Shaila Mitra - Academia.edu (original) (raw)

Papers by Shaila Mitra

Research paper thumbnail of Breast Cancer: Demographic Characterstics and Clinicopathological Presentation of Patients in Eastern Uttar Pradesh, India

GLOBAL JOURNAL FOR RESEARCH ANALYSIS

Worldwide the breast cancer is the most common cancer in the female population. The disease is st... more Worldwide the breast cancer is the most common cancer in the female population. The disease is steadily rising in the developing world like India in the last decade. The breast lesions whether inammatory, benign or malignant cause considerable anxiety in the patients many times leading to late presentation for diagnosis and treatment. Our study covers the population of eastern Uttar Pradesh comprising mainly of rural population where awareness for the disease is still bit low. The aim of the study was to provide an eagle view scan of the spectrum of breast diseases according to clinical presentation,age and histopathological correlation in this population so that target population can be focussed in better way in terms of early diagnosis and treatment.

Research paper thumbnail of Prognostic Value of Thyroid Hormone Dysfunction and Age in Septicemic Post-Surgical Patients

Journal of Pharmaceutical Research International

Introduction: Critical illness and sepsis are difficult to treat with increasing age because of t... more Introduction: Critical illness and sepsis are difficult to treat with increasing age because of the poor adaptive physiological system as age progresses. The study tries to identify prognostic markers among thyroid hormones for post-surgical critically ill subjects, who have sepsis, to improve the outcome of patients with increasing age. Methods: Free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were estimated by ARCHITECT immunoassay kits in 127 post-surgical critically ill patients with sepsis. Sequential Organ Failure Assessment (SOFA) score was recorded for each patient. Results: The FT3, FT4 and TSH levels decreased and SOFA score increased with increasing age. Thyroid markers were significantly inversely correlated with age (for FT4 r= -0.616, p<0.0001 and for TSH r= -0.453, p<0.0001), with the strongest correlation between FT3 and age (r=0.674, p<0.0001). A positive correlation was observed between SOFA score and age (r=0.577, p&...

Research paper thumbnail of Prevalence of thyroid dysfunction and its effects on fetomaternal outcome in pregnant women of Eastern Uttar Pradesh, India

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: The aim of the study is to determine the prevalence of thyroid dysfunction in pregnan... more Background: The aim of the study is to determine the prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome in Eastern Uttar Pradesh.Methods: This was a prospective observational study undertaken at antenatal clinics and indoor of BRD Medical College, Gorakhpur. Total 720 antenatal women, ≤20 weeks of gestation were recruited for the study. In all patients’ routine obstetrical investigations and thyroid function tests were done. All patients were followed up to delivery. Maternal and perinatal outcome were ascertained.Results: Prevalence of thyroid dysfunction among pregnant was found to be 21.1% and subclinical hypothyroidism (15.9%) was the commonest thyroid disorder. Most common complication observed in subclinical and overt hypothyroidism was preeclampsia (9.56 % versus 20%) followed by preterm labour (7.82% versus 10%). Major fetal complications in hypothyroid mothers included intrauterine growth restriction, low birth weight and stillbirth.Conclus...

Research paper thumbnail of Leukemic Pleural Eff Usion as Initial Man Ifestation of Acute Myeloid Leukemia: A Rare Case Report

Journal of Evolution of medical and Dental Sciences, 2015

Leukemic effusion is an uncommon presentation of Acute Myeloid leukemia with only isolated report... more Leukemic effusion is an uncommon presentation of Acute Myeloid leukemia with only isolated reports in literature. We report a case of 45 years old female who presented with unilateral pleural effusion and was diagnosed with haematological malignancy on pleural fluid cytology which revealed presence of myeloblasts. Subsequent, peripheral blood smear and bone marrow examination confirmed the diagnosis of Acute Myeloid Leukemia (AML M1). This case report highlights the uncommon presentation of AML as well as utility of meticulous examination of effusion fluids for diagnosing unsuspected malignancies.

Research paper thumbnail of Pleural effusion, Acute Myeloid Leukemia, Myeloblasts

Research paper thumbnail of Critically Ill Patients, Sepsis, Thyroid Hormone, Triiodothyronine, Thyroxine, Thyroid Stimulating Hormone, SOFA Score

Research paper thumbnail of Expression of Epidermal Growth Factor Receptor (EGFR) in Cervical Intraepithelial Neoplasia and Squamous Cell Carcinoma of Uterine Cervix

Indian Journal of Pathology: Research and Practice, 2018

Research paper thumbnail of Comparative evaluation of test characteristics of acetic acid, lugol’s iodine and toluidine blue stains in cervical cancer screening

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Oct 28, 2017

Cervical cancer rank second in female cancer and India alone account for one fourth of the global... more Cervical cancer rank second in female cancer and India alone account for one fourth of the global cervical cancer burden. About 122,844 new cervical cancer cases are diagnosed annually in India and 67,477 die from it. 1 Mortality due cervical cancer is also an indicator of health inequities, as 86% of all deaths due to cervical cancer are in developing, low and middle income countries. 2-4 Invasive cervical cancer is preceded by a long phase of precancerous lesion that can be detected by screening and if treated can prevent the invasive cancers. Despite careful examination, small developing lesions often go unrecognized by clinicians. To aid visual inspection in addition to normal light wide range of commercial adjunctive aids are available. All these adjunctive aids will of great use in detecting small lesion with a certain amount of dysplasia which appears normal under routine visual inspection. Cytology based screening programmes are difficult to organize owing to limited infrastructure, trained personnel and funds. 5 Thus, in developing countries like ours, there is need for alternative strategies which are available on large scale, cost effective and easy.

Research paper thumbnail of The use of molecular markers (Ki67 & p53) in premalignant and malignant cervical neoplasms

Tropical Journal of Pathology and Microbiology, 2016

Introduction: Cervical cancers are the second most frequent type of cancer in females. It develop... more Introduction: Cervical cancers are the second most frequent type of cancer in females. It develops from premalignant to invasive stages in a multistep process of carcinogenesis. The differentiation between cervical intraepithelial neoplasia III (CIN III) and early squamous cell carcinoma (SCC) of the cervix could be difficult to diagnose in certain situations unless we see the invasion. The objective of the study was to determine the expression of p53 & Ki67 in CIN and cervical cancers and its correlation with grading and differentiation of cervical cancers with special emphasis on whether the use of Ki67 & p53 markers could help in differentiating CIN III from early SCC. Material and Methods: A prospective study on 90 cases of cervical biopsies, including-cases of : chronic cervicitis (40), CIN III (19) and invasive carcinoma (31). All cases were evaluated by immunohistochemistry using Ki67 & p53 monoclonal antibodies. Results: Both Ki67 & p53 showed higher expression in CIN III and invasive cervical carcinoma than chronic cervicitis with statistically significant difference p<0.01 and p<0.001 respectively. High significant difference of p53 & Ki67 expression was found between patients with CIN III and invasive cervical carcinomas. There was a clear trend for increasing number of cases with positive Ki67 & p53 index with increasing grades of cervical cancer. Conclusion: Ki67 & p53 showed increased expression from CIN III to SCC and it may be helpful adjunct in differentiating these two lesions. These markers could be used as biomarkers in the evaluation of the proliferative activity and progressive potential of dysplastic and neoplastic changes.

Research paper thumbnail of Study of expression patterns of cytokeratin 8 and 18 in oral cancers

Tropical Journal of Pathology and Microbiology, 2016

Introduction: Squamous cell carcinoma of oral cavity is a morphological heterogenous disease. Cyt... more Introduction: Squamous cell carcinoma of oral cavity is a morphological heterogenous disease. Cytokeratin (CK) comprises a diverse group of intermediate filament protein that are expressed as pairs in both keratinized and non keratinized epithelial tissue. Very little is known of CK alteration in oral intraepithelial neoplasia III (OIN III) and invasive squamous cell carcinoma (SCC). The aim of the study is to evaluate the expression pattern of CK8/18 in oral carcinoma and to establish any correlation between the expressions of CK8/18 with tumor differentiation. Material and Methods: A total of 104 cases of Paraffin embedded formalin fixed sections from oral squamous cell carcinomas (N=60) including benign and inflammatory lesions (control; N=40) and oral intraepithethelial lesions (N=4) were stained with Haematoxylin and eosin stain and and then studied immunohistochemically using CK8 and CK18 immunomarkers. Result: Out of 60 cases of invasive squamous carcinomas, cytokeratin 8 showed positivity in 34 cases (56.67%) while expression of cytokeratin 18 was observed in 25 cases (41.67%) but its expression were absent in control and oral intraepithelial cases. Expression of CK 8 was seen in majority of poorly differentiated 4/5 (80%) followed by moderately differentiated 12/17 (70.59%), with its expression were significantly higher (56.67%) in invasive oral carcinomas compared with controls statistically. Similarly CK18 expression was seen in majority of poorly 4/5 (80%) followed by moderately differentiated squamous cell carcinomas 7/17 (41.18%). Conclusion: Aberrant expression of CK8/18 could be correlated with differentiation and recurrence and shows a great promise to be used as prognostic marker for human oral cancer.

Research paper thumbnail of Role of p16, Ki67 and CK17 in differentiating benign lesions, cervical intraepithelial neoplasia(CIN) and atypical immature squamous metaplasia(AIM) of uterine cervix

Tropical Journal of Pathology and Microbiology, 2017

Cervical intraepithelial neoplasia (CIN) is a premalignant lesion capable of progressing to cervi... more Cervical intraepithelial neoplasia (CIN) is a premalignant lesion capable of progressing to cervical cancer. Despite the existing well-defined criteria, the histopathological diagnosis is subject to high rates of discordance among pathologists. Aim: To study the role of p16, Ki67 and CK17 in differentiating benign lesions, cervical intraepithelial lesions(CIN) and atypical immature squamous metaplasia (AIM)and to improve intra and interobserver reproducibility of diagnosis of cervical neoplasia. Material and Methods: In a cross sectional study, a total of 75 cervical biopsies including benign lesions (n=24), AIM (n=28), CIN (n=23) were studied and analyzed immunohistochemically using p16, Ki67 and CK17 immunomarkers. Data was evaluated using chi-square test. Results: p16 and Ki 67positivity were observed in 91.3% and 78.26% of CIN and 28.57% of AIM respectively. None of the benign lesions expressed p16 and Ki67while CK17 positivity was observed in 46.42% of CIN and 100% of AIM with 12.5% of benign lesions. Conclusion: The three biomarkers (p16, CK17 and Ki67) had a high degree of sensitivity and specificity and appear to be a useful and reliable diagnostic adjunct to improve the routine diagnosis and reduce interobserver variability in cervical biopsy specimens. Immunohistochemical markers such as p16 alone or with Ki67 represents important tool for the pathologists in distinguishing high grade cervical dysplasia from its benign mimics such as AIM and reactive inflammatory lesion thus avoiding overtreatment.

Research paper thumbnail of Comparative Evaluation of Diagnostic Efficacy of Serum Anti-Müllerian Hormone and Ultrasound in Polycystic Ovarian Syndrome

Journal of SAFOG, 2018

Aim: To study the diagnostic efficacy of serum anti-Müllerian hormone (AMH) in polycystic ovarian... more Aim: To study the diagnostic efficacy of serum anti-Müllerian hormone (AMH) in polycystic ovarian syndrome (PCOS) and its comparison with ultrasonography (USG). Study design: Prospective observational study. Materials and methods: In the study group, a total of 80 women in the age group of 20 to 35 years with diagnosis of PCOS by Rotterdam's criteria were recruited at B.R.D. Medical College, Gorakhpur, India, during the period from January 2015 to December 2016. Women without PCOS, having regular cycles which were selected randomly comprised the control group (n = 80). Serum levels of luteinizing hormone (LH), folliclestimulating hormone (FSH), testosterone, androstenedione, estradiol, fasting insulin, and AMH were measured on days 2 to 3 of natural cycle or progesterone-induced withdrawal bleeding together with transvaginal sonography (TVS) for detection of the number of small follicles (<10 mm) and measurement of ovarian volume (OV). The AMH levels above 5 ng/mL were taken as diagnostic cutoff for diagnosing PCOS. Results: Anti-Müllerian hormone was positively correlated to LH, estradiol, testosterone, number of follicles (<10 mm), and OV; and negatively correlated to FSH. No correlation was found between AMH and age, body mass index (BMI), waist-hip ratio (WHR), and fasting insulin. The AMH-based diagnosis of PCOS showed sensitivity of 91.25% and a specificity of 95%. Conclusion: Serum AMH level is a promising marker for diagnosis of PCOS, especially in cases where reliable USG data are not available or when there are no typical clinical and laboratory findings.

Research paper thumbnail of Hypovitaminosis D in pregnancy and its correlation with preeclampsia and gestational diabetes mellitus

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017

Background: Hypovitaminosis D has been associated with a number of adverse pregnancy outcomes, an... more Background: Hypovitaminosis D has been associated with a number of adverse pregnancy outcomes, and has been recognised as a public health concern. The objective of this study was to determine the impact of Vitamin D deficiency on maternal complications like gestational diabetes mellitus (GDM) and preeclampsia (PE) among pregnant women.Methods: This was a case control study undertaken at antenatal clinics and indoor of BRD Medical College, Gorakhpur, Uttar Pradesh, India. Two maternal blood samples, one at <20 weeks and other at term along with cord blood at delivery were taken. Patients were classified into preeclampsia (n=60), gestational diabetes mellitus (n=35) and control group (n=180) after abstracting past medical records at delivery. Vitamin D was estimated by 25- Hydroxyvitamin D125 RIA kit and categorized according to ACOG criteria. Statistical analysis was done by using chi square test, binary logistic regression and Pearson’s correlation coefficient to compare between ...

Research paper thumbnail of Cytomorphological patterns of tubercular lymphadenitis and its comparison with Ziehl-Neelsen staining and culture in eastern up. (Gorakhpur region): Cytological study of 400 cases

Journal of Cytology, 2017

Tuberculous lymphadenitis is most common cause of lymphadenopathy in developing countries. Althou... more Tuberculous lymphadenitis is most common cause of lymphadenopathy in developing countries. Although enormous literature is available on various aspects of the disease including cytological patterns and its incidence in others parts of India and in other countries, only limited literature is available regarding its incidence and morphological spectrum on cytology in eastern parts of Uttar Pradesh in Gorakhpur region. The present study was undertaken to estimate the incidence of tuberculous lymphadenitis in our settings along with its morphological spectrum on cytology as well as to determine the utility of culture of fine needle aspirates in addition to cytology and Ziehl-Neelsen (ZN) staining. Four hundred cases of superficial lymphadenopathy were subjected to fine needle aspiration cytology (FNAC), and in case, smears were stained with Hematoxylin and eosin (H and E), Giemsa, and ZN stain and categorized into three cytomorphological patterns. All the aspirates were inoculated on two sterile Lowenstein Jensen (LJ) medium. Out of 400 cases of consecutive lymph nodes aspirated, 180 cases (45%) showed features of tuberculous lymphadenitis. Smears revealed epithelioid granulomas with caseous necrosis in maximum cases (40%). On statistical analysis, difference between group I and group II was found to be significant ( &lt; 0.05); while comparison between groups II and III as well as between groups I and III was found to be statistically insignificant. Overall, acid fast bacilli positivity was seen in 51.6% of the cases. FNAC has been proved very safe, highly sensitive, and first line investigation in diagnosing tubercular lymphadenitis. The sensitivity can be further be increased by complementary cytomorphology with acid fast staining. Diagnostic accuracy can further be increased by culture.

Research paper thumbnail of Ultrasound-guided fine-needle aspiration cytology of solid pseudopapillary tumor of the pancreas: a tertiary care centre experience

Oncology Discovery, 2014

Background: Solid pseudopapillary tumours (SPT) of pancreas is an unusual neoplasm with uncertain... more Background: Solid pseudopapillary tumours (SPT) of pancreas is an unusual neoplasm with uncertain malignant potential. It is seen predominantly in adolescent girls and young women. We present the clinical, ultrasound-guided fine needle aspiration (US-FNA) cytologic features, differential diagnosis and immunohistochemical findings in SPT. Methods: A retrospective 4-year (2007-2010) fine needle aspiration samples of 8 solid pseudopapillary tumours of pancreas were reviewed. Results: The entire cases were cured with exploratory laparotomy. This study includes 8 cases (1 male, 7 female) of solid pseudopapillary tumours of pancreas. All these cases showed characteristic cytomorphological features displaying hypercellular smears with presence of several papillary fragments lined by multilayered anisomorphic atypical cells having fine chromatin with delicate nuclear groove, myxoid stroma and foamy macrophages in a haemorrhagic background. Conclusions: Correct preoperative cytological diagnosis of solid pseudopapillary tumours of pancreas may be accurately possible by US-FNA technique and also aids in treatment of the surgically curable cancer in the patients.

Research paper thumbnail of Cytological diagnosis of microfilariae in filariasis endemic areas of eastern UP

Journal of Cytology, 2009

Filariasis is a major health problem in tropical countries including India. Fine needle aspiratio... more Filariasis is a major health problem in tropical countries including India. Fine needle aspiration cytology plays an important role in prompt recognition of disease. To assess the role of fine needle aspiration cytology (FNAC) in diagnosis of filariasis at all possible sites. Total 250 cases of superficial swellings at various sites were subjected to fine needle aspiration cytology. Out of 250 cases, 24 cases of filariasis were detected which include breast lumps (8 cases), lymph nodes (6 cases), scrotal swellings (4 cases), thyroid swellings (3 cases), soft tissue swellings (2 cases) and ascitic fluid (1 case). Eosinophilia was present in 8 out of 24 cases with a percentage ranging from 12-24%. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 3 out of 24 cases. In endemic areas, it should be considered one of the differential diagnoses of a superficial swelling. Careful screening of FNAC smears help in detecting microfilaria even in asymptomatic patients and thus plays a significant role in recognition of the disease and institution of specific treatment.

Research paper thumbnail of Spindle Epithelial Tumor with Thymus-Like Differentiation: A Case Report and Review of Literature

Acta Cytologica, 2013

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare type of t... more Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare type of thyroid tumor with fewer than 35 reported cases available in the literature so far, most of them having been diagnosed histologically after resection. The tumor is believed to be derived from branchial-pouch or thymic remnants, occurring in young adults, predominantly in males, with a male:female ratio 1.8:1. Case: A 14-year-old girl presented with a nodular mass in her right thyroid that had been present for 1 year. Ultrasonological study revealed a heterogeneous solid mass (2.5 × 1.5 × 1.5 cm) in the right lobe of the thyroid. Fine-needle aspiration (FNA) smears were highly cellular and comprised of predominantly dissociated uniform spindle cells with naked oval nuclei along with some aggregates and groups. Occasional islands of epithelial cells were also present. Cytologically, the spindle cells had bland nuclear chromatin, with very scanty mitotic figures. Upon examination of the FNA ...

Research paper thumbnail of Ultrasound-Guided Fine Needle Aspiration Cytology of Malignant Gallbladder Masses

Acta Cytologica, 1997

ABSTRACT To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspirati... more ABSTRACT To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses. We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases. After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease. US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.

Research paper thumbnail of Role of Thyroid Biomarkers in Association with Sofa Score in Predicting the Prognosis of Post-Operative Critically Ill Patients

Journal of Evolution of Medical and Dental Sciences, 2018

BACKGROUND Thyroid hormone alterations in critically ill patients are very common and may add to ... more BACKGROUND Thyroid hormone alterations in critically ill patients are very common and may add to the severity of disease and the outcomes of patients in Intensive Care Unit (ICU). This observational study was conducted to detect the thyroid biomarkers as independent predictors of ICU mortality to predict prognosis more accurately in post-operative critically ill ICU patients with sepsis. This study also tries to determine any association between the thyroid biomarkers and SOFA (sepsis-related organ failure assessment) score. MATERIALS AND METHODS This is a prospective observational study. We investigated free triiodothyronine (FT3), free thyroxine (FT4) and Thyroid Stimulating Hormone (TSH) in low SOFA score patients (LSS; n= 21, SOFA= 0-6) and in high SOFA score patients (HSS; n= 82, SOFA > 6). The serum levels of FT3, FT4 and TSH were correlated with SOFA score. Further, prognosis on fifth day of ICU admission was defined on the basis of SOFA score, FT3, FT4 and TSH. RESULTS The serum levels of FT3 (p= 0.004), FT4 (p= 0.025) and TSH (p > 0.05) decreased in HSS than LSS. A negative correlation was observed between thyroid biomarkers and SOFA score (> 6). Patients who deteriorated on the fifth day of ICU admission had significantly high SOFA score (p= 2.15E-06) and significantly low FT3 (p= 3.17E-10), FT4 (p= 4.06E-05) and TSH (p= 2.21E-05) on first day of ICU admission than those who improved on fifth day. CONCLUSION Thyroid biomarkers, specifically low FT3 might be an efficient biomarker or risk factor in evaluating prognosis of the postoperative critically ill patients.

Research paper thumbnail of Image-Guided Fine Needle Cytology with Aspiration Versus Non-Aspiration in Retroperitoneal Masses: Is Aspiration Necessary?

Journal of Pathology and Translational Medcine, 2015

Background: Although using fine needle cytology with aspiration (FNC-A) for establishing diagnose... more Background: Although using fine needle cytology with aspiration (FNC-A) for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA) for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Methods: Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. Results: By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%). The diagnostic accuracy of other sites by FNC-A varied from 75.0%-81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%-72.8%. Conclusions: Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.

Research paper thumbnail of Breast Cancer: Demographic Characterstics and Clinicopathological Presentation of Patients in Eastern Uttar Pradesh, India

GLOBAL JOURNAL FOR RESEARCH ANALYSIS

Worldwide the breast cancer is the most common cancer in the female population. The disease is st... more Worldwide the breast cancer is the most common cancer in the female population. The disease is steadily rising in the developing world like India in the last decade. The breast lesions whether inammatory, benign or malignant cause considerable anxiety in the patients many times leading to late presentation for diagnosis and treatment. Our study covers the population of eastern Uttar Pradesh comprising mainly of rural population where awareness for the disease is still bit low. The aim of the study was to provide an eagle view scan of the spectrum of breast diseases according to clinical presentation,age and histopathological correlation in this population so that target population can be focussed in better way in terms of early diagnosis and treatment.

Research paper thumbnail of Prognostic Value of Thyroid Hormone Dysfunction and Age in Septicemic Post-Surgical Patients

Journal of Pharmaceutical Research International

Introduction: Critical illness and sepsis are difficult to treat with increasing age because of t... more Introduction: Critical illness and sepsis are difficult to treat with increasing age because of the poor adaptive physiological system as age progresses. The study tries to identify prognostic markers among thyroid hormones for post-surgical critically ill subjects, who have sepsis, to improve the outcome of patients with increasing age. Methods: Free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were estimated by ARCHITECT immunoassay kits in 127 post-surgical critically ill patients with sepsis. Sequential Organ Failure Assessment (SOFA) score was recorded for each patient. Results: The FT3, FT4 and TSH levels decreased and SOFA score increased with increasing age. Thyroid markers were significantly inversely correlated with age (for FT4 r= -0.616, p<0.0001 and for TSH r= -0.453, p<0.0001), with the strongest correlation between FT3 and age (r=0.674, p<0.0001). A positive correlation was observed between SOFA score and age (r=0.577, p&...

Research paper thumbnail of Prevalence of thyroid dysfunction and its effects on fetomaternal outcome in pregnant women of Eastern Uttar Pradesh, India

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: The aim of the study is to determine the prevalence of thyroid dysfunction in pregnan... more Background: The aim of the study is to determine the prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome in Eastern Uttar Pradesh.Methods: This was a prospective observational study undertaken at antenatal clinics and indoor of BRD Medical College, Gorakhpur. Total 720 antenatal women, ≤20 weeks of gestation were recruited for the study. In all patients’ routine obstetrical investigations and thyroid function tests were done. All patients were followed up to delivery. Maternal and perinatal outcome were ascertained.Results: Prevalence of thyroid dysfunction among pregnant was found to be 21.1% and subclinical hypothyroidism (15.9%) was the commonest thyroid disorder. Most common complication observed in subclinical and overt hypothyroidism was preeclampsia (9.56 % versus 20%) followed by preterm labour (7.82% versus 10%). Major fetal complications in hypothyroid mothers included intrauterine growth restriction, low birth weight and stillbirth.Conclus...

Research paper thumbnail of Leukemic Pleural Eff Usion as Initial Man Ifestation of Acute Myeloid Leukemia: A Rare Case Report

Journal of Evolution of medical and Dental Sciences, 2015

Leukemic effusion is an uncommon presentation of Acute Myeloid leukemia with only isolated report... more Leukemic effusion is an uncommon presentation of Acute Myeloid leukemia with only isolated reports in literature. We report a case of 45 years old female who presented with unilateral pleural effusion and was diagnosed with haematological malignancy on pleural fluid cytology which revealed presence of myeloblasts. Subsequent, peripheral blood smear and bone marrow examination confirmed the diagnosis of Acute Myeloid Leukemia (AML M1). This case report highlights the uncommon presentation of AML as well as utility of meticulous examination of effusion fluids for diagnosing unsuspected malignancies.

Research paper thumbnail of Pleural effusion, Acute Myeloid Leukemia, Myeloblasts

Research paper thumbnail of Critically Ill Patients, Sepsis, Thyroid Hormone, Triiodothyronine, Thyroxine, Thyroid Stimulating Hormone, SOFA Score

Research paper thumbnail of Expression of Epidermal Growth Factor Receptor (EGFR) in Cervical Intraepithelial Neoplasia and Squamous Cell Carcinoma of Uterine Cervix

Indian Journal of Pathology: Research and Practice, 2018

Research paper thumbnail of Comparative evaluation of test characteristics of acetic acid, lugol’s iodine and toluidine blue stains in cervical cancer screening

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Oct 28, 2017

Cervical cancer rank second in female cancer and India alone account for one fourth of the global... more Cervical cancer rank second in female cancer and India alone account for one fourth of the global cervical cancer burden. About 122,844 new cervical cancer cases are diagnosed annually in India and 67,477 die from it. 1 Mortality due cervical cancer is also an indicator of health inequities, as 86% of all deaths due to cervical cancer are in developing, low and middle income countries. 2-4 Invasive cervical cancer is preceded by a long phase of precancerous lesion that can be detected by screening and if treated can prevent the invasive cancers. Despite careful examination, small developing lesions often go unrecognized by clinicians. To aid visual inspection in addition to normal light wide range of commercial adjunctive aids are available. All these adjunctive aids will of great use in detecting small lesion with a certain amount of dysplasia which appears normal under routine visual inspection. Cytology based screening programmes are difficult to organize owing to limited infrastructure, trained personnel and funds. 5 Thus, in developing countries like ours, there is need for alternative strategies which are available on large scale, cost effective and easy.

Research paper thumbnail of The use of molecular markers (Ki67 & p53) in premalignant and malignant cervical neoplasms

Tropical Journal of Pathology and Microbiology, 2016

Introduction: Cervical cancers are the second most frequent type of cancer in females. It develop... more Introduction: Cervical cancers are the second most frequent type of cancer in females. It develops from premalignant to invasive stages in a multistep process of carcinogenesis. The differentiation between cervical intraepithelial neoplasia III (CIN III) and early squamous cell carcinoma (SCC) of the cervix could be difficult to diagnose in certain situations unless we see the invasion. The objective of the study was to determine the expression of p53 & Ki67 in CIN and cervical cancers and its correlation with grading and differentiation of cervical cancers with special emphasis on whether the use of Ki67 & p53 markers could help in differentiating CIN III from early SCC. Material and Methods: A prospective study on 90 cases of cervical biopsies, including-cases of : chronic cervicitis (40), CIN III (19) and invasive carcinoma (31). All cases were evaluated by immunohistochemistry using Ki67 & p53 monoclonal antibodies. Results: Both Ki67 & p53 showed higher expression in CIN III and invasive cervical carcinoma than chronic cervicitis with statistically significant difference p<0.01 and p<0.001 respectively. High significant difference of p53 & Ki67 expression was found between patients with CIN III and invasive cervical carcinomas. There was a clear trend for increasing number of cases with positive Ki67 & p53 index with increasing grades of cervical cancer. Conclusion: Ki67 & p53 showed increased expression from CIN III to SCC and it may be helpful adjunct in differentiating these two lesions. These markers could be used as biomarkers in the evaluation of the proliferative activity and progressive potential of dysplastic and neoplastic changes.

Research paper thumbnail of Study of expression patterns of cytokeratin 8 and 18 in oral cancers

Tropical Journal of Pathology and Microbiology, 2016

Introduction: Squamous cell carcinoma of oral cavity is a morphological heterogenous disease. Cyt... more Introduction: Squamous cell carcinoma of oral cavity is a morphological heterogenous disease. Cytokeratin (CK) comprises a diverse group of intermediate filament protein that are expressed as pairs in both keratinized and non keratinized epithelial tissue. Very little is known of CK alteration in oral intraepithelial neoplasia III (OIN III) and invasive squamous cell carcinoma (SCC). The aim of the study is to evaluate the expression pattern of CK8/18 in oral carcinoma and to establish any correlation between the expressions of CK8/18 with tumor differentiation. Material and Methods: A total of 104 cases of Paraffin embedded formalin fixed sections from oral squamous cell carcinomas (N=60) including benign and inflammatory lesions (control; N=40) and oral intraepithethelial lesions (N=4) were stained with Haematoxylin and eosin stain and and then studied immunohistochemically using CK8 and CK18 immunomarkers. Result: Out of 60 cases of invasive squamous carcinomas, cytokeratin 8 showed positivity in 34 cases (56.67%) while expression of cytokeratin 18 was observed in 25 cases (41.67%) but its expression were absent in control and oral intraepithelial cases. Expression of CK 8 was seen in majority of poorly differentiated 4/5 (80%) followed by moderately differentiated 12/17 (70.59%), with its expression were significantly higher (56.67%) in invasive oral carcinomas compared with controls statistically. Similarly CK18 expression was seen in majority of poorly 4/5 (80%) followed by moderately differentiated squamous cell carcinomas 7/17 (41.18%). Conclusion: Aberrant expression of CK8/18 could be correlated with differentiation and recurrence and shows a great promise to be used as prognostic marker for human oral cancer.

Research paper thumbnail of Role of p16, Ki67 and CK17 in differentiating benign lesions, cervical intraepithelial neoplasia(CIN) and atypical immature squamous metaplasia(AIM) of uterine cervix

Tropical Journal of Pathology and Microbiology, 2017

Cervical intraepithelial neoplasia (CIN) is a premalignant lesion capable of progressing to cervi... more Cervical intraepithelial neoplasia (CIN) is a premalignant lesion capable of progressing to cervical cancer. Despite the existing well-defined criteria, the histopathological diagnosis is subject to high rates of discordance among pathologists. Aim: To study the role of p16, Ki67 and CK17 in differentiating benign lesions, cervical intraepithelial lesions(CIN) and atypical immature squamous metaplasia (AIM)and to improve intra and interobserver reproducibility of diagnosis of cervical neoplasia. Material and Methods: In a cross sectional study, a total of 75 cervical biopsies including benign lesions (n=24), AIM (n=28), CIN (n=23) were studied and analyzed immunohistochemically using p16, Ki67 and CK17 immunomarkers. Data was evaluated using chi-square test. Results: p16 and Ki 67positivity were observed in 91.3% and 78.26% of CIN and 28.57% of AIM respectively. None of the benign lesions expressed p16 and Ki67while CK17 positivity was observed in 46.42% of CIN and 100% of AIM with 12.5% of benign lesions. Conclusion: The three biomarkers (p16, CK17 and Ki67) had a high degree of sensitivity and specificity and appear to be a useful and reliable diagnostic adjunct to improve the routine diagnosis and reduce interobserver variability in cervical biopsy specimens. Immunohistochemical markers such as p16 alone or with Ki67 represents important tool for the pathologists in distinguishing high grade cervical dysplasia from its benign mimics such as AIM and reactive inflammatory lesion thus avoiding overtreatment.

Research paper thumbnail of Comparative Evaluation of Diagnostic Efficacy of Serum Anti-Müllerian Hormone and Ultrasound in Polycystic Ovarian Syndrome

Journal of SAFOG, 2018

Aim: To study the diagnostic efficacy of serum anti-Müllerian hormone (AMH) in polycystic ovarian... more Aim: To study the diagnostic efficacy of serum anti-Müllerian hormone (AMH) in polycystic ovarian syndrome (PCOS) and its comparison with ultrasonography (USG). Study design: Prospective observational study. Materials and methods: In the study group, a total of 80 women in the age group of 20 to 35 years with diagnosis of PCOS by Rotterdam's criteria were recruited at B.R.D. Medical College, Gorakhpur, India, during the period from January 2015 to December 2016. Women without PCOS, having regular cycles which were selected randomly comprised the control group (n = 80). Serum levels of luteinizing hormone (LH), folliclestimulating hormone (FSH), testosterone, androstenedione, estradiol, fasting insulin, and AMH were measured on days 2 to 3 of natural cycle or progesterone-induced withdrawal bleeding together with transvaginal sonography (TVS) for detection of the number of small follicles (<10 mm) and measurement of ovarian volume (OV). The AMH levels above 5 ng/mL were taken as diagnostic cutoff for diagnosing PCOS. Results: Anti-Müllerian hormone was positively correlated to LH, estradiol, testosterone, number of follicles (<10 mm), and OV; and negatively correlated to FSH. No correlation was found between AMH and age, body mass index (BMI), waist-hip ratio (WHR), and fasting insulin. The AMH-based diagnosis of PCOS showed sensitivity of 91.25% and a specificity of 95%. Conclusion: Serum AMH level is a promising marker for diagnosis of PCOS, especially in cases where reliable USG data are not available or when there are no typical clinical and laboratory findings.

Research paper thumbnail of Hypovitaminosis D in pregnancy and its correlation with preeclampsia and gestational diabetes mellitus

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017

Background: Hypovitaminosis D has been associated with a number of adverse pregnancy outcomes, an... more Background: Hypovitaminosis D has been associated with a number of adverse pregnancy outcomes, and has been recognised as a public health concern. The objective of this study was to determine the impact of Vitamin D deficiency on maternal complications like gestational diabetes mellitus (GDM) and preeclampsia (PE) among pregnant women.Methods: This was a case control study undertaken at antenatal clinics and indoor of BRD Medical College, Gorakhpur, Uttar Pradesh, India. Two maternal blood samples, one at <20 weeks and other at term along with cord blood at delivery were taken. Patients were classified into preeclampsia (n=60), gestational diabetes mellitus (n=35) and control group (n=180) after abstracting past medical records at delivery. Vitamin D was estimated by 25- Hydroxyvitamin D125 RIA kit and categorized according to ACOG criteria. Statistical analysis was done by using chi square test, binary logistic regression and Pearson’s correlation coefficient to compare between ...

Research paper thumbnail of Cytomorphological patterns of tubercular lymphadenitis and its comparison with Ziehl-Neelsen staining and culture in eastern up. (Gorakhpur region): Cytological study of 400 cases

Journal of Cytology, 2017

Tuberculous lymphadenitis is most common cause of lymphadenopathy in developing countries. Althou... more Tuberculous lymphadenitis is most common cause of lymphadenopathy in developing countries. Although enormous literature is available on various aspects of the disease including cytological patterns and its incidence in others parts of India and in other countries, only limited literature is available regarding its incidence and morphological spectrum on cytology in eastern parts of Uttar Pradesh in Gorakhpur region. The present study was undertaken to estimate the incidence of tuberculous lymphadenitis in our settings along with its morphological spectrum on cytology as well as to determine the utility of culture of fine needle aspirates in addition to cytology and Ziehl-Neelsen (ZN) staining. Four hundred cases of superficial lymphadenopathy were subjected to fine needle aspiration cytology (FNAC), and in case, smears were stained with Hematoxylin and eosin (H and E), Giemsa, and ZN stain and categorized into three cytomorphological patterns. All the aspirates were inoculated on two sterile Lowenstein Jensen (LJ) medium. Out of 400 cases of consecutive lymph nodes aspirated, 180 cases (45%) showed features of tuberculous lymphadenitis. Smears revealed epithelioid granulomas with caseous necrosis in maximum cases (40%). On statistical analysis, difference between group I and group II was found to be significant ( &lt; 0.05); while comparison between groups II and III as well as between groups I and III was found to be statistically insignificant. Overall, acid fast bacilli positivity was seen in 51.6% of the cases. FNAC has been proved very safe, highly sensitive, and first line investigation in diagnosing tubercular lymphadenitis. The sensitivity can be further be increased by complementary cytomorphology with acid fast staining. Diagnostic accuracy can further be increased by culture.

Research paper thumbnail of Ultrasound-guided fine-needle aspiration cytology of solid pseudopapillary tumor of the pancreas: a tertiary care centre experience

Oncology Discovery, 2014

Background: Solid pseudopapillary tumours (SPT) of pancreas is an unusual neoplasm with uncertain... more Background: Solid pseudopapillary tumours (SPT) of pancreas is an unusual neoplasm with uncertain malignant potential. It is seen predominantly in adolescent girls and young women. We present the clinical, ultrasound-guided fine needle aspiration (US-FNA) cytologic features, differential diagnosis and immunohistochemical findings in SPT. Methods: A retrospective 4-year (2007-2010) fine needle aspiration samples of 8 solid pseudopapillary tumours of pancreas were reviewed. Results: The entire cases were cured with exploratory laparotomy. This study includes 8 cases (1 male, 7 female) of solid pseudopapillary tumours of pancreas. All these cases showed characteristic cytomorphological features displaying hypercellular smears with presence of several papillary fragments lined by multilayered anisomorphic atypical cells having fine chromatin with delicate nuclear groove, myxoid stroma and foamy macrophages in a haemorrhagic background. Conclusions: Correct preoperative cytological diagnosis of solid pseudopapillary tumours of pancreas may be accurately possible by US-FNA technique and also aids in treatment of the surgically curable cancer in the patients.

Research paper thumbnail of Cytological diagnosis of microfilariae in filariasis endemic areas of eastern UP

Journal of Cytology, 2009

Filariasis is a major health problem in tropical countries including India. Fine needle aspiratio... more Filariasis is a major health problem in tropical countries including India. Fine needle aspiration cytology plays an important role in prompt recognition of disease. To assess the role of fine needle aspiration cytology (FNAC) in diagnosis of filariasis at all possible sites. Total 250 cases of superficial swellings at various sites were subjected to fine needle aspiration cytology. Out of 250 cases, 24 cases of filariasis were detected which include breast lumps (8 cases), lymph nodes (6 cases), scrotal swellings (4 cases), thyroid swellings (3 cases), soft tissue swellings (2 cases) and ascitic fluid (1 case). Eosinophilia was present in 8 out of 24 cases with a percentage ranging from 12-24%. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 3 out of 24 cases. In endemic areas, it should be considered one of the differential diagnoses of a superficial swelling. Careful screening of FNAC smears help in detecting microfilaria even in asymptomatic patients and thus plays a significant role in recognition of the disease and institution of specific treatment.

Research paper thumbnail of Spindle Epithelial Tumor with Thymus-Like Differentiation: A Case Report and Review of Literature

Acta Cytologica, 2013

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare type of t... more Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare type of thyroid tumor with fewer than 35 reported cases available in the literature so far, most of them having been diagnosed histologically after resection. The tumor is believed to be derived from branchial-pouch or thymic remnants, occurring in young adults, predominantly in males, with a male:female ratio 1.8:1. Case: A 14-year-old girl presented with a nodular mass in her right thyroid that had been present for 1 year. Ultrasonological study revealed a heterogeneous solid mass (2.5 × 1.5 × 1.5 cm) in the right lobe of the thyroid. Fine-needle aspiration (FNA) smears were highly cellular and comprised of predominantly dissociated uniform spindle cells with naked oval nuclei along with some aggregates and groups. Occasional islands of epithelial cells were also present. Cytologically, the spindle cells had bland nuclear chromatin, with very scanty mitotic figures. Upon examination of the FNA ...

Research paper thumbnail of Ultrasound-Guided Fine Needle Aspiration Cytology of Malignant Gallbladder Masses

Acta Cytologica, 1997

ABSTRACT To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspirati... more ABSTRACT To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses. We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases. After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease. US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.

Research paper thumbnail of Role of Thyroid Biomarkers in Association with Sofa Score in Predicting the Prognosis of Post-Operative Critically Ill Patients

Journal of Evolution of Medical and Dental Sciences, 2018

BACKGROUND Thyroid hormone alterations in critically ill patients are very common and may add to ... more BACKGROUND Thyroid hormone alterations in critically ill patients are very common and may add to the severity of disease and the outcomes of patients in Intensive Care Unit (ICU). This observational study was conducted to detect the thyroid biomarkers as independent predictors of ICU mortality to predict prognosis more accurately in post-operative critically ill ICU patients with sepsis. This study also tries to determine any association between the thyroid biomarkers and SOFA (sepsis-related organ failure assessment) score. MATERIALS AND METHODS This is a prospective observational study. We investigated free triiodothyronine (FT3), free thyroxine (FT4) and Thyroid Stimulating Hormone (TSH) in low SOFA score patients (LSS; n= 21, SOFA= 0-6) and in high SOFA score patients (HSS; n= 82, SOFA > 6). The serum levels of FT3, FT4 and TSH were correlated with SOFA score. Further, prognosis on fifth day of ICU admission was defined on the basis of SOFA score, FT3, FT4 and TSH. RESULTS The serum levels of FT3 (p= 0.004), FT4 (p= 0.025) and TSH (p > 0.05) decreased in HSS than LSS. A negative correlation was observed between thyroid biomarkers and SOFA score (> 6). Patients who deteriorated on the fifth day of ICU admission had significantly high SOFA score (p= 2.15E-06) and significantly low FT3 (p= 3.17E-10), FT4 (p= 4.06E-05) and TSH (p= 2.21E-05) on first day of ICU admission than those who improved on fifth day. CONCLUSION Thyroid biomarkers, specifically low FT3 might be an efficient biomarker or risk factor in evaluating prognosis of the postoperative critically ill patients.

Research paper thumbnail of Image-Guided Fine Needle Cytology with Aspiration Versus Non-Aspiration in Retroperitoneal Masses: Is Aspiration Necessary?

Journal of Pathology and Translational Medcine, 2015

Background: Although using fine needle cytology with aspiration (FNC-A) for establishing diagnose... more Background: Although using fine needle cytology with aspiration (FNC-A) for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA) for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Methods: Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. Results: By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%). The diagnostic accuracy of other sites by FNC-A varied from 75.0%-81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%-72.8%. Conclusions: Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.