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   Table of Contents - Current issue
January-June 2021
Volume 5 | Issue 1
Page Nos. 1-29

Online since Friday, June 18, 2021

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Human tissue studies in primary headache disorders: A scoping review p. 1
Mohammed A Amer, Diana Almader-Douglas, Vanessa Dimayuga Smith, Jonathan Helmsley Smith
Background: Despite the identification of structures with putative pathophysiological significance in primary headache disorders (e.g., posterior hypothalamus in cluster headache) there appears to be a paucity of human tissue studies examining the neuropathology of these regions. Objective: To synthesize the extent and knowledge pertaining to direct human tissue analysis in primary headache disorders. Methods: Scoping literature review. Results: Of 2718 located articles, 15 were eligible for inclusion. These studies evaluated either migraine (9, 60%) or cluster headache (6, 40%). Approximately 75% were published before or during the era of the first edition of the International Classification of Headache Disorders. The most common study design was case-control (8, 53.3%), and the most commonly examined tissues equally included skin (3, 20%), muscle (3, 20%), and brain (3, 20%). Thematically, these manuscripts generally evaluated peripheral nervous and systemic pathology, as well as more targeted pathophysiological aspects, including mitochondrial and mast cell dysfunction. Conclusions: While interest in this type of study design appears to be waning, histopathological evaluation of human tissue provides unparalleled opportunity to reveal novel pathophysiological insight. Considerations for future study design and reporting of work involving human tissue is suggested based on our review.
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Clinicopathological correlation of non-neoplastic nodular skin lesions: Experience from a tertiary care institute p. 9
Sarita Bhalla, Kavita Mardi
Aim: To evaluate the efficacy and diagnostic accuracy of fine-needle aspiration cytology (FNAC) in nonneoplastic nodular skin lesions. Materials and Methods: Nonneoplastic nodular skin lesions were assessed by FNAC and slide stained by Giemsa staining followed by biopsy in all cases. Histopathological slides were stained by haematoxylin and eosin stain and the special stain was used wherever required. Efficacy and accuracy were determined using histopathology as a gold standard. Results: Thirty-five cases with nodular skin lesions were subjected to cytological examination followed by biopsy. The most common infectious nodule was granulomatous dermatitis (20%) followed by cutaneous leishmaniasis (17.14%). The most commonly encountered noninfectious nonneoplastic nodular lesion was epithelial cyst (83.33%) followed by ganglion (16.67%). FNAC had a sensitivity of 80%, the specificity of 100% and diagnostic accuracy of 93.8% in diagnosing nonneoplastic skin nodules. Conclusion: Cytology FNAC is safe, cost-effective and patient complaint procedure for the evaluation of nonneoplastic nodular skin lesions and can be performed in the outpatient clinic.
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Prognostic significance of evaluation of tumor infiltrating lymphocytes in triple-negative breast cancer in residual disease postneoadjuvant chemotherapy p. 13
Jagannath Dev Sharma, Anupam Sarma, Partha Sarathi Roy, Argha Baruah, Rakesh Mishra, Amal Chandra Kataki, Manoj Kalita
Background: Triple-negative breast cancer (TNBC) are highly heterogeneous tumors and are not eligible for hormonal therapies or human epidermal growth factor receptor type 2(HER 2)-targeted agents and they are associated with failure to achieve pathological complete response (pCR) and has unfavorable prognosis. In the residual disease (postneoadjuvant chemotherapy and surgery) of cases of TNBC, identification of parameters for risk stratification is needed for better identification of high-risk patients who require additional systemic treatments. Tumor-infiltrating lymphocytes (TIL's) are a part of the tumor microenvironment and they are indicator for monitoring immune response and they influence cancer growth, progression, and metastasis. With the success of immunotherapy in various cancers, there is an increasing interest in directly targeting the immune system in TNBC. Material and Methods: In our study, 115 TNBC cases were taken and stromal TIL's were calculated on H and E stained slides and TIL grades (scoring according to International TIL's Working Group) were compared with clinicopathological parameters and overall survival. Results: Statistically significant correlation was found between Stage of presentation, axillary lymph node positivity, relapse, metastasis, and TIL (P < 0.0001). High stage of the tumor, axillary lymph node positivity, cases of relapse, metastasis was associated with Low-grade TIL. High-grade TIL showed a good overall survival (100%) in comparison to intermediate grade TIL 2 (90%) and low-grade TIL 1 (52%). Conclusion:TIL scoring in residual disease post neoadjuvant chemotherapy can help in the stratification of high-risk cases and can help in prognostication.
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An unusual case of fatal rabies encephalitis despite completing postexposure prophylaxis p. 17
Hemant Kumar Sharma
Rabies continues to be a major health scourge in many developing countries including India. It can be effectively prevented by providing postexposure prophylactic treatment. Failure of Rabies postexposure prophylaxis (PEP) is a rare occurrence. Our patient, a 39-year-old Male, was bitten by stray dog on the left hand. It was Category III dog bite for which proper wound care and PEP 5 doses of antirabies cell culture vaccine and Human Rabies Immunoglobulin was given. Two days after completing the 5th dose of PEP, he presented with fever, neck rigidity, drooling of saliva, pain, and numbness in the left hand along with auditory and visual hallucinations without hydrophobia and aerophobia. On 2nd say of hospitalization, he developed progressive respiratory difficulty and decreased oxygen saturation for which he was intubated and put on invasive ventilator support. However, he suffered fatal cardiac arrest and succumbed to his illness. Based on his symptoms, a clinical diagnosis of febrile encephalopathy with differential diagnosis of acute rabies encephalitis was made. On autopsy, his brain was markedly congested and histopathological examination was suggestive of acute rabies encephalitis. However, no Negri bodies were seen. Further examination of brain tissue by immunohistochemical labeling revealed numerous Negri bodies and confirmed the diagnosis of rabies encephalitis.
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Negative images of mycobacteria revisited in rapid on-site evaluation p. 21
Tummidi Santosh, Arundhathi Shankaralingappa, Pavithra Balakrishna, A Prudhvinath Reddy, Naresh Kumar Pannerselvam
Rapid on-site evaluation (ROSE) with routine fine-needle aspiration cytology (FNAC) is a simple, economical, highly accurate tool in the diagnosis of tuberculous lesions. The sample collected can be used for ancillary studies, i.e., Ziehl–Neelsen stain, Cartridge-based nuclei acid amplification testing (CB-NAAT) and bacterial culture for confirmation of the tubercular species. We report a case of a 31-year-old male who presented with left supraclavicular lymphadenopathy. ROSE with FNAC helped in the diagnosis of the patient. FNAC is a rapid minimally invasive method for the early detection of tubercular lesions and helps in proper treatment.
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Schwannoma at an unusual locations: Report of two cases and review of literature p. 25
Savitri M Nerune, Surekha U Arakeri, T Chaitra
Schwannomas are benign tumors of Schwann cells which are commonly seen at head, neck regions, and extremities. Schwannomas at rare locations such as breast and parotid are very uncommon. Here, we present two case reports of breast schwannoma and parotid schwannoma. In first case, 24-year-old female presented with left breast lump which was clinically diagnosed as fibroadenoma and lumpectomy was done. In second case, 50-year-old female presented with left parotid swelling associated with mild pain. Pleomorphic adenoma was suspected clinically and lesion was excised. Histologically, both cases showed hypocellular and hypercellular areas suggestive of schwannoma. Further, the diagnosis was confirmed with S-100 immunohistochemistry marker. Thus, schwannoma should be considered as one of the differential diagnosis for spindle cell lesion in breast and parotid swelling.
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Metastatic Hodgkin's lymphoma: An extremely rare cause of breast lump p. 28
Kavita Mardi
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