Pandit Raghunath Murmu Medical College and Hospital

Abstract Introduction Lung cancer remains a leading cause of global cancer-related mortality. While bronchial washing via flexible bronchoscopy is a standard diagnostic tool, conventional cytology (CC) often suffers from low sensitivity. This study aimed to evaluate the incremental diagnostic yield and accuracy of combining the cell block (CB) technique with CC in the diagnosis of pulmonary neoplasms. Materials and methods In this prospective, observational cross-sectional study (2019–2021), 150 patients with suspected pulmonary neoplasms underwent flexible video-bronchoscopy. Bronchial washings were split for CC (H&E stain) and CB preparation (plasma-thromboplastin method). Diagnostic performance was calculated for CC alone and the combined CC + CB approach, using histopathology as the gold standard. Immunohistochemistry (IHC) for TTF-1 and p40 was performed on CB sections to assess subtyping utility. Results Of the 150 patients, 120 were confirmed malignant by biopsy (82 Squamous Cell Carcinoma [SCC], 38 Adenocarcinoma [ADC]). CC alone demonstrated a sensitivity of 55.0%, specificity of 86.7%, and an overall accuracy of 61.3%. The combined CC + CB approach significantly improved diagnostic performance, yielding a sensitivity of 84.2%, specificity of 96.6%, and an accuracy of 86.7%. The combined method identified an additional 35 malignancies missed by CC alone, reducing the false-negative rate from 45.0% to 15.8%. CBs provided sufficient formalin-fixed paraffin-embedded (FFPE) material for definitive IHC subtyping in all tested cases, effectively differentiating ADC (TTF-1+/p40-) from SCC (p40+/TTF-1). Conclusion The integration of CB with CC significantly enhances the diagnostic sensitivity and reliability of bronchial washings. The CB technique’s ability to preserve tissue architecture and facilitate ancillary IHC studies supports its routine implementation in clinical protocols to ensure timely and accurate diagnosis of lung malignancies.

Background Tuberculous lymphadenitis (TBLN) is the most frequent manifestation of extrapulmonary tuberculosis. However, its definitive diagnosis, especially in HIV-negative individuals, remains challenging. This study sought to identify signature biochemical markers for lymphadenitis, if any, and evaluate whether CBNAAT-test outcome is related to host biochemical parameters. Methods Individuals with lymph node enlargement >1 cm suspected of TBLN were subjected to FNAC, and their cytomorphological patterns were determined. The CBNAAT test was used to confirm TBLN. Blood biochemical parameters were compared between 115 histologically confirmed lymphadenitis (75 CBNAAT-positive, 40 CBNAAT-negative) patients and 59 age- and sex-matched controls from Mayurbhanj, Odisha. Results Lymphadenitis was significantly associated with lower serum uric acid, hemoglobin, and lipids, accompanied by elevated hepatic enzymes (SGOT, SGPT, ALP), compared to controls. Stratification based on CBNAAT outcomes revealed higher SGPT and protein levels, and paradoxically lower ESR in test-positive subgroups compared to test-negative. Further, plasma protein, ESR, and hemoglobin emerged as independent predictors of CBNAAT-positivity in logistic regression analysis, with a unit increase in plasma protein doubling (odds ratio = 2.079) the CBNAAT-positivity. Interestingly, a distinct cluster of elevated liver enzymes (ALP and SGPT) was demonstrated in CBNAAT-positive patients. Conclusion Distinct blood biochemical indices between CBNAAT-positive and CBNAAT-negative individuals highlight their pathophysiological differences and provide a basis for improving diagnostic accuracy using these biochemical markers.

Introduction Effective labor analgesia plays a crucial role in improving maternal comfort and the overall childbirth experience. The aim of the present study was to compare maternal satisfaction and breakthrough pain between programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI) techniques for labor analgesia. Materials and methods This cross-sectional study was conducted in the Department of Anesthesiology among 192 term pregnant women who received epidural labor analgesia. The participants were equally divided into PIEB (n = 96) and CEI (n = 96) groups according to the maintenance epidural regimen received during labor. Maternal satisfaction was assessed using a 0-10 numeric rating scale. Secondary outcomes included breakthrough pain, physician-administered rescue boluses, patient-controlled epidural analgesia (PCEA) utilization, analgesic consumption, adverse events, and willingness to repeat the same analgesic technique. Statistical analysis was performed with p < 0.05 considered statistically significant. Results Maternal satisfaction scores were significantly higher in the PIEB group than in the CEI group (8.6 ± 0.9 vs. 7.9 ± 1.2; p = 0.001). High satisfaction (score ≥8) was observed in 72 (75.0%) participants in the PIEB group compared with 56 (58.3%) in the CEI group. Breakthrough pain occurred less frequently in the PIEB group than in the CEI group (p = 0.011). The number of physician-administered top-up boluses and PCEA activation was significantly lower in the PIEB group. Total local anesthetic volume and fentanyl consumption were also significantly reduced in the PIEB group (p < 0.05). Adverse maternal events were low and comparable between the groups. Conclusions PIEB provided superior maternal satisfaction and improved analgesic efficacy with lower anesthetic consumption than CEI while maintaining a comparable safety profile. These findings support the use of PIEB as an effective maintenance strategy for epidural analgesia during labor.

Background: The present study was conducted to compare dexmedetomidine and nalbuphine as adjuvants to levobupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block, duration of analgesia, and hemodynamic changes.Methods: A randomized, prospective, single-blinded controlled study was conducted among 110 patients aged 18–55 years belonging to ASA grade I and II undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 55 each. Group LD received levobupivacaine with dexmedetomidine, while Group LN received levobupivacaine with nalbuphine. Sensory block onset, motor block onset, duration of sensory and motor block, duration of analgesia, pulse rate, mean arterial pressure, and oxygen saturation were assessed. Results: The mean age of participants in Group LD and Group LN was 36.40±10.89 years and 39.18±12.05 years, respectively. Dexmedetomidine significantly reduced the onset time of sensory block (7.29±0.76 min vs 10.07±1.11 min; p<0.001) and motor block (13.09±0.84 min vs 16.27±0.98 min; p<0.001). Duration of sensory block (13.21±1.16 h vs 12.14±1.11 h; p<0.001), motor block (10.01±1.04 h vs 7.30±0.74 h; p<0.001), and analgesia (13.83±0.78 h vs 12.07±0.99 h; p<0.001) were significantly prolonged in Group LD. Pulse rate and mean arterial pressure were significantly lower in Group LD at 60 min, 2 h, and 6 h. Oxygen saturation remained stable and comparable between groups throughout the study. Conclusion: Both dexmedetomidine and nalbuphine serve as effective adjuncts to levobupivacaine for supraclavicular brachial plexus blockade. Dexmedetomidine provides enhanced efficacy through rapid onset and extended analgesia, whereas nalbuphine presents a cost-effective option with a commendable safety profile. Recommendation: Dexmedetomidine may be preferred as an adjuvant to levobupivacaine for supraclavicular brachial plexus block due to its faster onset and prolonged analgesic effect, while nalbuphine can be considered a cost-effective alternative.

Introduction: Hypertension is a major non-communicable disease and a leading contributor to cardiovascular morbidity and mortality worldwide. Tribal populations in India, despite their distinct socio-cultural characteristics, are increasingly exposed to lifestyle transitions that may increase their risk of hypertension. However, there is limited evidence on the prevalence and determinants of hypertension among tribal communities in Odisha. Objectives: To estimate the prevalence of hypertension and identify associated risk factors among the adult tribal population of Sambalpur district. Method: A community-based cross-sectional study was conducted among 360 adult tribal individuals aged 18–60 years in Sambalpur district. Participants were selected using a multistage sampling technique. Data were collected through face-to-face interviews using a pretested structured questionnaire, and blood pressure was measured using standard procedures. Data were analyzed using descriptive statistics, chi-square test, and logistic regression to identify factors associated with hypertension. Results: The mean age of participants was 41.5 ± 11.6 years, and males constituted 54.4% of the study population. The overall prevalence of hypertension was 13.6%. Among hypertensive individuals, 40.8% were newly diagnosed during the survey. Only 20.6% of known hypertensive cases had their blood pressure under control. Multivariable logistic regression showed that age 41–60 years (AOR = 2.578; p = 0.016), family history of hypertension (AOR = 4.288; p < 0.001), and alcohol consumption (AOR = 2.825; p = 0.010) were significant predictors. Conclusion: Hypertension is prevalent among the tribal population of Sambalpur. Strengthening early detection, lifestyle modification, and primary healthcare services is essential to address this public health concern.