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Background: The Bethesda system for reporting thyroid cytopathology (TBSRTC) represents a major step in the interpretation of thyroid fine needle aspiration (FNA) creating uniformity and clarity and providing clinically relevant information assisting the referring physicians in the management of the patients. Aims: To study the cytological features of thyroid FNA and interpretation of the smears by TBSRTC. Materials and Methods: A retrospective study of thyroid FNAs from May 2013 to June 2015 is carried out in the Pathology Department of a tertiary care institute. The results are interpreted according to the features and categories given in the monograph of TBSRTC. Results: A total of 576 cases studied. The distribution of the various categories from evaluated thyroid FNAs are as follows: nondiagnostic/unsatisfactory - 5.2%, benign - 89.9%, atypia of undetermined significance - 0%, follicular neoplasm (FN) or suspicious for a FN - 2.2%, suspicious for malignancy - 0.3%, malignant - 2.2%. Conclusion: The Bethesda system allows a more standard and uniform method of reporting thyroid cytology providing a clear and consistent management guidelines for the clinicians.

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Background: Spinal anesthesia is often used for both elective and emergency cesarean section. One earlier study has shown that intrathecal levobupivacaine given in L _3-4 space did not provide satisfactory intraoperative analgesia in all parturients. We assume that the same dose may work if given in L _2-3 intrathecal space, especially in our population with shorter stature. Materials and Methods: After Institutional Ethical Committee approval, 100 parturients (American Society of Anesthesiologists I-II, aged 18-40 years) and after obtaining written informed consent to received spinal anesthesia for cesarean section were randomized into four groups: Group I (0.5% hyperbaric bupivacaine 7.5 mg in L _2-3 intrathecal space), Group II (0.5% hyperbaric levobupivacaine 7.5 mg in L _2-3 intrathecal space), Group III (0.5% hyperbaric bupivacaine 10 mg in L _3-4 intrathecal space), and Group IV (0.5% hyperbaric levobupivacaine 10 mg in L _3-4 intrathecal space), respectively. Hypotension (systolic blood pressure <100 mmHg or fall >20% from baseline) was treated with injection mephentermine 3 mg intravenous (iv) increment (s). For the ethical reason, inadequate analgesia was treated with 0.5 mg/kg iv ketamine. Statistical analysis was performed using the SPSS version 20 software windows. A P < 0.05 was considered significant. Results: Time to onset of sensory block was faster in 0.5% hyperbaric levobupivacaine 10 mg given in L _3-4 intrathecal space (Group IV P = 0.013). No significant difference was found in time to reach maximum block level (T ₄ -T ₆ ). Median peak sensory block level was significantly lower in Group II as compared with other group T ₆ versus T ₄ ; F = 106.159; P < 0.001). Time to regression by two dermatomes was significantly shorter with a lower dose of either bupivacaine or levobupivacaine given at L _2-3 intrathecal space (P = 0.028). The degree of motor block or motor block regression was similar in all the groups. Intraoperative rescue analgesia was required in 20% of patients in Group II (levobupivacaine 7.5 mg in L _2-3 ); it was 4% in each of the remaining groups (P = 0.082). Injection mephentermine used was 24%, 32%, 48%, and 28%, respectively, in Group I to IV though it did not reach statically significance. Conclusion: Levobupivacaine 7.5 mg can be used in lower segment cesarean section when given in L _2-3 space. Onset is faster, and hemodynamic stability is more with levobupivacaine. At the higher dose, the duration of action bupivacaine seems to be longer.

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Background: Noninfectious granulomatous dermatoses (NGDSs) are a broad group of distinct reactive inflammatory conditions that share clinical as well as histological similarities. Because of these similarities, these lesions pose a diagnostic difficulty to naοve and even expert dermatologists and pathologists and need a clinicopathological correlation. Aims and Objectives: We aimed at determining the histopathological profile of NGDS in Western Indian population correlating it with morphology, age, and anatomic distribution with an attempt to find the etiology. Materials and Methods: In a prospective study conducted over 2 years in a tertiary care referral center in Mumbai, out of 1872 skin biopsies received, 29 histopathologically diagnosed cases of NGDS were selected and studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Results: Out of the total 1872 skin biopsies received in our department in 2 year period, 29 biopsies were histopathologically diagnosed as NGDS of which necrobiotic granulomas (n = 14) were the most common diagnosis which included granuloma annulare (78.57%), necrobiosis lipoidica (14.29%), and rheumatoid nodule (7.14%). Other frequently diagnosed lesions were sarcoidosis (13.79%), actinic granuloma (10.34%), erythema nodosum (6.89%), and erythema induratum (3.44%). Conclusions: Various NGDS exhibit histopathological features with considerable overlap. However, their knowledge is must to understand the clinical behavior. Similarly, detailed clinical history and examination of early and mature lesions help in differentiating between lesions sharing similar histological features.

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Background: The prevalence of diabetes mellitus and impaired glucose tolerance is higher in patients with cirrhosis of any cause than in the general population. Hepatitis B infection is one of the causes. Objectives: To study the prevalence of glucose intolerance in chronic hepatitis B (CHB) virus (HBV) infection and to find out the association between glucose intolerance and severity of fibrosis, genotype, and HBV DNA levels. Materials and Methods: The study was a retrospective cohort type conducted in the Department of Medicine, Regional Institute of Medical Sciences, which included 29 patients. Fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were performed. HBV DNA levels and genotype were determined. Liver fibrosis was assessed by fibroscan. Results: The number of patients with impaired and diabetic range of FBS was 5 (17.2%) and 7 (24.1%), respectively. Similarly for PPBS, 8 (27.6%) patients had impaired range and 11 (37.9%) patients with diabetic range. Glycated hemoglobin (HbA1C) value ≥5.7 was present in 20 (69%) patients. A majority of patients were found to have genotype C (72.4%). Comparison for association between patients having impaired and diabetic range of FBS, PPBS, and HbA1C with fibroscan value >12.5 kPa was found to be statistically significant but that of genotype and HBV DNA levels was not considered significant. Conclusion: The prevalence of glucose intolerance is increased in patients with CHB infection. Patients having severe fibrosis or cirrhosis of the liver are found to be more glucose intolerant.

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Background: Laryngoscopy and intubation is a noxious stimulus, which can provoke many untoward responses, particularly in the cardiovascular system in the form of hypertension, tachycardia, and dysrhythmia, which can be detrimental in cardiovascular compromised patients. The aim of the study was to compare the efficacy of preoperative oral pregabalin and gabapentin in attenuating hemodynamic responses to laryngoscopy and intubation. Materials and Methods: One hundred and twenty adult patients undergoing elective surgery under general anesthesia were randomly allocated by computer-generated randomization into three groups of forty patients each to receive preoperatively - Group C - vitamin capsules, Group G - gabapentin 800 mg, and Group P - pregabalin 150 mg, 90 min before the scheduled surgery. Systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, 1, 5, 10, and 15 min after intubation. Results: The increase in HR response to laryngoscopy and intubation was minimized by both gabapentin and pregabalin when compared with the control group (P < 0.05) at baseline and 1 min; however, there was no statistically significant difference between the two study groups (P > 0.05). There was statistically significant reduction in SBP, DBP, and MAP at 1 min with P = 0.026, 0.014, and 0.001 and at 5 min with P = 0.002, 0.007, and <0.001, respectively, in gabapentin group. In pregabalin group, there was a reduction in SBP, DBP, and MAP at 1 min following intubation with P < 0.001, <0.001, and <0.001 and at 5 min with P = 0.001, <0.001, and <0.001, respectively. Conclusion: Oral pregabalin and gabapentin in the present study attenuates hemodynamic responses to laryngoscopy and intubation. There was a significant reduction in SBP, DBP, and MAP, but not the tachycardia.

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Background: In developing countries, cervical cancer is the most common cancer cause of death among women. Aim: This study was undertaken to evaluate the cervical cytology smears in postmenopausal and elderly age group women, and also to assess the usefulness of cytological screening in elderly women. Materials and Methods: In this prospective study, a total of 600 Papanicolaou smears were evaluated and categorized according to Bethesda system for reporting cervical cytology 2014. Of these, 420 smears were obtained from postmenopausal women aged over 45-65 years and 180 were from elderly women aged over 65 years. Results: Overall, the prevalence of epithelial cell abnormality was 5.5%. Epithelial cell abnormalities found in elderly women were 10.5% and in postmenopausal women were 3.3%. Reactive cellular changes associated with inflammation were observed in 72.3% of postmenopausal women and 28.3% of the elderly female; whereas, atrophic changes were noted 61.1% in elderly female and 24.2% in postmenopausal women. Both these findings revealed statistically significant differences (P < 0.001). Conclusion: The present study showed that postmenopausal and elderly female from rural areas and low socio-economic groups significantly suffered from precancerous lesions of the cervix; even though, the rate seems to be low. Hence, our study concluded that postmenopausal and elderly female should undergo cervical cancer screening to avoid morbidity and mortality.

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Background: Role of emergency ultrasound screening (EUS) in the evaluation of all patients with clinically suspected acute pyelonephritis (APN) in the emergency department (ED) remains unclear. The aim of the study was to describe the frequency of abnormal EUS findings in APN presenting to ED and ascertain the laboratory abnormalities associated with significant abnormal findings to identify the subgroup of patients who will benefit from EUS in ED. Methodology: In this retrospective study, electronic medical records were searched to identify all adult patients who underwent EUS screening from ED for initial clinical diagnosis of APN over 1 year. The EUS findings were categorized into normal, major abnormalities (hydronephrosis, renal abscess, and emphysematous pyelonephritis), and mild abnormalities (cysts, calculi, and renal edema). Results: A total of 1218 patients with initial clinically diagnosed APN underwent EUS. Nearly 49% had a normal EUS while 51% had at least one major or minor abnormality. The frequency of hydroureteronephrosis, renal calculi emphysematous changes, and renal abscess was 19.1%, 8.9%, 2.1%, and 1.9%, respectively. Only 72 (5.9%) patients required emergency percutaneous nephrostomy or drainage of an abscess. Among these patients, EUS was able to identify a major abnormality in sixty (83.3%) patients. Male gender, presence of diabetes mellitus, peripheral white blood cell (WBC) count >10,000 cells/cumm, serum creatinine >1.4 mg%, and urine WBC count >100 cells/hpf were found to independently predict the presence of an abnormality on an EUS. Conclusion: A large proportion of APN patients have only normal or minor abnormalities and do not need additional screening and intervention.

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Valproic acid is a branched chain aliphatic carboxylic acid which is widely used as antiepileptic drug. Valproic acid-induced acute pancreatitis is an uncommon cause of acute pancreatitis. Hereby we describe a 23-year-old unmarried female, who developed acute pancreatitis following the 12 ^th day of valproate monotherapy prescribed for seizure disorder. Valproate was immediately stopped and replaced with levetiracetam. She improved on conservative management.

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Background and Aims: In this retrospective analysis, we report our experience with the high-dose methotrexate-based chemotherapy B-ALL protocol of the German ALL study group followed by consolidative mediastinal radiotherapy in patients with adult primary mediastinal large B-cell lymphoma (PMLBCL) as a single-center trial. Setting and Design: Nineteen patients with newly diagnosed/untreated PMLBCL who were treated between June 1999 and May 2013 were included. Patients received a high-dose methotrexate protocol consisting of six cycles. Materials and Methods: Patients received thrice block A [day 1: methotrexate 1,500 mg/m² for 24 h; days 1-5: ifosfamide 800 mg/m²; days 4-5: VM-26 100 mg/m² and ara-C 2x150 mg/m² (bid); days 1-5: dexamethasone 10 mg/m² p.o.] and thrice block B [day 1: vincristine 2 mg i.v., MTX as in block A; days 1-5: cyclophosphamide 200 mg/m²; days 4-5: adriamycin 25 mg/m²; days 1-5: dexamethasone 10 mg/m² p.o.] applied alternatively every 3 weeks. Results: After chemotherapy five patients achieved CR, nine patients CRu and four patients PR. The restaging procedures after consolidation radiotherapy showed an overall response rate of 95% (9 CR and 9 CRu). With a median follow-up of 56 months, progression free survival and overall survival at 60 months were 88%. The most common grade 3/4 hematological toxicities were leukocytopenia and neutropenia (100%), thrombocytopenia (95%), and anemia (63%). Conclusion: Our data suggest that the current high-dose methotrexate-based chemotherapy protocol followed by consolidation mediastinal radiotherapy in patients with adult PMLBCL is feasible, effective, and moderately tolerated.

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Benign joint hypermobility syndrome (BJHS) is a connective tissue disorder with hypermobility, in which musculoskeletal symptoms occur in the absence of systemic rheumatologic disease. It is an inherited connective tissue disorder and is different from other genetic connective tissue disorders such as Marfan's and Ehler-Danlos syndromes that also cause joint hypermobility and generalized joint laxity. We are reporting three cases of BJHS for the first time from Manipur, who presented with nonspecific symptoms and arthralgias.

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Background: Traumatic brain injury (TBI) is affected by multiple injury factors. Geography and vehicle prone to the accident may have an important role on the outcome. Aims: This study aims to study the details of place and mechanism of injury and their effect on discharge outcome. Settings and Design: Prospective study. Methods: This is a prospective study where 337 patients diagnosed with TBI were selected from an emergency department, after obtaining their consent. The details of place and cause of injury data was recorded on standard proforma using FileMaker Pro Advanced 13 software. Statistical Analysis: The data were analyzed using Stats Direct version 3.0.150. Results: The study reports that age, gender, and severity of the injury as per Glasgow coma scale was significant with the outcome at discharge. Higher number of patients was from rural setup (72.6%). Roadside accidents account for about 56% of injuries. About 77% of injuries were due to accidents. Two-wheeler was cause for accidents in 54% of injuries. Mechanism of injury like motor vehicle accident, fall, blunt, and the penetrating injury was significant with discharge outcome. Conclusion: The study addresses that majority of TBI patients are from rural areas and injuries are due to accidents. Mechanism of injury has significance with discharge outcome.

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Collecting duct carcinoma (CDC) is an extremely rare subtype of renal epithelial neoplasm arising from the distal segment of the collecting ducts of Bellini in the renal medulla. It accounts for <1% of all renal cell carcinoma cases. It has been reported to have a tendency toward early dissemination. This aggressive malignancy is difficult to be diagnosed despite its characteristic histological and immunohistochemical findings. We report a case of a CDC with sarcomatoid differentiation in a 64-year-old female who presented with a right renal mass and underwent right radical nephrectomy.

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Fulminant infectious mononucleosis (FIM) is a rare but life-threatening complication of Epstein-Barr virus infection that usually affects immunodeficient individuals. It is a hyperinflammatory syndrome caused due to release of massive amount of various cytokines, leading to hemophagocytic lymphohistiocytosis on histopathology, and a plethora of clinical manifestations due to simultaneous involvement of multiple organs of the body. The case of a young male who presented with fever and dyspnea and died within 12 h of presentation to the hospital was taken for autopsy. The postmortem evidence of hemophagocytic lymphohistiocytosis in the spleen, bone marrow, lymph nodes, liver, and lungs and the presence of large, basophilic intranuclear inclusions that stained latent membrane protein-1 positive on immunohistochemistry led to the diagnosis of FIM.

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Ectopia cordis is a rare congenital heart anomaly where the heart is abnormally located outside the thoracic cavity. The defect lies in the failure of the midline closure of the body wall by lateral and head and tail folds. Because of its associated abnormalities, ectopia cordis is a challenging congenital anomaly. The prognosis of ectopia cordis depends on its classification and associated intracardiac anomalies.

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