽  
Clinicopathological Parameters ◽  
Lymph Node Status ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Whipple’S Procedure ◽  
The Mean

Introduction: Pancreaticoduodenectomy (PD) is done for a myriad of tumours as well as inflammatory condition affecting the duodenum, common bile duct, ampulla of vater and the head of pancreas. The diagnostic accuracy of the histopathology report is largely determined by the preliminary meticulous gross examination of the specimen. Aim: To comprehensively analyse the clinicopathological parameters of Whipple’s specimen and thus evaluate the trends in indication of Whipple’s procedure in Southern India .Materials and Methods: This was an observational time bound descriptive study done in the Department of Pathology, Father Muller Medical College Hospital, Mangalore, Karnataka from May 2014 to April 2019 wherein histopathological and clinical data of all the patients who underwent Whipple’s procedure were retrieved and analysed. The gross specimens were retrieved from the museum and records were assessed for the type of grossing method employed. The H&E slides were reassessed for the tumour type, grade, margins, perineural and angioinvasion, lymph node status and staging. Immunohistochemical marker (CD 117) and cytochemical like Mucicarmine and Alcian blue were employed wherever required. Descriptive analysis of the data involved calculating percentage, mean, median and range. The p-value was calculated using Fischer-Exact test with statistical significance level at <0.05. Results: Total of 45 patients underwent Whipple’s procedure, of which 28 (62.2%) were males and 17 (37.8%) were females with a ratio of 1.6:1. The most common symptom was jaundice (33 cases-73.3%) followed by pain abdomen (7 cases-15.6%). The mean age was 56.2 years. The mean tumour size was 2.8 cm. Malignancy was seen in (43 cases- 95.6%). The others being, inflammatory lesions (2 cases-2.2%). The most common site of localisation of tumours was periampullary (16 cases-37.2%) followed by pancreatic head (15 cases-34.9%).The most common histological subtype was adenocarcinoma (40 cases-93%). There were two cases of grade 2 neuroendocrine tumours (2 cases-4.7%) and one case (2.3%) of malignant Gastrointestinal Stromal Tumour (GIST). Lymph node positivity was most commonly seen in pancreatic cancers (7 cases-46.7%) with a significant p-value of 0.001. Lymphovascular invasion were seen in 16 cases (37.2%) and perineural invasion in 23 cases (53.5%). The most common tumour stage was T2 (16 cases-37.2%) followed by T3 (12 cases-27.9%). Margins were free in most of the malignant tumours (37 cases-86.04%). Conclusion: Thorough gross inspection of the Whipple’s specimen along with sound knowledge of the anatomy of the region is of utmost importance. The present analysis showed that periampullary adenocarcinoma was the most common subtype, many of the cases being diagnosed at an advanced stage, emphasising on early diagnosis through clinicoradiological modalities and guided biopsies. A meticulous and careful evaluation of the Whipple’s specimen is a pre-requisite for accurate histopathological differentiation of tumours originating in this anatomical region. Subtyping the tumor,reporting margin clearance, lymphovascular and perineural invasion, also has prognostic implications. Whipple’s PD may rarely be done for non-neoplastic conditions like chronic pancreatitis.

scholarly journals Significance of Immunohistochemical Biomarker in Breast Carcinoma from a Single Tertiary Care Hospital of Southern Assam

2021 ◽  
Author(s):  
Naiding Momota ◽  
Choudhury Biswadeep ◽  
Bezbaruah Babul ◽  
Nivedita Dasgupta ◽  
Deuri Biman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Breast Carcinoma ◽  
Tumor Size ◽  
Tertiary Care Hospital ◽  
Histological Grade ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Tumor Grade ◽  
Lymph Node Status ◽  
Care Hospital

Abstract Background: Breast carcinoma is the most common malignancy in female worldwide, leading cause of death in women.immunohistochemistry plays a very important role in the prognostication and treatment determination of breast carcinoma patients. Objective: To analyze the immunohistochemical markers in invasive carcinoma of breast and to correlate the expression of hormonal receptors with age of the patient, tumor size, histological grade and lymph node metastasis.Materials and method: The study was conducted on 88 infiltrating ductal breast carcinoma sample in a tertiary care hospital of Southern Assam for a period of two year (January2018- December 2019). Data including age, tumor size, and histologic grade and lymph node status retrieved from pathology department. Chi- square was used to determine the statistical significance between ER/PR status HER2/neu status along with their correlation with various clinicopathological parametres with respect to infiltrating ductal breast carcinoma.Result: The mean age of the patients was 56.6 years. We observed correlation between ER and PR expression with age, tumor size, tumor grade. There was correlation between HER2/neu expression and age only. None of the markers showed correlation with lymph node involvement (P>0.05).Conclusion: Our findings showed the importance of biomarkers (ER, PR, HER2/neu) expression as prognostic factors for therapeutic decision.

scholarly journals Clinicopathological Study of Mucinous Carcinoma of Breast with Emphasis on Cytological Features: A Study at Tertiary Care Teaching Hospital of South India

2020 ◽  
Vol 12 (01) ◽  
pp. 68-75
Author(s):  
Panduranga Chikkannaiah ◽  
Deinu Thangngeo ◽  
Chanigaramaiah Guruprasad ◽  
Srinivasamurthy Venkataramanappa
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tertiary Care ◽  
Mucinous Carcinoma ◽  
Needle Aspiration ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
Cytological Features ◽  
The Mean ◽  
Needle Aspiration Cytology

Abstract Introduction Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Depending on the amount of mucin, it is classified into pure mucinous carcinoma (> 90%, PMC) and mixed mucinous carcinoma (MMC; < 90%). In comparison to most common subtypes, MC is having better prognosis. There exist clinicopathological differences among PMC and MMC and also MC and IDC-NOS. Materials and Methods MCs diagnosed between January 2012 and December 2017 were included. Fine needle aspiration cytology smears were screened for cellularity, ECM, nuclear pleomorphism, signet ring cells (SRC), mucinophages, and myxovascular fragments (MVF). Histopathology slides were screened to confirm the diagnosis. Immunohistochemistry slides were graded as per the standard protocol. Statistical analyses were performed by SPSS software. Results In the present study, MC constituted 3.3%. The mean age of the patients was 50.9 years. ECM, mucinophages, and SRC were the key diagnostic cytological features. The PMC and MMC were clinicopathologically distinct with respect to gross findings and lymph node status. MMCs were highly proliferative. The mean duration of follow-up was 24.5 months. Complications were more common in MMC than PMC. Lymph node involvement is the key prognostic factor and it is independent of other prognostic factors like age, size, and hormonal receptor status. Conclusion PMC are rare subtype of breast cancer. The diagnostic cytological features are ECM, MVF, and SRC. MMC and PMC are clinicopathologically and genetically distinct.

scholarly journals Prostatic lesions: Histopathological study in a tertiary care hospital

2018 ◽  
Vol 4 (1) ◽  
pp. 12-19
Author(s):  
S. Bhatta ◽  
S. Hirachan
Keyword(s):  
Histopathological Examination ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Histopathological Study ◽  
P Value ◽  
Care Hospital ◽  
Significant Difference ◽  
Nodular Hyperplasia ◽  
Malignant Lesions ◽  
The Mean

Background: Prostatic lesions like Nodular hyperplasia of prostate, inflammation and carcinoma are common causes of morbidity and mortality in males. The incidence of these lesions increases with age. This study was conducted with the objective of evaluating histopathological pattern of prostatic lesions.Methods: This was a retrospective study conducted at KIST Medical College from Jan 2014 to Jan 2018. The study included ninety six prostatic specimens received in department of pathology. Hematoxylin and Eosin stained slides were retrieved and reviewed. The specimens and slides were analyzed according to type of specimen, age of patient, histopathological pattern and final diagnosis. Results were analyzed using Statistical Package for Social Science (SPSS, version 21) for Windows. Independent t test was used to correlate the mean age between patients with benign and malignant lesions. P value less than 0.05 was considered as statistically significant.Results: The most common benign lesion was nodular hyperplasia of prostate 86(89.58%). Malignant lesions comprised 8 (8.34%) cases of all prostatic lesions. All the cases of prostate carcinoma were adenocarcinoma. The most frequent Gleason score was 9. Mean age for benign and malignant lesions were 69.6 ± 8.1 years and 72.9 ± 5.2 years respectively. There was no significant difference in the mean age between patients with benign and malignant lesions (p value 0.27).Conclusion: Benign lesions of prostate are more common than malignant lesions. Histopathological examination of prostate specimens have important role in diagnosing various benign and malignant lesions, especially to rule out incidental carcinoma.JMMIHS.2018;4(1):12-19

scholarly journals Assessing the Learning environment of major Specialty PGRs in a tertiary care Hospital by Health Education Learning Environment Survey (HELES)”

2020 ◽  
Vol 3 (1) ◽  
pp. 53-58
Author(s):  
Qamar Ashfaq Ahmad
Keyword(s):  
Health Education ◽  
Learning Environment ◽  
Personal Development ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Three Dimensions ◽  
P Value ◽  
Care Hospital ◽  
System Maintenance ◽  
The Mean

Background: There are many surveys available to quantify educational climate of postgraduate residents but these are lacking in validity and theoretical background. Health education learning environment survey (HELES) with 35 questions in six subscales is used in undergraduates with good results. Objectives: To quantify current health education learning environment of our Post graduate residents of FCPS/MS/MD in Surgery, Medicine and Gynae & Obs in a tertiary care hospital by using HELES tool. This quantification will help Supervisors, Hospital administrators to monitor their programs, suggest and bring improvement.     Methods: A cross sectional study was done in Services Institute of Medical Sciences Lahore from 10th Sep to 1st Oct 2019. A sum of 90 residents in FCPS/MS/MD program with 30 each from Surgery, Medicine and Gynae & Obstetrics were selected.  A predesigned HELES proforma with 35 questions subdivided in 6 factors and 3 main dimensions was used. In “Personal development “a mean score of 34 and above was taken as positive score. In “Relationship” and in “System maintenance” dimension a mean score of 48 and above was taken as positive. Data was analyzed using SPSS 22 and p value of 0.05 was taken as significant. Results: Out of 90 residents, 57 (63.3%) were males and 33 (36.7%) were females without any significant difference between gender. The mean age was 27.4 ± 3.6 years. The mean score of all the residents in Surgery, Medicine and Gynae & Obs in all the three dimensions remained below the average reference values, which implies that our postgraduates are not content with the learning environment they live in.  The comparison of means among different specialties was 0.02 which was statistically significant. Resident’s response in all the three dimensions with their year of training was significant with a p value of < 0.05. 2nd year residents of all specialties scored comparatively high in all the three dimensions Conclusion:  PGRs in the 3 major specialties were dissatisfied with their health education learning environment. Maximum were discontent in Relationship dimension especially in Faculty relationship factor, then in System maintenance and then in Personal development dimension. Residents of Gynae & Obstetrics exhibited significantly low score in System Maintenance dimension.   Key words: Health, education, learning, environment, residents

scholarly journals Epidemiological charactristics of acute hepatitis in tertiary care hospital.

2021 ◽  
Vol 28 (7) ◽  
pp. 1039-1043
Author(s):  
Hafiz Mughees Ather ◽  
◽  
Arfan Mahmood ◽  
Affan Shahid ◽  
Mohammed Osama ◽  
...  
Keyword(s):  
Acute Hepatitis ◽  
Tertiary Care ◽  
Stable Condition ◽  
Water Source ◽  
Categorical Variables ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Cross Sectional ◽  
Epidemiological Characteristics

Objective: To record the epidemiological, characteristics of Acute hepatitis patients. Study Design. Cross Sectional study. Setting: Government General Hospital Ghulam Muhammad Abad, Faisalabad. Period: March 2019 to 30th of September 2019. Material & Methods: A total of 92 patients included in the study. Patient’s epidemiological characteristics, symptoms and lab results were recorded during hospital stay. Categorical variables were analyzed using Chi-Square and Fissure Exact tests. P value of <0.05 was considered statistically significant. Results: 78% were male & 22% were female. Water source was 16% filtered water, 32% ground water & 52% was Government supplied water. Most common symptom was yellow sclera (100%), Dark urine (100%), Nausea, fatigue and anorexia (Each 87%), Vomiting (83%), Fever (73%), Right hypochondriac pain (70%), Body aches (66%) and headache was 61%. Among the risk factors other than water source, outside eating was present in 74% and tattooing was present in 5% while blood transfusion history and Ear/Nose piercing was 0%. All 92 patients discharged in stable condition (100%). Tests for determination of cause i.e HAV & HEV serology were ordered in each case. Conclusion: Young males were affected more commonly. Presentation of acute hepatitis varies in symptoms but mostly the disease is self-limiting and running a mild course without leading to liver failure. Most common risk factor was outside eating in unhygienic environment which should be avoided.

scholarly journals Ki67 and P53 expression in breast cancer and their correlation with clinicopathological parameters

2021 ◽  
Vol 8 (4) ◽  
pp. 478-484
Author(s):  
Sukanya Gogoi ◽  
Bandita Das ◽  
Mondita Borgohain ◽  
Gayatri Gogoi ◽  
Jayanta Das
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Menopausal Status ◽  
Clinicopathological Parameters ◽  
Lymph Node Status ◽  
P Value ◽  
Axillary Lymph ◽  
Ki 67 ◽  
P53 Expression ◽  
Node Status

Breast carcinoma is the most common malignancy in females and is a leading cause of death. Treatment depends upon various pathological and prognostic markers like lymph node status, size, type and grade of the tumour which influences the outcome of breast cancer. Markers like Ki-67 and p53 have been studied extensively and their roles in breast cancer are yet to be established.We evaluated the expression of Ki67 and P53 in breast cancer and their association with other clinico-pathological factors was studied. Ki67 and P53 expression was assessed in 60 breast cancer cases admitted to our hospital over a period of one year. Association with other prognostic parameters was evaluated. Statistical analysis was done by Chi square test and a p value of &#60;0.05 was taken as significant. 43.33% cases had low proliferative Ki-67 score whereas 56.67% of the cases were highly proliferative. p53 expression was seen in 41.66% cases. Ki-67 and p53 expression were not significantly related to age, menopausal status, and tumour size whereas a significant correlation was seen with positive axillary lymph node status, high histological grade, negative hormone receptor status (ER, PR) and positive HER2/neu expression. Significant association was seen between Ki-67 and p53 expression.Ki67 and P53 may be considered as a valuable biomarker in breast cancer patients which can help in planning treatment strategies.

scholarly journals Brixia Chest X-ray Scoring System in Critically Ill Patients with COVID-19 Pneumonia for Determining Outcomes

2021 ◽  
Author(s):  
Nishant Agrawal ◽  
Samruddhi Dhanaji Chougale ◽  
Prashant Jedge ◽  
Shivakumar Iyer ◽  
John Dsouza
Keyword(s):  
Scoring System ◽  
Early Stage ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Care Hospital ◽  
X Ray ◽  
Lung Abnormalities ◽  
Chest X Ray ◽  
The Mean

Introduction: In early stage of disease of Coronavirus Disease 2019 (COVID-19) infection chest Computed Tomography (CT) imaging is considered as the most effective method for detecting lung abnormalities. A Brixia Chest X-ray (CXR) scoring system which uses an 18-point severity scale to grade lung abnormalities due to COVID-19 was developed to improve the risk stratification for infected patients. Aim: To ascertain the validity of Brixia scoring system and to measure the outcome in COVID-19 patients. Materials and Methods: A retrospective study was conducted from 1st April 2020 to 31st July 2020, at a tertiary care hospital in India. Baseline CXR of COVID-19 patients were scored based on Brixia scoring system. The lungs were divided into six equal zones. Subsequently, scores (from 0-3) were assigned to each zone, based on lung abnormalities. A group comparison was implemented using Chi-Square test for categorical variables. Whereas an independent t-test was applied for continuous variables that followed normal distribution. Results: The study included 130 patients. The mean age was 57.09±13.73 years, 70.8% patients included were males. Out of 130 patients, 79 patients died. Among patients who died the mean CXR score was calculated to be 12.13±2.50. The mean CXR score was calculated to be 11.18±2.30 in patients who recovered and got discharged. During the process of comparison of CXR scores with the outcomes, the t-value came out to be 2.20 and the resulting p-value was 0.03 (statistically significant). Conclusion: Brixia score more than 12 was associated with increased mortality due to COVID-19, with p-value of 0.03.

scholarly journals The Diurnal Variation of Thyroid Hormones in Individuals Attending Tertiary Care Hospital, Kanchipuram District

2020 ◽  
Vol 13 (4) ◽  
pp. 1729-1735
Author(s):  
Santhosh Viswan ◽  
Gurulakshmi Gurusamy ◽  
Khadeja Bi Altaff ◽  
Suganya Subbarayalu ◽  
Gomathi Surendran
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Tertiary Care ◽  
Biologically Active ◽  
Enzyme Linked Immunosorbent Assay ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Free Thyroid Hormones ◽  
The Mean

Free thyroxin hormones FT4 and FT3 are unbounded thyroid hormone are biologically active and involves in regulation of metabolism. Measuring the concentrations of free thyroid hormones is of great diagnostic value. A cross sectional study was carried out during the March 2019 to September 2019 in patients between 18 years to 60 years. A total of 60 samples were collected from 30 patients attending Karpaga Vinayaga Institute of Medical Sciences at morning (6am-8am) and 2nd sampling at night (8pm-9pm). FT4, FT3 and TSH were measured by Enzyme linked immunosorbent assay, using Avantor kit.In our study 36.67% participants were males, 63.3% participants were females. The mean FT3, FT4 and TSH in day are 2.43±0.56, 1.14±0.44 and 2.74±3.16 respectively. The mean night FT3, FT4 and TSH are 2.66±0.55, 1.3±0.61 and 3.21±3.18 respectively. The one sample t test shows difference of FT3, t 4.489 and p value 0.000, FT4, t value 3.092 and p value 0.004 and TSH t value 3.394 and p value 0.002. The time of blood sampling has an important role in the interpretation of TSH levels. However fluctuations in diurnal variations in thyroid hormone levels are less. In our study although statistically significant, all the values are within the normal biological reference interval Further studies in larger cohorts is essential to desire important conclusions.

scholarly journals Pseudocholinesterase, aspartate transaminase, alanine transaminase as markers for cervical cancer: a study in a tertiary care hospital

2017 ◽  
Vol 4 (6) ◽  
pp. 1557
Author(s):  
Vydehi Veeramalla
Keyword(s):  
Cervical Cancer ◽  
Negative Correlation ◽  
Tertiary Care ◽  
Malignant Neoplasm ◽  
Mean Value ◽  
Alanine Transaminase ◽  
P Value ◽  
Care Hospital ◽  
Aspartate Transaminase ◽  
The Mean

Background: Cervical cancer is a malignant neoplasm arising from cells originating in the cervix, almost always caused by human papillomavirus (HPV). Butyrylcholinesterase is a non-specific cholinesterase enzyme that hydrolyses different choline esters. PCHE levels were lower than the normal at all the stages of cancer cervix. The present study was attempted to find out the role of some of the biochemical markers like serum pseudocholinesterase (PCHE), serum aspartate transaminase (AST), and serum alanine transaminase (ALT), in malignancy of the uterine cervix.Methods: 60 patients aged between 30 -70 years who were having cervical cancer were included into the study and 30 healthy patients within the same age group were included as controls. 5ml of venous blood was collected from all the study participants under aseptic conditions in a plain tube. Serum Pseudocholinesterase, Serum Aspartate transaminase and Serum Alanine transaminase was estimated for all the patients in both the groups.Results: The mean value of pseudocholinesterase in cervical cancer patients was lower in the cases when compared to controls and it was statistically significant (P value 0.0005), while the mean value of serum AST and ALT were higher in cases when compared to controls and it were also statistically significant. When compared with Pearson’s coefficient, the serum PChE had a significant negative correlation with AST and ALT, while the serum AST had a significant positive correlation with ALT and a negative correlation with PChE.Conclusions: Among the women with cervical cancer, it was observed that the enzyme activity of PChE was lower than normal, while that of SGPT and SGOT were higher. PCHE, AST, and ALT can be used as tumor markers in the management of malignancy of the uterine cervix.

scholarly journals Profile of tuberculous pneumothorax and comparison with pulmonary tuberculosis without pneumothorax

2019 ◽  
Vol 7 (3) ◽  
pp. 658
Author(s):  
Gayatri D. Yellapu ◽  
Surya K. Vipparthi ◽  
Rohini K. Vangara
Keyword(s):  
Pulmonary Tuberculosis ◽  
Hospital Stay ◽  
Past History ◽  
Financial Burden ◽  
Tertiary Care ◽  
Control Group ◽  
P Value ◽  
Care Hospital ◽  
Common Cause ◽  
The Mean

Background: Tuberculosis is the most common cause of secondary spontaneous pneumothorax (SSP) in India. The prevalence of SSP in patients with pulmonary tuberculosis (PTB) is between 1- 3%. There were only few studies in the literature that specifically analyze tuberculous PNTX. In a study from this hospital, author found PTB was the most common cause of SSP. Now, author aimed at studying the clinical profile of tuberculosis associated PNTX cases and compared with pulmonary tuberculosis cases without PNTX.Methods: This was a single centre prospective observational case control study done at a tertiary care hospital. Fifty patients of tuberculous pneumothorax as cases, and 100 patients of pulmonary tuberculosis without pneumothorax were taken as control. The demographic data, clinical presentation, and radiologic presentation, outcomes after treatment were recorded in both the groups. The data was analyzed using statistical software (SPSS) using appropriate statistical tools.Results: The mean age of patients in the PNTX group was 38.18±14.132, where as in the control group it was 45.29±14.89 (p-value of 0.0052). Past history of tuberculosis was present in 27 (54%) cases of PNTX group and in 41 (41%) cases in the control group (p-value of 0.091). The mean duration of length of hospital stay in PNTX group was 16.5±11.865 days and in non-pneumothorax group was 6.2±2.54 days (p-value was 0.0001).Conclusions: Tuberculous pneumothorax was more common between 30-40 yrs age group. Gender and smoking have no association with PNTX. Tuberculous pneumothorax was more common in previously treated cases of TB. Patients with tuberculous PNTX have prolonged hospital stay and complications resulting in increased morbidity, financial burden and mortality.

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