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.
The magnitude of the problem of sickle cell disease (SCD) in India is very large and diverse. For people living with SCD there are several unmet health care needs making it pertinent to focus on recognizing the important public health burden of SCD in the country. In a bid to achieve this goal, the Indian College of Hematology (ICH) of the Indian Society of Hematology and Blood Transfusion (ISHBT) in collaboration with Indian Council of Medical Research (ICMR) has formulated a Guideline on Management and Control of Sickle Cell Disease in India. This was achieved by a national taskforce comprising top experts from the field who held multiple sessions to deliberate on different aspects and form consensus on preparing a comprehensive document on SCD care in India. The taskforce has presented its recommendations on various aspects of SCD in India, all of which have been evaluated based on the best evidence. Where the evidence was weak, the recommendations have been based on consensus among the experts. This review which is adapted from the comprehensive guideline document gives a concise treatise on various aspects of sickle cell disease in India along with specific recommendations. The section on screening and diagnosis provides an evidence-based background to scientifically select the most appropriate and feasible test option(s) in various Indian practice settings. The other aspects covered in this review are management of SCD in stable condition, iron overload and chelation therapy, vaso-occlusive crisis, management of other complications of SCD, blood transfusion in SCD, haematopoietic stem cell transplant and gene therapy in SCD, immunization and antibiotic prophylaxis in SCD and monitoring of patients with SCD. It also gives guidance on special circumstances such as pregnancy and surgery in SCD. It concludes with a note on prevention and control of SCD in India with an outline of a defined roadmap to make this possible.
Familial hypercholesterolemia is primarily a disorder of reduced low-density lipoprotein (LDL) clearance, which can be inherited in either homozygous or heterozygous form. Despite the availability of various modalities to achieve target LDL cholesterol levels, inadequate control remains a significant risk factor for accelerated atherosclerosis in the pediatric population. Moreover, the occurrence of coronary artery disease in adolescents poses unique management challenges given the limited representation of this age group in clinical trials. We report 2 cases of coronary artery disease and 1 case of subclinical atherosclerosis in adolescent patients with genetically confirmed familial hypercholesterolemia, outlining the diagnostic work-up, challenges in achieving LDL cholesterol control, measures undertaken, including plasma exchange, and revascularization strategies using drug-eluting stents or drug-coated balloons, in accordance with current guidelines.
