Category: Nevin Manimala

Ugeskr Laeger. 2023 Dec 11;185(50):V202311.

ABSTRACT

Introduction Acetylsalicylic acid (ASA) has commonly been touted for its potential to extend the aesthetic lifespan (EL) of Christmas trees when added to the water in the tree stand. This study examined the efficacy of ASA in prolonging the aesthetic longevity of spruce branches, in comparison to placebo and sildenafil. Intervention We conducted a triple-blinded, randomised clinical trial, wherein 60 spruce branches were allocated to one of three treatment arms in a 1:1:1 ratio. The primary intervention was ASA, compared against both placebo and sildenafil treatments. The study’s primary endpoint was the EL of the spruce branches. Results All participating branches completed the study. No statistically significant differences were observed in the survival times across the three groups: ASA 17 days (standard deviation (SD): 6), placebo 20 days (SD: 8), and sildenafil 21 days (SD: 7); p = 0.30. Both the log-rank test and adjusted Cox proportional-hazards analyses failed to show any significant variations in aesthetic survival time among the treatment arms (p > 0.05). Conclusion Given our findings, there is no empirical support for the widely held recommendation of adding ASA to the water at the base of a Christmas tree to extend its aesthetic lifespan. Funding none. Trial registration none.

PMID:38084621

Ugeskr Laeger. 2023 Dec 11;185(50):V20239.

ABSTRACT

Introduction While some studies have investigated the cooling properties of warm beverages, no studies have examined thermal well-being in warm environments in relation to beverage temperature. Methods Thirty researchers were randomised in a 1:1 ratio in a double-blinded cross-over study. Participants were randomised to drink 10cl of 10°C and 50°C decaffeinated tea, 15 minutes apart while staying outside in the Turkish summer heat at noon. Well-being was assessed using the American Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE) thermal sensation scale, Bedford thermal comfort scale, Brief Mood Introspection Scale (BMIS), and the last two domains of EuroQol 5-domain, 5-point scale: EQ-5D-5L. Results Neither clinically nor statistically significant differences were found in well-being between warm and cold tea. Moods soured significantly as the trial course passed (using BMIS, µ 1.9; P=0.03), but comfort in the heat bettered (using Bedford, µ -0.37; P less-than 0.001). These changes were not considered to be clinically significant. Conclusion We were unable to show any correlation between beverage temperature and comfort in a hot environment. The mood of participants did, however, deteriorate as time passed-a lesson to any future researchers conducting drawn-out experiments just before lunch. Funding none. Trial registration NCT05900960.

PMID:38084617

Anaesthesiol Intensive Ther. 2023;55(4):291-296. doi: 10.5114/ait.2023.132531.

ABSTRACT

INTRODUCTION: The Russian invasion of Ukraine has caused huge damage to all medical infrastructure and impairs patient safety. The aim of our study was to assess the impact of implementation of the WHO Surgical Safety Checklist and Anesthesia Equipment Checklist on patient outcomes and adherence to safety standards in low-resource settings, affected by an ongoing war.

MATERIAL AND METHODS: A prospective multicenter study was conducted in 6 large Ukrainian hospitals. The study was conducted in two phases: a control period, lasting five months, followed by a study period, when the two checklists (the WHO Surgical Safety Checklist and Anesthetic Equipment Checklist) were introduced in the designated operating rooms. The primary outcomes were any major complications, including death, during 30 days after surgery.

RESULTS: A total of 2237 surgical procedures were recorded – 1178 in the control group and 1059 in the intervention group. Major postoperative complications occurred in 82 (6.9%) patients in the control group and in 25 (2.4%) in the study group (OR = 0.32 [0.19-0.52], P < 0.001). The effect on the incidence of specific postoperative complications was statistically significant for the “surgical infection” (1.5% vs. 0.1%; OR = 0.31 [0.1-0.8], P = 0.01) and “reoperation” (1.7% vs. 0.5%; OR = 0.32 [0.1-0.8], P = 0.01) cate-gories as well as for the 30-day mortality (1.3% vs. 0.3%; OR = 0.35 [0.1-0.9], P = 0.03). Better adherence to basic WHO surgical safety recommendations was observed for every check mentioned in the WHO Surgical Safety Checklist ( P < 0.05).

CONCLUSIONS: The WHO Surgical Safety Checklist and the Anesthesia Equipment Checklist improve patient outcomes in war-affected low-resource settings.

PMID:38084574 | DOI:10.5114/ait.2023.132531

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):804-809. doi: 10.4103/ijpm.ijpm_1146_21.

ABSTRACT

BACKGROUND: Cyclic adenosine monophosphate (cAMP) is an intracellular signal transmitter involved in the regulation of melanocyte growth, proliferation, and melanogenesis. R21 is a monoclonal antibody against the soluble adenylyl cyclase (sAC) protein. Various nuclear and cytoplasmic R21 expression patterns in melanocytic lesions have been previously reported. Pan-nuclear staining was defined as specific for melanoma and was found supportive in the assessment of surgical margins.

AIMS: The aim of this study is to evaluate the different expression patterns of R21 immunostain and investigate its effectiveness in the differential diagnosis of cutaneous malignant and benign melanocytic lesions.

SETTINGS AND DESIGN: Fifty invasive cutaneous melanoma and 50 benign melanocytic proliferation were included in the study.

MATERIALS AND METHODS: Paraffin blocks that best reflected tumor morphology were studied via immunohistochemical staining for R21. For all patterns, the cases showing staining in 25% or more tumor cells were considered as positive.

STATISTICAL ANALYSIS USED: Yates’ Chi-square, Pearson Chi-square exact test, Spearman correlation were used.

RESULTS AND CONCLUSIONS: Dot-like Golgi staining was characteristic for nevi (12/50) and seen only in one melanoma. Pan-nuclear staining was striking for melanoma (36/50). This pattern was observed in 2 dysplastic and 3 common melanocytic nevi too. None of the Spitz nevi expressed R21 in pan-nuclear pattern. For the diagnosis of melanoma, sensitivity and specificity of the pan-nuclear expression were 72% and 90%, respectively. Positive and negative predictive values were found as 87% and 76%. R21, a second-generation immunohistochemical marker, can be used in the differential diagnosis of benign and malignant melanocytic lesions.

PMID:38084536 | DOI:10.4103/ijpm.ijpm_1146_21

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):799-803. doi: 10.4103/ijpm.ijpm_1183_21.

ABSTRACT

CONTEXT: Squalene epoxidase (SQLE) is overexpressed in a variety of tumors, which may play an important role in their tumorigenesis, development, and prognosis.

AIMS: The aim of this study is to investigate the expression of SQLE and explore its clinicopathological significance in gastric cancer.

SETTINGS AND DESIGN: The correlation between its positive expression and the pathological characteristics of patients (such as sex, age, tumor size, survival, tumor differentiation, TNM staging, and lymph node metastasis) was analyzed.

MATERIALS AND METHODS: Immunohistochemical method was used to detect its expression in 107 cases of gastric carcinoma and 34 cases of tumor-adjacent tissues.

STATISTICAL ANALYSIS USED: Counting data were analyzed by Chi-square test. Its overall survival was analyzed by Kaplan-Meier method and log-rank test. Its hazard factors were analyzed by Cox multivariate analysis.

RESULTS: The positive rate of SQLE in gastric cancer is 67.3%, which is higher than that in tumor-adjacent tissues (17.6%), <0.001. Expression of SQLE is closely related to tumor differentiation, TNM staging and lymph node metastasis (P = 0.030, P = 0.009, and P = 0.011, respectively). Furthermore, compared with those low expression of SQLE, the patients of overexpression had worse overall survival by Kaplan-Meier analysis (P = 0.025). Cox multivariate analysis shows that lymph node metastasis, tumor differentiation, SQLE, and TNM staging are independent factors for prognosis of gastric cancer (P = 0.003, 0.020, 0.018, and P = 0.001 respectively).

CONCLUSIONS: SQLE is overexpressed in gastric cancer. It could be used for the diagnosis and prognosis of the gastric cancer patients.

PMID:38084535 | DOI:10.4103/ijpm.ijpm_1183_21

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):780-785. doi: 10.4103/ijpm.ijpm_1230_21.

ABSTRACT

BACKGROUND: Though the recommended sampled lymph node number in colorectal carcinomas is at least 12, due to shrinkage after preoperative neoadjuvant chemoradiotherapy (NCRT), it can be difficult to attain that number.

AIM: Our aim is to increase the lymph node number by applying alcohol fixation on the formalin-fixed resection materials of the patients that received or not received neoadjuvant therapy and to evaluate the changes in staging due to obtained lymph nodes.

SETTINGS AND DESIGN: Non-randomized controlled trial.

MATERIALS AND METHODS: Lymph node dissection was performed in the resection materials with rectum tumor which were formalin- and afterwards, alcohol-fixed. The number of lymph nodes obtained by both of the methods and status of metastasis were evaluated statistically.

RESULTS: Of the total 76 rectal tumors, 57 had and 19 had not received NCRT. The number of lymph node was adequate in 89.5% cases with no NCRT and in 63.2% cases with NCRT. While no change was observed after the alcohol fixation in the cases fulfilling adequacy criterion among those with no NCRT (p = 1.000), the adequacy rate increased from 63.2% to 87.7% in those with NCRT (p < 0.001). Although statistically insignificant, there was a change in pN stage in eight cases. In three of them, the stage varied from pN0 to pN1c, and in five cases, from pN1a to pN1b.

CONCLUSION: Using solutions as alcohol during fixation might facilitate the identification of metastatic lymph nodes, might change the stage of the disease and therefore, might affect the patient-based therapy.

PMID:38084532 | DOI:10.4103/ijpm.ijpm_1230_21

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):775-779. doi: 10.4103/ijpm.ijpm_389_22.

ABSTRACT

BACKGROUND: Microscopic examination of cells and tissues requires the preparation of very thin and good-quality sections mounted on glass slides and appropriately stained to demonstrate normal and abnormal structures. Before this step, the tissue must undergo preparatory treatment known as tissue processing. The various stages of tissue processing are dehydration, clearing, impregnation, and embedding, each with a particular duration for proper completion of the process. Xylene is the most frequently used clearing agent whose carcinogenic potential is well documented. Hence, attempts were made to substitute xylene with a biosafe clearing agent. The present study aimed to evaluate and compare the efficacy of hematoxylin and eosin stain (H and E stain) when xylene is completely replaced by turpentine or kerosene oil.

MATERIALS AND METHODS: A total number of 50 tissue samples were taken in the study, which included 40 study samples and 10 controls. All the samples were randomly separated into three groups and routine tissue processing and H and E staining were performed. The result was further subjected to statistical analysis by using Fisher’s exact test. Group-1: Ten tissue samples were processed and H and E staining was done in xylene. Group-2: Twenty tissue samples were processed and H and E staining was done in turpentine oil. Group-3: Twenty tissue samples were processed and H and E staining was done in kerosene oil.

RESULTS: Nuclear staining, cell morphology, and uniformity of staining were better in kerosene sections, while cytoplasmic and clarity of staining of turpentine sections were comparable with xylene sections.

CONCLUSION: Turpentine and kerosene as clearing agents can be used in the future with certain modifications in their concentration and routine staining protocol.

PMID:38084531 | DOI:10.4103/ijpm.ijpm_389_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):758-763. doi: 10.4103/ijpm.ijpm_126_22.

ABSTRACT

BACKGROUND: As the world has been going through a pandemic of coronavirus disease 2019 (COVID-19) for the past two years, a safe and effective vaccine was urgently needed. Vaccination against the disease was launched in India on January 16, 2021 with healthcare workers, frontline workers, and the elderly above 60 years being the first beneficiaries. Vaccines being used in India are Covishield and Covaxin.

MATERIALS AND METHODS: Fifteen healthcare workers (HCWs) who were vaccinated with Covishield or Covaxin were included in the study, and T cell, B cell and antibody response of the HCWs were analyzed. Blood samples collected from every subject were sent for antibody analysis, hematological workup for cell counts, and flow cytometry was performed for various subsets of lymphocytes. Hematological variables in naïve HCWs (who never had any natural infection) and recovered HCWs (those recovered from natural infection) were compared.

RESULTS: Antibody index among recovered HCWs was significantly higher than the naïve HCWs. All the leucocyte parameters showed a higher median value in the recovered group except total leucocyte count (TLC), T helper cell count (Th cell), T helper cell to T cytotoxic cell (Th cell: CTL) ratio and natural killer (NK) cell. But only Th: CTL ratio showed a statistically significant difference.

CONCLUSION: This study shows that the antibody index among individuals who had both vaccination and COVID-19 infection is significantly higher than those who just had vaccination. T helper cell to T cytotoxic cell ratio is lowered in the recovered HCWs as compared to the naïve HCWs and this finding is statistically significant.

PMID:38084528 | DOI:10.4103/ijpm.ijpm_126_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):744-750. doi: 10.4103/ijpm.ijpm_357_22.

ABSTRACT

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is an uncommon form of primary liver carcinoma. It is heterogenous in terms of morphology, immunohistochemistry, radiology, and clinical features; making it a challenging entity for diagnosis.

AIMS: The purpose of the present study was to evaluate clinicopathological characteristics of patients with cHCC-CCA.

SETTINGS AND DESIGN: Retrospective observational study.

MATERIALS AND METHODS: The patients diagnosed with cHCC-CC were identified from hepatic surgical specimens and were evaluated.

STATISTICAL ANALYSIS: Survival was estimated as per Kaplan-Meier method.

RESULTS: Out of six patients, five had undergone resection while one had liver transplant. Five were male and one was female and the mean age was 52 years. Tumor markers revealed raised serum alfa-fetoprotein and CA19.9 in four and three patients, respectively. Five of the liver specimens were cirrhotic. Diagnosis was predominantly based on tumor morphology. All cases were of Allen and Lisa type B and cHCC-CCA as per WHO (2019) classification. Stem cell features <5% were noted in two cases. Immunohistochemistry for programmed death 1/programmed death ligand 1 (PD1/PDL1) was negative in both the hepatocellular and cholangiocellular components in all six cases. Mismatch repair (MMR) protein expression was retained in two and deficient in four cases. The median follow-up after surgery was 21.3 months (range, 5-46.2 months). Five patients had intrahepatic and/or extrahepatic recurrence on follow-up after surgery. The median recurrence-free survival was estimated at 13.1 months (95% CI 5.67-20.6). Three patients had received salvage treatment. The median overall survival was estimated at 20 months (95% CI 0-45.3).

CONCLUSIONS: The present study highlights the role of morphology in the diagnosis of cHCC-CCA. The choice of locoregional and/or systemic therapy after surgery may be individualized based on the clinicopathological characteristics.

PMID:38084526 | DOI:10.4103/ijpm.ijpm_357_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):740-743. doi: 10.4103/ijpm.ijpm_528_22.

ABSTRACT

BACKGROUND: Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy.

AIMS: To study the pathological features of SPE at autopsy.

MATERIALS AND METHODS: Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy.

STATISTICAL ANALYSIS: Nil.

RESULTS: According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis.

CONCLUSION: Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications.

PMID:38084525 | DOI:10.4103/ijpm.ijpm_528_22